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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ivy Durant, sister of Tonji Durant.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Perryman provided a copy of the letter to Healthbeat.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Infants hospitalized in California, Pennsylvania, Washington

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

However, no type of hantavirus is on this list.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

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

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

Hello from Nairobi.

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

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

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

The hantavirus outbreak … breaks out of health news

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ok, so we’re off to a terrible start.

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

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

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

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

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

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

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

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

What the hantavirus panic gets right

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Because next time might not be another drill.

Fake rumors of shrinking genitals… no laughing matter!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– William

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

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

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

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

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

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

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

Supreme Court will consider restricting access to medication-assisted abortion

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

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

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

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

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

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

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

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

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

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

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

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

Babies are dying because parents are refusing vitamin K

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

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

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

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

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

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

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

Celebrating Mother’s Day

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

- Jay

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

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

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

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

Hello from Nairobi.

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

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

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

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

The neglected disease trap for better drugs

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

Enter our hero: moxidectin.

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

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

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

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

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

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

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

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

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

Where are we now?

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

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

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

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

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

Stalled pandemic negotiations, part 2

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

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

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

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

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

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

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

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

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

The takeaway? Break up the negotiations!

Counting global conflict’s health toll

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

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

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

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

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

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

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

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

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

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

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

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

HealthInsuranceGPT

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

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

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

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

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

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

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

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

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

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

The Hantavirus cruise

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

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

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

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

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

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

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

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

Fine. It gets the closing slot!

I’ll see you next week,

William

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Increasing access to treatment at odds with Medicaid cuts

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

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

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

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

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

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

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

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

People with private insurance may be affected, too.

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

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

Prevention efforts may be hampered by funding, staff cuts

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

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

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

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

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

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

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

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

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

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

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

‘Rhetoric over reality’ on test strips to detect fentanyl

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

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

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

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

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

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

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

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

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

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

Tick season has arrived early and aggressively

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

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

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

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

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

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

Will we soon have a vaccine for Lyme disease?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where to look for advice on tick bite prevention

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

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

Until next week,

Jay

Scientists find clue to cause of noma, an illness that disfigures children across Africa

2026-04-30T11:00:00+00:00

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Hello from Nairobi.

This week we’re following some remarkable medical advances: a potential breakthrough in a long-neglected disease, and new treatments and tests for the world’s deadliest parasite. We also have an update to last week’s story on American HIV aid, and, at the end, a sci-fi-meets-Ken-Kesey story that combines psychedelic toad-licking, ayahuasca, tobacco, and genetically engineered bacteria.

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

‘Astonishing discovery’ for a little-studied, disfiguring disease

Scientists believe they may have finally found the root cause of noma, a disfiguring illness in the sad bucket of “neglected tropical diseases,” The Guardian reports.

Disease breakdown: Noma is a rare but rapidly progressing disease of the mouth and face. It’s largely a children’s disease of poverty, with no single, proven cause, but an estimated 30,000 to 140,000 cases a year. Most cases are in children under 6 years old, across a belt of African countries from Mauritania to Nigeria to Ethiopia. Untreated, it kills 90% of those affected, and even with treatment the heartbreaking disease often leaves lifelong facial deformities and scars.

The new discovery was a bit serendipitous. Researchers at the Liverpool School of Tropical Medicine set out to map the bacteria living in the mouths of 19 children with noma across Nigeria. In the process, they uncovered a previously unknown species of bacteria, now called Treponema A.

The obvious question followed: Could this be the cause of the illness? To make sure it wasn’t a fluke, the researchers went back to “reanalyze older samples from other noma patients” and found the same bacteria there, too.

As The Guardian reports, this “astonishing discovery” doesn’t necessarily prove that the new bacteria cause the disease, but it certainly gives scientists something concrete to chase. As one researcher put it, “we don’t know if [Treponema A] can colonize a noma wound, because of the architecture and the environment, or if it causes the noma wound.”

Still, it’s an incredible starting point.

I reached out to Stuart Ainsworth, an infection biology and microbiome expert at the University of Liverpool, and part of the team behind the discovery. We discussed what this finding means and what it shows about the value of researching neglected diseases.

I started by asking Ainsworth how a disease this severe could still have such basic unanswered questions, and how a lead like this could have gone unnoticed for so long. Ainsworth was frank: “There has hardly been any research on noma at all,” he said.

He pointed to a 2021 review of the history of noma research, which found that there have only been 147 studies done on the disease since the year 1850. “In comparison, there were around 650 papers on rabies in 2021 alone,” he told me.

The core issue is that noma, Ainsworth says, “is the quintessential neglected disease. It only affects the very poorest in society and typically occurs in remote rural regions.” And because those who aren’t killed by the disease are often “left debilitated and scarred and generally hidden from society,” he said, “there is little impetus globally to invest in research.”

It’s a brutal dynamic, and one that cuts to the core purpose of medical research. “The goal with all diseases is to eradicate them, or at least control them to the point where they are no longer an issue.” And yet, “all of these things are impossible if you do not have at least a very basic understanding of what is the cause of the disease,” he said.

But that bleak starting point is also what gives this kind of scientific work such an incredible upside. “We know so very little” about noma that even “simple targeted research could potentially have a huge impact,” he said.

Looking forward, Ainsworth says further research could help move beyond the current treatment for noma, which is a shotgun approach of broad antibiotics, and that “we hope that these types of studies will eventually enable us to develop the targeted prevention, diagnostic, and treatment options to eradicate or prevent noma.”

A stalling fight against HIV, part 2

Last week we covered new data that showed U.S.-funded HIV treatment holding steady on paper, but testing, prevention, and case detection dropped sharply, raising fears about a surge in new infections.

Well, there are a few follow-on stories that are worth your time.

(First, we’re owed a correction. I flagged the State Department’s claim that “20.6 million people” are on HIV treatment, but it appears that the official figures don’t actually match the underlying data, which puts the number closer to 20.3 million.)

Second, the person in charge of the science behind that data just left. Mike Reid, the HIV program’s chief science officer, stepped down. He blames a system where American HIV aid is being “entangled with access to critical minerals or geopolitical positioning,” to the detriment of the work, Reuters reports.

Reid posted a full essay on Substack upon his departure, and there are a few sections worth pulling out to understand why he walked.

Reid starts with the core shift:

“When life-saving health assistance, often beyond the immediate capacity of partner countries, is conditioned on unrelated commercial or strategic objectives, something essential is lost … That is not a marginal adjustment. It is a different model. And I do not believe that model is consistent with the purpose of global health. I do not believe it serves patients, or countries, or ultimately even the long-term interests of the United States.”

He follows with a strikingly blunt assessment, which directly contradicts the State Department’s framing, and echoes what many HIV experts have been warning about.

“We have asked partner governments to take on substantial new responsibilities despite constrained fiscal space, high levels of sovereign debt, and growing demographic pressures, all while programs themselves have been weakened by recent U.S. funding cuts. In places like Zambia, which I care about deeply, the consequences of stepping away too abruptly could be devastating, and avoidable. I have to take that possibility seriously.”

Ultimately, Reid casts his resignation as a break with the core idea of the field itself. “I’ve believed that global health — at its best — is a form of solidarity. Not charity. Not strategy.” And now, that very belief “is why I am resigning my post as chief science officer at PEPFAR in the U.S. State Department.”

A malaria drug for newborns

For the first time, there’s a malaria drug for newborns, Deutsche Welle reports.

Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

The treatment was just approved by the World Health Organization for “babies weighing less than 5 kilograms (11 pounds).” Its development closes what was previously a “medical care gap for 30 million babies born each year in malaria-endemic areas" across Africa, which is by far the hardest-hit continent.

Technically, it’s a new formulation of two existing treatments: artemether and lumefantrine, which were developed thanks to a secret Chinese military project in the ’60s and ’70s to aid the North during the Vietnam war. (Really!)

Together, the drugs hijack the malaria parasite’s eating process, so that the blood molecules (hemoglobin) that should feed it actually end up destroying it.

You may be asking: If this is the first ever treatment, how have sick infants been treated until now? Well, routinely “infants have been treated with drugs developed for older children,” an imperfect workaround, as these drugs can “expose newborns to risks of dosing errors and toxicity.”

My takeaway: It’s encouraging that medical science keeps providing tools to fight and treat this disease. Earlier this month, the WHO also approved three new rapid tests for “malaria parasites [that] have evolved to become harder to detect,” as they stopped producing the molecule that older tests relied on.

Very timely! In some countries in the Horn of Africa (like Ethiopia, Djibouti, and Somalia), those tests started missing “up to 80% of cases.”

India’s largest pharma deal

India’s largest drugmaker, Sun Pharmaceutical Industries, has just made the country’s “largest pharma deal,” Reuters reports.

The company has agreed to buy the U.S.-based Organon & Co. It’s an $11.75 billion all-cash deal, the most expensive overseas acquisition ever by an Indian company.

Why does this matter?

Let me pepper in a bit of context: As we’ve written before, India, the “pharmacy of the world,” is where a fifth of all generic drugs and well over half of all vaccines are manufactured. And Sun Pharma is India’s biggest drugmaker by revenue, churning out over a thousand separate medicines and drug ingredients. A true generics giant, those drugs include everything from diabetes treatments and psychiatric drugs to cancer therapies and dermatology medicines.

Meanwhile, Organon (which started as an insulin producer over 100 years ago) makes specialty medicines: contraceptives and drugs for pregnancy and menopause, along with a variety of other hormone-based therapies. Although it’s a minnow in the American market, it produces “70 women’s health and general medicines sold across about 140 countries.”

If you scan through the link you’ll see that the Reuters story is a business one, full of debt figures and deal details. What’s more interesting is what this deal reflects about India’s pharma sector more broadly.

The big takeaway is this: India’s pharmaceutical sector is enormous, and only growing. Many projections have the entire sector doubling in value from 2025 to just 2030. Much of that growth is expected to come from a shift out of cheap generics into specialty medicines, and so this is exactly the kind of deal that will help make that shift real.

Whatever you do, don’t smoke this

Let’s end on a fairly wild story from New Scientist: A research group based at the Weizmann Institute of Science in Israel has "engineered tobacco plants to produce five powerful psychedelic compounds,” all in a single plant.

As the authors argue, this could offer a more sustainable way to produce psychedelic drugs, “which are increasingly in demand for research and medical uses.”

What I find particularly interesting about this story isn’t just the tie dye-inducing tobacco plant. It’s the fascinating technique the scientists used, which lands just shy of permanent gene-editing.

Here’s the explainer from the story:

“[The scientists] modified Nicotiana benthamiana plants using a technique called agroinfiltration, which involves using a bacterium to introduce genes from other organisms into a plant. The modified plant then makes the proteins encoded by those genes, but the DNA isn’t incorporated into the plant’s genome, so the effect is short-lived.”

Ultimately, those bacteria induced the tobacco plants to produce psilocin and psilocybin, two compounds found in “magic mushrooms”; DMT, which is found in the psychoactive drink ayahuasca; and bufotenin and 5-methoxy-DMT, which are secreted by Colorado river toads.

The researchers argue that their method is a much easier way to produce these molecules for medical testing than, say, raising cages full of toads. And it’s doing it across biological kingdoms, creating compounds from fungi, plants, and animals in a single organism.

The takeaway: As the article outlines, “the idea of growing drugs through pharmaceutical farming, or ‘pharming,’ certainly isn’t new.” As far back as 2002, we’ve had corn engineered to produce trypsin, a digestive enzyme. But doing it temporarily, without forever altering the plant’s genome, limits the risk of these traits escaping or persisting in the wild.

And heck, it makes the infamous “Simpsons” “tomacco” plant look as everyday as a steamed ham.

Until next week,

William

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

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

2026-04-29T11:00:00+00:00

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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 global nonprofit that promotes economic mobility and well-being for vulnerable communities. Views expressed here are my own.

This week I am reminded how little we know about the brain and how that lack of understanding impairs our ability to address two of the most serious public health problems in America: severe mental illness and dementia.

A White House event was either a historic turning point for mental health or a dangerous workaround of the Food and Drug Administration’s safety regulations; and a new report found that Alzheimer’s drugs have almost no benefit.

We also saw updates to two important stories involving the Centers for Disease Control and Prevention and a chance to highlight one of the most important, but least well known, programs it runs.

Psychedelics and mental health: promising, but let’s do this right

In the past decade, there have been several positive developments in mental health, including a growing willingness of prominent people — athletes, elected officials, musicians — to talk about their struggles and reduce stigma. Unfortunately, there has not been an equivalent increase in access to services, and most treatment approaches have limited effectiveness or durability.

That is why there has been so much excitement recently around a new approach to serious mental illness: psychedelic-assisted therapy. We saw a remarkable event at the White House last week. President Donald Trump, flanked by Health and Human Services Secretary Robert F. Kennedy Jr. and podcaster Joe Rogan, signed an executive order directing federal agencies to accelerate research into psychedelic medicines and expand access to them for treating serious mental illness.

Psychedelics are a group of compounds either derived from naturally occurring organisms, such as psilocybin from “magic mushrooms” and ibogaine from a shrub found in Gabon, or synthesized in laboratories, such as LSD and MDMA. While chemically distinct, psychedelics have in common the ability to profoundly alter perception, cognition, and consciousness.

In mental health therapy, psychedelics work very differently from conventional pharmacology. Antidepressants and other approved psychiatric medications primarily seek to alleviate symptoms. Patients must take them daily, and symptoms recur when they stop.

In contrast, psychedelic therapy involves one structured session or a few sessions in which the person takes the psychedelic and undergoes talk therapy before, during, and after. Rather than suppressing emotions or thoughts as with traditional psychiatric medications, these compounds create a window of openness in which patients can access deeply buried feelings, e.g., grief, shame, trauma, and help to rewire the way people feel and think about problems.

As a JAMA editorial put it, the approach “addresses the cause of symptoms rather than merely suppressing them.”

Psychedelic therapy is primarily being evaluated for severe depression, post-traumatic stress disorder, obsessive-compulsive disorder, and substance-use disorders — conditions for which existing treatments often produce only modest, short-lived benefit.

The executive order commits $50 million to ibogaine research and directs the FDA to prioritize review of psychedelics holding the agency’s Breakthrough Therapy designation, reserved for drugs showing early evidence of substantial improvement over existing treatments.

I am genuinely excited about this research. And I am also concerned that the way it’s being rolled out could undermine its promise. While the early data are impressive, making therapy available at scale requires the government to ensure safety and efficacy the way we do for other medications.

The executive order expands access through the Right to Try Act, a pathway designed for terminally ill patients to obtain experimental treatments outside clinical trials. This administration has shown a fondness, unfortunately, for treating unproven compounds as standard consumer goods rather than medications.

For example, Kennedy has used a similar approach to peptides, arguing that individual freedom matters more than safety and efficacy. While there is substantial real-world data on the safety of most psychedelics, we need high-quality research to demonstrate the effectiveness of different dosages and treatment protocols. I believe this study on MDMA-assisted psychotherapy for PTSD, although somewhat controversial, shows what can and should be done to advance the field.

What I want is something modeled after the work of HIV/AIDS activists, such as Treatment Action Group. They believed — correctly — that access and evidence do not have to compete with each other. You can modernize trial designs to accelerate data collection and mobilize staffing to accelerate regulatory review, so that you can have safety, efficacy, and access.

Another more recent example was Operation Warp Speed for Covid vaccines. The result was faster access to medical interventions that actually worked. That is what I want for psychedelics.

Alzheimer’s drugs: when statistical significance isn’t enough

For decades, the leading hypothesis for Alzheimer’s disease has been that dementia is caused by the buildup of a protein called amyloid-beta in the brain, forming plaques that disrupt neurons and cause progressive cognitive decline. This “amyloid hypothesis” has driven billions of dollars in drug development.

The Cochrane Collaboration, an international network that systematically reviews the best available evidence, published an analysis this month of seven monoclonal antibody drugs developed to clear amyloid from the brain. The review examined 17 randomized controlled trials involving more than 20,000 patients and concluded that the clinical benefit of these drugs is, at best, trivial.

Cognitive function, dementia severity, and ability to manage daily activities showed little to no meaningful change after 18 months of treatment. The drugs can also increase the risk of brain swelling and bleeding, though in most patients these side effects cause no symptoms.

Some Alzheimer’s experts argue that the Cochrane review improperly lumps failed drugs together with the two most recently approved treatments. One critic compared it to mixing rotten ingredients with fresh food and declaring the meal inedible. While that is a legitimate methodological concern, even the trial results for those two recently approved drugs showed only modest slowing of cognitive decline, i.e., patients got worse, but just not as quickly as they would have without treatment.

Whether patients or their families can perceive that difference is genuinely unclear. As one Cochrane author put it, the benefit was “far below the minimal effect that’s needed to be noticeable at all for patients and caregivers.”

This points to one of the most underappreciated problems in pharmaceutical regulation: the gap between statistical significance and clinical significance. A drug can clear an approval threshold based on an effect large enough to be measurable, but too small to matter to anyone living with the disease.

One of the successes of public health is longevity: People are living longer across the world. But our ability to prevent and manage conditions of aging is not advancing fast enough. This latest study shows that even the best available pharmacological therapies are not worth using.

CDC: one step backward, one step forward, and one cause for celebration

Two weeks ago, I wrote about how the CDC had been blocked from publishing a study showing that Covid vaccines reduced hospitalizations by about 55% during the past winter season. An HHS spokesman confirmed last week it will not be published, citing methodological concerns, even though a flu vaccine study using the exact same methods was published in the Morbidity and Mortality Weekly Report just one week before the Covid study was blocked.

Unfortunately, this confirms what I have been worried about all along. Even with widespread uproar in the media that a methodologically sound study was being blocked, the current administration will continue to hide data that demonstrate the harms of the Covid virus and the benefits of Covid vaccines.

On a more hopeful note, the White House nominated Dr. Erica Schwartz, a former deputy surgeon general and retired Coast Guard officer, to serve as the permanent CDC director. Dr. Jennifer Shuford, Texas state health commissioner, was announced as incoming CDC chief medical officer. I think the public health community needs to see this as a minor victory in the ongoing battle to protect the CDC from further damage.

I have heard from many current and former CDC colleagues that they have concerns about Schwartz’s actions when she was deputy surgeon general, but they are absolutely elated by the choice of Shuford as chief medical officer.

Many people who have worked with Shuford in the past, including during the large Texas measles outbreak in 2024, have praised her knowledge, skills, and temperament and are holding out hope that she can serve as an effective counterbalance to some of the anti-science positions that HHS leadership continues to push.

Finally, I want to highlight the 75th anniversary of one of the most important and least known public health programs in the country: The CDC’s Epidemic Intelligence Service. I entered the program after completing my medical residency, and EIS taught me skills I could not have learned anywhere else.

I learned to design epidemiologic studies by investigating real outbreaks, received hands-on mentorship in policy development and public communication, and worked with government agencies at every level, domestically and globally over two years.

Since 1951, EIS has trained more than 4,300 people — including physicians, veterinarians, nurses, pharmacists, lawyers — who have investigated nearly every major public health crisis of the past seven decades: smallpox, HIV/AIDS, Ebola, influenza pandemics, the 2001 anthrax attacks, and Covid-19.

Today, 1 in 3 state epidemiologists in the United States is an EIS alumnus, and 4 of the 12 CDC directors in history completed the program. At a moment when the CDC’s institutional capacity is under serious strain, it is worth recognizing what 75 years of investment in training has built and what would be lost if that were allowed to erode.

While many lay people hear about the limits of science and turn away to other approaches, I think we should see those limits as a reason to demand more. We need more trials, more rigorous review of data, and more protection of the institutions, like EIS, that have spent 75 years turning science into health promotion and disease prevention.

Until next week,

Jay

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.

Many babies sickened in ByHeart formula botulism outbreak needed more treatment after hospitalization

2026-04-24T22:15:24+00:00

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Most of the babies hospitalized in a recent nationwide outbreak of infant botulism linked to ByHeart baby formula have needed additional physical therapy and other medical support after going home, according to new data shared Friday.

“Although many infants are now progressing in their recovery, evaluating their outcomes is essential to understanding the progression and severity of illness observed during this outbreak,” said Myra Brooks, a member of the Centers for Disease Control and Prevention’s Epidemic Intelligence Service, who presented the data at the service’s annual conference in Atlanta. The conference highlights the work of the agency’s disease detectives.

Brooks, a first-year EIS officer, works with the CDC’s National Botulism Consultation Service and was part of the response to the outbreak linked to ByHeart infant formula last year. It is the first documented outbreak of infant botulism linked to powdered formula, she noted.

The CDC declared the outbreak over on Feb. 26, with 48 confirmed and probable cases of infant botulism in 17 states that were linked to the baby formula. All of the infants required hospitalization; there were no deaths. All of ByHeart’s Whole Nutrition Infant Formula products were recalled.

Infant botulism is caused by babies ingesting spores of Clostridium botulinum bacteria, which can activate in their intestines and produce a dangerous toxin that can cause muscle weakness and paralysis. Initial symptoms can include difficulty sucking and swallowing, constipation, and loss of head control. Without treatment, breathing difficulties can develop.

Health investigators were able to obtain and review the medical records for 46 of the 48 infants, which showed that most of those who were sickened had moderate to severe disease.

Those with moderate disease, 61% of the infants in the outbreak, required assisted feeding or non-invasive respiratory support, Brooks said Friday. Another 11% of the infants had severe disease. “During hospitalization, these infants experienced respiratory difficulty, requiring intubation or received a surgically placed feeding tube,” she said.

The remaining 28% of infants in the outbreak were classified as having mild disease, although they still needed hospitalization.

While the outbreak cases stayed in the hospital for a median of eight days, some of those with severe disease were hospitalized for more than a month, according to her presentation slides.

For many of the infants sickened in the outbreak, their medical treatments needed to continue after leaving the hospital, Brooks said.

“A third of infants were discharged with nasogastric tubes to supplement feeding, and two-thirds of infants had follow-up orders for physical, speech or occupational therapy,” she said.

The infant botulism outbreak was first identified in early November by the California Department of Public Health, which runs the national infant botulism program that distributes the only FDA-approved drug to treat children sickened by the toxin. The department noticed an increase in medication requests among babies who had consumed ByHeart formula and alerted federal officials.

Outbreak cases continued to rise in the weeks that followed amid delays by retailers in removing recalled formula from store shelves that were compounded by delays by the Food and Drug Administration in sharing information with state food safety officials about where the product was being sold.

While health officials initially thought babies had started falling ill in August 2025, they later identified cases going back to December 2023.

Although ByHeart’s products made up only about 1% of the formula products sold in the United States, the premium organic brand had a loyal following and the outbreak shook some consumers’ confidence in formula safety generally.

The federal investigation of how ByHeart’s formula became contaminated has in recent months focused on the product’s ingredients. Earlier this year, the FDA announced that tests had detected contamination with Clostridium botulinum – the bacteria that cause infant botulism – in some samples of powdered whole milk used to make the formula.

The FDA has said its investigation into the root cause of the contamination is ongoing, but the agency has not provided any update since Feb. 26.

ByHeart’s media team, in an email to Healthbeat late Friday, said the company continues to work with the FDA on its investigation. “Our root cause investigation remains ongoing, and we’ll share updates as they become available,” the email said.

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

PEPFAR snapshot after funding cuts: Less HIV testing means more cases

2026-04-23T11:00:00+00:00

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Hello from Nairobi.

This week we’re heavy on the Africa news. We’ll cover two important HIV stories, one about new U.S. data, and one on South Africa. Together, they offer a clearer read on the global HIV response and, I hate to say it, they undo some of the cautious optimism I’d started to feel. We’ve also got a hopeful malaria story from Eswatini, and a broad snapshot of vaccination across the continent.

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

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

New data: a stalling fight against HIV

The U.S. State Department finally released new data Friday on PEPFAR, the two-decade-old U.S. President’s Emergency Plan for AIDS Relief at the center of the global fight against HIV/AIDS.

As Reuters reports, this was the first public update in 16 months, and the only official snapshot of the program after the widespread disruptions in 2025 and a roughly 30% drop in funding. (Worth noting: The data are also incomplete. The update only covers the final quarter of 2025.)

What’s the topline?

The Trump administration is pointing to a single figure: that 20.6 million people are still on HIV treatment. Taken alone, that’d be fine news, because it’s nearly level with the figures from both 2024 and 2023.

But, as Reuters notes, that treatment figure relies on some funky accounting. It includes about “3 million people whose care was provided by their own governments.” And even setting that aside, advocates are worried for a simpler reason: Treatments may be steady, but the data indicate significantly more new HIV infections are slipping through.

The data paint a clear picture.

From 2024 to 2025, 4.7 million fewer people were tested for HIV (a drop of about 22%). About 78,000 fewer people were diagnosed with HIV (20%). And 2 million fewer people were taking preventive treatment (10%).

It’s a fairly shocking downturn, and portends a future of more HIV, not less.

As Charles Kenny, a senior fellow at the Center for Global Development who has been tracking the data, told Reuters: “If people aren’t tested, they can’t know if they’re positive. If we don’t know they’re positive, they cannot be put on drugs … We’re building up problems for the future."

Or, as Kenny told the New York Times, “the long-term trajectory could be back to as depressing as I thought it was going to be last year.”

Inside South Africa’s HIV slowdown

Ok, so that new PEPFAR data give a global view.

But this week Physicians for Human Rights, a U.S.-based non-profit, also zeroed in on what these changes look like with a report from one country: South Africa, home to the largest HIV epidemic in the world.

South Africa is a fascinating case to focus on, because there are several reasons you could expect it would be better positioned to absorb the shock of the HIV funding cuts than many other countries.

Why? For one, it’s an upper-middle-income country that spends a hefty 16.8% of its budget on health. And in recent years, the United States covered just 17% of its overall HIV response, with the majority managed domestically. (That’s far less than in countries like Uganda, Tanzania, or Lesotho, where international funding has historically paid for the vast majority of those programs.)

But in the report, the interviews with health workers, researchers, and patients across South Africa tell a different story: a system where “a future surge in otherwise preventable new HIV infections [is] all but inevitable,” and where “catastrophic” cuts to HIV research are already having global effects.

I reached out to the co-authors of the report: Karen Naimer, the director of programs at Physicians for Human Rights, and Emily Bass, an author and HIV/AIDS expert, to understand what’s actually breaking here.

First, we talked about the hit to laboratories.

As Naimer explained, for years South Africa has been a global center for HIV research, with both a large number of cases and the advanced, scientific infrastructure to study them. That’s one reason why before 2025, South Africa was the largest foreign recipient of funding from the U.S. National Institutes of Health — America’s federal medical research agency. Roughly $400 million went into studies that shaped how HIV is treated worldwide.

But, as she explained, much of that work has been cut off.

Alongside a pullback in dollars, a new NIH rule has blocked U.S. funding from reaching overseas research partners, leaving “terminated studies, the loss of clinical trial capacity, and the attrition of skilled personnel,” she said. And this isn’t just a South Africa problem, “that dismantling of the clinical research infrastructure in South Africa will have global implications.”

What about on the ground – how is everyday HIV prevention and care in South Africa faring?

The report really paints the picture of why testing is falling and fewer HIV cases are being found.

As Bass explained, while the United States funded a minority of South Africa’s overall HIV response, it covered a majority share of the front-line prevention work, especially the more intensive and expensive programs like community testing and outreach. “And virtually all of that investment ended overnight in South Africa,” she said, adding that much of it still hasn’t been replaced.

Ultimately, HIV prevention depends on reaching people who feel fine and aren’t thinking about HIV. They’re not seeking medical care, so the system has to go to them. (Think mobile testing vans or having social media influencers chat about HIV prevention).

Take that away, and you’re left with clinics. And if that’s the whole strategy, it’s no wonder it’s falling short. As Bass put it, “people are not going to regularly elect to go to a clinic and wait hours to get a test, just to find out if they are HIV negative.”

One final note: These cuts to preventive care are hitting just as lenacapavir (the breakthrough HIV prevention drug we’ve been covering extensively) was about to be rolled out.

So, instead of hitting the ground with speed, Bass tells me, the very systems meant to deliver this new drug have been dismantled. “We destroyed that platform, and it really is destruction,” she said.

Holding the line on malaria

The Guardian has an interesting story out of Eswatini (the small, landlocked country between South Africa and Mozambique) that is seemingly close to eliminating malaria altogether.

How close? Well, in 2024, the country of 1.2 million recorded only “362 confirmed malaria cases.” A feat all the more impressive given that “cases have risen globally for six consecutive years,” even in neighboring countries.

As the story shows, part of what’s made the malaria response so effective is the tight disease surveillance system in Eswatini, where individual infections are treated with immediate house-to-house testing and spraying.

There is some peculiarity here worth mentioning. The last mile is often the hardest and most expensive in disease control (polio is a classic example). But malaria is a little different because the symptoms are so visible, and the disease spreads very locally.

What this means is that once malaria cases get very low, a country can concentrate resources on each infection with remarkable efficiency. (This is the very dynamic that allowed the United States to pull off malaria elimination in 1951.)

Unfortunately, Eswatini’s progress nevertheless sits right up against a very different reality in neighboring Mozambique, where there are more than 11 million cases a year. It’s an ever present challenge that, well, mosquitoes don’t care much for borders.

And there are other looming challenges, too. As Mark Edington, the head of grant management at the Global Fund, told the Guardian:

“If you look at the combination of decreased malaria funding, from us and probably from the U.S.; you look at increased resistance towards both drugs and insecticide; you look at population growth; you look at extreme weather events, which are increasing; and you put that all in a mixing bowl, the result is not good … It is worrying.”

What’s the takeaway?

Certainly Eswatini deserves kudos for this heroic effort. But the real question is whether it can hold the line. With 11 million cases just across the border, a lasting elimination of the disease is just not possible, and keeping numbers this low will require the same constant, expensive vigilance year after year.

Immunization across Africa

The World Health Organization has released a new snapshot on the state of vaccinations across the African continent. As the AP reports, it’s both the “first-ever comprehensive analysis” of its type and a mixed bag of news.

Let’s start with the positive, which is the long view. The data in the report make a strong case that vaccination efforts on the continent have been one of the most consequential humanitarian achievements in modern history.

Think I’m overselling it?

Consider that over the last 50 years, vaccination efforts have “saved more than 50 million lives.” Even just since 2000, routine programs have reached “more than 500 million children,” preventing more than “4 million deaths each year.”

Zooming in a bit, there have been some very specific successes, too. Wild polio has been eliminated from the continent (the last case was in 2016). And tetanus infections during childbirth, once a major killer, have also been largely eliminated as a public health threat.

What’s the worse news?

The report outlines that most vaccine-preventable diseases have been mired in stalled vaccination coverage, and in many cases for more than a decade.

For example, only half of children on the continent are receiving two doses of the measles shot, which is the only sure-fire preventative for the disease. HPV vaccination sits at just 28%. And the hepatitis B shot, which is given at birth, reaches only 17%.

The WHO’s target for all these vaccines is 90%. We’re not even close.

And, unfortunately, we’re on track to see things worsen.

The funding behind these programs is shrinking, with the AP noting that “the U.S. withdrawal from WHO in January resulted in the loss of about 40% of the agency’s overseas development funding,” and the Gavi Vaccine Alliance is also “experiencing a financial crunch.”

What’s the takeaway? I have mixed feelings. It’s worth appreciating the extraordinary amount of human suffering we’ve reduced through vaccination. But it’s not enough, and it’s frustrating to realize we may be stuck at an arbitrary high-water mark well short of what we’re capable of.

I’ll see you next week.

William

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

Most Americans believe vaccines are safe and effective

2026-04-22T11:00:00+00:00

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

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

This week, a headline about vaccine skepticism made me gasp – that is, until I read the actual data. Then I turned my attention to another important federal health program that is at risk of being gutted the same way Centers for Disease Control and Prevention vaccine policy was. And a surprise comment from President Donald Trump has upended what had been promising bipartisan momentum on child care, a service that is critical to health.

Do Americans trust that vaccines are safe and effective?

I gasped this past week when I read a headline that said that “more Americans doubt vaccine safety than trust it.” With measles and pertussis resurging, this headline suggested that vaccine skeptics are winning and made me worry that even more fearsome vaccine-preventable infections, such as polio and diphtheria, might soon return as well.

The headline came from a Politico poll of 3,851 U.S. adults, conducted in March by Public First. The poll found that nearly half of respondents said the facts on vaccines are “still up for debate” and that it is “damaging to enforce their uptake.” A plurality also said they support reducing the number of vaccines Americans receive. Politico reported that the findings suggest “RFK Jr.’s views are commonplace across the land.”

As an epidemiologist, I knew I needed to set aside time to review the actual data in more detail. Thankfully, other experts I trust had already done that.

Pediatrician and public health physician David Higgins analyzed the poll’s methodology and identified a fundamental flaw. The core question was what survey researchers call a “double-barreled” question, except, as Higgins pointed out, it actually had four barrels.

Respondents were asked to choose between two statements: one saying the science is clear and it is “damaging to question it,” and another saying the facts are “up for debate” and it is “damaging to enforce” vaccine uptake. Those are four distinct and independent beliefs fused into a single complicated and odd choice.

For example, a pediatrician who thinks the science is clear but believes vigorous debate is essential to good science has no good answer. Neither does a parent who trusts vaccines, has chosen to vaccinate their children, and also opposes government mandates. Because this question was so poorly worded, it was wrong for Politico to report the sweeping conclusion that half the country now shares Health and Human Services Secretary Robert F. Kennedy Jr.’s worldview.

NYC launched a $1M campaign to promote vaccination. Here’s what it gets right, and where it misses.

Other data from the same poll are reassuring and were downplayed. Only 10% of respondents chose the most skeptical position that vaccine risks are significant and enforcing vaccines is dangerous. And only 34% said they see reducing vaccines as a core principle of the Make America Healthy Again movement, the ideological home of anti-vaccine politics.

The idea that vaccine skepticism is now the default is itself a public health threat. People who see misleading headlines may begin to wonder why they are the outlier in trusting vaccines. Public health advocates need to both loudly oppose the anti-vaccine movement and widely celebrate the fact that most Americans still believe that vaccines are safe and effective.

Eager for some good news about vaccine uptake in the United States, I was also pleased to see a famous athlete endorsing vaccines this week. Basketball star Tyrese Haliburton — who led the Indiana Pacers to the cusp of the NBA championship last year before tearing his Achilles tendon in the final game — was recently diagnosed with shingles.

In an interview about his experience, he had this message to the audience: “I would tell anybody over 50 years old to get the [shingles vaccine]. This has sucked.” I strongly agree with that recommendation, as I have written about previously.

What is the future of the U.S. preventive services task force?

A federal program tasked with guiding doctors and health insurance companies on disease prevention has effectively been shuttered, but testimony from Kennedy last week suggests that he might do to it what he did to CDC’s vaccine program.

The U.S. Preventive Services Task Force is one of the most valuable, though least known, programs in American health policy. Established in 1984, it is an independent, volunteer panel of physicians and health professionals that reviews scientific evidence on preventive services and grades them on a scale from A to D. Think about mammograms, colonoscopies, depression screening, cholesterol tests, and HIV pre-exposure prophylaxis. Under the Affordable Care Act, insurance companies are required to fully cover services rated A or B at no cost to patients.

Since he took over, Kennedy has cancelled all of the task force’s scheduled meetings and refused to name replacements for five of its 16 members whose terms expired in December. As a result, there have been no new recommendations on important issues, and the task force was unable to publish a legally mandated annual report to Congress. Nineteen senators sent Kennedy a letter last month demanding he stop blocking the panel’s work.

Leadership disruptions at the CDC endanger American health

Then, in testimony before Congress last week, Kennedy went further. He called the task force “lackadaisical and negligent for 20 years” and said he would appoint new members with “a clear mission.” What’s Kennedy’s version of a clear mission? I worry that he wants the U.S. government to do what he did to the CDC’s Advisory Committee on Immunization Practices and stock it with people ideologically aligned to him. This could mean that the task force starts recommending interventions that have no basis in evidence but that Kennedy endorses, such as peptide injections and raw milk.

Why does this matter so much?

As public health expert Tom Farley argues, the U.S. health care system needs an independent, conflict-free body to evaluate evidence. Otherwise, the guidance that flows to physicians and patients gets distorted by financial interests. Medical specialty societies often publish their own guidelines, but many of their members have financial ties to the companies that stand to benefit from the tests and treatments being recommended.

The task force’s credibility to me and other practicing physicians has always rested on the fact that its members have no such conflicts and consider the totality of evidence, including the costs of testing or treating too much.

The importance of health and safety in child care

Trump recently upended the national conversation about child care saying that he does not believe the federal government should be in the business of paying for it. Until recently, child care had been a rare issue in which there is genuine bipartisan consensus in Washington. Lawmakers from both parties have been advocating for more federal investment, arguing that child care is important infrastructure for adults to be able to work and to grow the U.S. economy.

At an Easter lunch on April 1, Trump said, “We can’t take care of day care. We’re a big country, we have 50 states. We have all these other people, we’re fighting wars. We can’t take care of day care.”

Millions of American families have no child care options available to them, and, even among those that do, the cost is exorbitant, often exceeding the cost of college tuition. Many states are looking for local resources to fund child care expansion. In my home city of New York, the new mayor ran on a promise of universal child care for children from 2 to 4 years old.

If states do find their own resources to expand the number of child care seats, I am hoping that they also allocate sufficient funding for health and safety. In a report I recently authored, I argue that expanding the number of child care seats without ensuring health could make the system even more fragile with facilities closed because of outbreaks or staff shortages.

States need to budget for protecting children’s health, supporting child care workers’ health, and designing and maintaining facilities safely. These are important issues that parents can also try to assess when deciding where to enroll their children.

Until next week,

Jay

Half the world still doesn’t have a national public health agency

2026-04-16T18:32:06+00:00

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

Hello from Nairobi.

I had a fascinating last week! I drove up to Ol Pejeta wildlife conservancy in central Kenya, and saw the last two northern white rhinos on Earth. I was a bit surprised to find that the story wasn’t exactly the tragedy I was expecting. While the last male rhino died in 2018, there’s hope. Scientists preserved his sperm, and now there’s a few dozen embryos that are being kept frozen in a lab in Italy.

The researchers are attempting to implant those embryos into females of a sister species (because they’re not willing to risk pregnancy complications in the final two) in a last-minute bid for de-extinction.

The last two white rhinos on Earth are at the Ol Pejeta wildlife conservancy in central Kenya.

Anyhow, this week’s stories are a bit more of an emotional mix; some genuinely hopeful, others tougher to sit with. We cover some surprising resilience in setting up national public health agencies around the world, the spread of measles in one of the world’s most densely populated countries, and the shadow of war on health systems in Gaza and Sudan, among other stories.

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

Public health agencies … rarer than you’d think

Our first story starts with a stat that genuinely surprised me: Of 195 countries, only 101 have a national public health agency, like the U.S. Centers for Disease Control and Prevention. Naively, I had thought them to be nearly universal.

Sure, all countries have something akin to ministries or agencies responsible for health and well-being. (Nobody’s truly flying blind.) But in about half the world, there is still no single institution that oversees disease surveillance, labs, or outbreak response during emergencies, like a pandemic.

That’s a core point of a Think Global Health essay by two World Health Organization officials who are advocating for more of these agencies. The WHO officials argue that they are often the deciding factor in whether outbreaks are contained early in a given country.

They cite Ethiopia’s rapid response to the Marburg outbreak last year, which was centrally coordinated by The Ethiopian Public Health Institute. As we covered in January, within just weeks, Ethiopian authorities “conducted 3,800 diagnostic tests, airlines screened 4.8 million travelers, and health officials ran a prevention-awareness campaign that reached more than 20 million households.” In sum: It was wildly successful.

In countries without a single public health agency, all those functions may have been scattered across various ministries, regional or state governments, or even research institutes. That fragmentation can slow decision-making at exactly the moment when speed matters most. As the authors write:

“It complicates decision-making when every hour is critical. In a scenario when a virus with pandemic potential suddenly emerges in a country, leaders need to do everything they can to stop the disease from spreading before it becomes uncontainable. Whom would the president or prime minister call?”

I reached out to Chikwe Ihekweazu, one of the authors and the head of the WHO’s health emergencies program, to ask whether the crunch in global health funding has slowed the momentum behind building these agencies, and what it takes to stand one up.

First, they thankfully haven’t slowed down. “Despite the current global health landscape” of funding cuts, Ihekweazu said, his team is helping “20 countries” establish these agencies right now. It’s a geographically diverse list that includes “Kuwait, Namibia, Sri Lanka, and Zimbabwe,” among others.

That’s steady progress, especially given that back in 2000, only 51 countries had one of these agencies.

Today, “the majority countries without a national public health agency are small island states in the Caribbean or the Western Pacific” that have historically banded together to share a regional health body, like the Caribbean Public Health Agency, he told me.

I was surprised to learn that the biggest deciding factor for these agencies isn’t so much about funding, Ihekweazu says, but countries recognizing what they’re missing after a crisis. In many ways, the latest countries on the docket are part of the long tail of Covid.

As for what it takes to stand up one of these agencies, Ihekweazu pointed me to a framework the WHO published just this year, which lays out 12 things countries need to get right, from leadership and funding to the nuts and bolts of detecting and stopping outbreaks. (It’s classic WHO: dry, quite lengthy … but technically excellent.)

Strip down that framework, and it points to something simple: In a crisis, a country has to be able to act as one. As Ihekweazu put it, “the next pathogen is sure to emerge, and either clarity or confusion will define the response. For the sake of the world’s health, let every country have the public health agency it needs.”

A measles outbreak in Bangladesh

Bangladesh is scrambling to contain a fast-moving measles outbreak that has killed more than 100 children in less than a month, the Associated Press reports.

The country, which is one of the most densely populated in the world, has launched an emergency vaccination campaign targeting “children age 6 months to 5 years old” in several high-risk districts. So far, “900 cases of measles have been confirmed … since March 15.”

Disease breakdown: Measles is one of the most contagious viruses on Earth. It spreads through the air when an infected person coughs or breathes. It causes fever, cough, a distinctive rash, and can lead to death, especially in young children. Two doses of the 50-year-old measles vaccine is 97% effective and remains the only viable way to stop the spread of the disease.

It’s worth noting that the current emergency surge of vaccinations is essentially the only path forward for the country. (Well, the only path that’s not a downward spiral.)

As Healthbeat has been reporting, measles’ level of contagion means outbreaks can take off quickly wherever vaccination rates slip. In the United States, cases have surged past 1,600 this year, with officials warning that infections are likely being undercounted and continuing to spread across multiple states.

Where measles is spreading in the U.S.: Outbreaks fuel infections in states coast to coast

In Bangladesh, the outbreak is likewise exposing deep gaps in immunization coverage, “particularly among zero-dose and under-vaccinated children, while infections among infants under 9 months, who are not yet eligible for routine vaccination, are especially alarming,” Rana Flowers, UNICEF’s representative in Bangladesh, told the AP.

Troublingly, the outbreak is also colliding with political fallout from an uprising last year, where “the vaccination campaign for measles was disrupted.”

My takeaway? What’s particularly terrifying about this story is the math.

Measles requires about 95% vaccination coverage to stop the spread of the disease. Bangladesh has come a long way, from 2% coverage in 1979 to 81.6% today. But with a virus this contagious, that remaining gap is everything.

Gaza: amputees and hypothermia

This week there are two health stories out of Gaza that are worth reading.

The first, from The Guardian, follows Palestinians who managed to leave for treatment in Egypt after losing limbs in the war. The story has both dramatic photos and some fairly shocking figures.

“More than 6,000 adults and children have undergone amputations since October 2023,” including children who were, at one point, losing legs at a rate of 10 per day. But the story isn’t just about the horrors of those injuries. It’s also about what comes after.

Many amputees are currently stranded in Egypt, without legal status, unable to work, and cut off from long-term care. As one patient put it (which put a pit in my stomach,) “I want to return to Gaza because my daughters are there … When I am allowed to leave, I will go back to my daughters.”

The second story, from Think Global Health, is not much better. A health worker from Project HOPE describes this year’s winter in Gaza, where children died of hypothermia in tents, and where wet blankets and fuel shortages turned cold snaps into repeated medical emergencies. Part of this exposure stems from the fact that “81% of all structures in the Gaza Strip” are estimated to be damaged.

The author writes that hypothermia “acts not in isolation but as a deadly multiplier,” worsening malnutrition and disease in a system where most hospitals no longer function, even after the fighting has ceased.

I thought about both these stories when I listened to a podcast Tuesday morning, on a conversation about the “permanent” state of Palestine between commentator Ezra Klein and political scientists Marc Lynch and Shibley Telhami.

Ultimately, the medical situation in Gaza is no longer some acute crisis. The children freezing in tents, amputees stranded across the border, families packed into ruins, and endless limbo with no real horizon for relief…

That is now the baseline. It is daily life.

Famine in Sudan

I’m always a little hesitant about where to draw the line between humanitarian crises and global public health in the Checkup. But I have to include this next story, because I don’t think we truly appreciate what’s unfolding in Sudan right now.

According to Reuters, “millions of people in Sudan are surviving on just one meal a day” as the country’s war grinds into its third year. All told, nearly 29 million people, about 62% of the population, are unable to consistently access enough food to live a normal, healthy life.

The reporting draws on a new analysis from a group of aid organizations, including Action Against Hunger, CARE International, and the International Rescue Committee.

“In the two areas worst hit by the conflict,” the aid organizations found that millions of families often “miss meals for entire days,” with many people resorting to “eating leaves and animal feed to survive.”

The takeaway (and the trajectory here) is unmistakable. It’s the “f” word.

Famine thresholds have already been crossed in parts of the country, with child malnutrition rates “nearly double the famine threshold” in some areas.

This is shaping up to be a catastrophe on a scale the world has not seen in years, potentially decades, if conditions continue to deteriorate. It’s worth noting, the three NGOs I linked to above are taking donations, and saving lives with them.

‘Molecular surgery’

I’ll leave you with an op-ed published in the New York Times, written by Jeff Coller, a scientist who works on gene-editing technology. It is a hopeful-but-frustrated letter on what Coller says may be “the most important medical story of the decade.”

Coller opens with a striking vignette from last year.

A baby is born with a rare and deadly genetic disorder, stemming from a single DNA error. A liver transplant could fix the issue, but only after many months, and likely after “irreversible neurological damage” had set in.

So, instead, doctors and medical researchers designed a custom, DNA-altering therapy specifically for the rare disease in this one child. The drug was injected into his blood and the DNA error was permanently rewritten.

Coller’s point is that the age of truly personalized genetic medicine is no longer theoretical. It has already begun. And today, we are capable of eliminating entire categories of rare genetic diseases, most of which still have no approved treatments.

Ok ok, that was the hopeful bit. Now for the frustration.

As Coller sees it, even if the constraint today isn’t technological, “I believe that the biggest obstacle, however, is structural,” he says. Globally, our medical approval systems simply aren’t built for these kinds of custom treatments. In the United States, each one is treated like a brand-new drug, requiring its own approval process. As he puts it:

“Our regulatory and commercial infrastructure was built for blockbuster drugs that treat millions of patients with the same pill. It was never designed for diseases for which each patient may need a bespoke correction to a unique mutation. But we already have a model for individualized, high-stakes interventions that correct specific defects in specific patients. We call it surgery. Consider a surgeon who performs a heart valve repair. No one asks that surgeon to run a clinical trial before operating on the next patient with a slightly different anatomy.”

That’s the shift Coller is calling for. To stop treating these therapies like traditional drugs, and start approving them more like a platform, or even like a kind of “molecular surgery.”

After all, “radically new science demands radically new thinking about how we regulate, manufacture, pay for, and deliver treatments,” he says.

Ten years from now, if children are still dying of conditions we know how to correct, it will not be because the science wasn’t ready.”

Until next week,

William

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

How politics and AI are making it harder to ‘follow the science’

2026-04-15T11:00:00+00:00

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

During the peak of the Covid pandemic, the phrase “follow the science” became a popular refrain, used first by those advocating stronger infection control policies and later by those opposed to them. Today I am discussing how, in the past few weeks, scientific evidence has been selectively chosen to meet a specific political or economic end, and how artificial intelligence is making it harder than ever to know which scientific studies we can trust.

Politics of Covid vaccines and origins continue to cause trouble

The Washington Post broke a story last week that acting Centers for Disease Control and Prevention Director Jay Bhattacharya has been preventing CDC career scientists from publishing a study about the benefit of Covid vaccines during the recent winter respiratory virus season.

The report, which had cleared the agency’s full scientific review process and was scheduled for publication in the CDC’s flagship journal, the Morbidity and Mortality Weekly Report, on March 19, found that, between September and December 2025, healthy adults who received a Covid vaccine reduced their likelihood of emergency department and urgent care visits by 50% and the likelihood of Covid-associated hospitalizations by 55%.

According to the story, Bhattacharya, a health economist, thinks that the methodology used by CDC scientists is flawed. He is arguing that the CDC should only be publishing randomized control trials, a position completely at odds with the overwhelming consensus of vaccine scientists and epidemiologists who work in academia, government, and industry.

Randomized controlled trials are used to answer the question: “Does this vaccine prevent an infectious disease when used as intended in a selected population?” In contrast, the methods used in the suppressed Covid study are used to answer a different question: “Does this vaccine prevent an infectious disease when used in a real-world population under real-world conditions?”

The Food and Drug Administration and industry consider this "real world evidence," and the CDC has been using the exact same method for decades to estimate the effectiveness of the seasonal flu vaccine after each flu season has ended.

A report about flu vaccine effectiveness this past winter, using the exact same methods, was published in the MMWR just a week before Bhattacharya blocked the Covid study. (I covered the flu study last week). Why did his concerns about scientific methods apply to the Covid vaccine study and not the flu vaccine study?

I fear that the real reason Bhattacharya has squashed this study is that he does not want the CDC publishing any data about the benefit of Covid vaccines. Despite his repeated podcasting and writing about the importance of scientific debate, he rose to prominence as a Covid contrarian and is using his positions as National Institutes of Health and CDC director to promote his views and squash opposing scientific views.

On March 20, in his role as NIH director, Bhattacharya hosted the inaugural lecture of a series he is calling “NIH Scientific Freedom.” That talk featured a science writer from the UK named Matt Ridley about the “search for the origin of Covid-19.” Ridley argues that Covid was engineered in a lab and released accidentally. His talk completely disregarded the extensive evidence that points to an opposing hypothesis: The virus spilled over from animals into humans and amplified into an outbreak at a live animal market in Wuhan, China.

Thankfully, a diverse team of experts recently pushed back. Twenty-three of the 27 original members of the World Health Organization’s Scientific Advisory Group for the Origins of Novel Pathogens recently published a careful, detailed review concluding that most peer-reviewed scientific evidence supports that SARS-CoV-2 spilled over from an animal into humans. They found no conclusive evidence for a lab leak, and noted that government and intelligence reports favoring a lab leak rely on political, rather than scientific, arguments. Virologist Angela Rasmussen has written a considerably more caustic assessment of the Ridley lecture that is also worth reading.

In studies about the origins of a virus, we can rarely say anything is 100% certain. While a lab leak is certainly possible, the evidence strongly and consistently points elsewhere.

Politics of raw milk products causes trouble at FDA

Science remains a point of contention in an ongoing outbreak of E. coli O157 infections that CDC and FDA investigators have linked to cheddar cheese sold by a company known as RAW FARM.

Identifying the source of a food-borne disease outbreak is straightforward when people are exposed to the contaminated food at a single event — what’s known as a “point source” outbreak. When the exposure occurs over a wide geographic area and a long period — such as a food product sold around the country over weeks — the investigation is far more challenging.

Epidemiologists need to interview every patient about any foods they may have eaten before they became sick, relying on human memory and electronic records, neither of which are completely reliable.

Microbiologists need to obtain specimens from patients and link them together using genomic analyses. Ideally, they are also able to obtain specimens from food, but this is often difficult because the contamination may have been intermittent or limited to a batch that has already been sold and discarded.

Because it is so difficult to find a “smoking gun,” public health officials need to use a preponderance of scientific evidence to decide what to do, similar to the debates about how much evidence we need to decide Covid originated in nature or that vaccines work in the real world.

In this outbreak, the epidemiological case against RAW FARM is substantial. As of early April, nine people had been infected with the outbreak strain of E. coli across three states. Eight of these nine people were interviewed, and all reported eating raw dairy products. Of the seven who remembered the brand, all named RAW FARM. Genomic sequencing confirmed all the infections were genetically identical, meaning everyone probably got sick from the same source.

And yet RAW FARM twice refused FDA requests to voluntarily recall its cheese, posting on social media that the outbreak was not connected to its products and resharing testimonials from customers who continued to buy and feed the cheese to their children. When the company finally issued a recall on April 2, it did so “under protest,” continuing to deny the investigation’s findings.

Unfortunately, this not just a problem of one defiant cheese maker. The FDA took weeks longer than it would have previously to compel action, and the company’s defiance was likely emboldened by the current political moment, in which the head of the federal department overseeing food safety has celebrated raw dairy as a health food and framed food safety regulations as an assault on consumer freedom.

When leading government officials signal that food safety standards have changed, some producers are going to test that proposition and sicken us in the process.

AI is causing trouble with the scientific literature

An article published last week in Nature illustrates a different and perhaps more insidious threat: how AI can corrupt scientific communication and literature.

A medical researcher at the University of Gothenburg, Almira Osmanovic Thunström, invented a fake skin condition called “bixonimania,” a name she chose specifically because it sounded absurd, a psychiatric term attached to an eye condition.

She uploaded two obviously fake preprints about the condition to an academic website in early 2024, complete with a fictional author, a made-up university, and acknowledgements thanking “Professor Sideshow Bob” and “the Galactic Triad” for funding support. One of the papers stated explicitly that it was “made up.” Her goal was to test whether AI systems would pick up and repeat fabricated medical information.

The experiment worked faster and more thoroughly than she had anticipated. Within weeks, major AI chatbots were telling users that bixonimania was a real condition, describing its prevalence, and advising them to see an ophthalmologist.

Even more troubling, the fake papers were then cited in actual peer-reviewed medical literature, suggesting that some researchers were using AI-generated references without reading the underlying papers. One such paper, published in a Springer Nature journal, was retracted only after Nature’s reporters contacted the journal to ask about it.

As recently as March, some versions of major AI chatbots were still describing bixonimania as an “emerging condition” or a “proposed new subtype” of a real disorder. Millions of people now use AI chatbots as a first stop for health information. If the scientific literature that feeds those systems can be poisoned by fake papers, bad actors could potentially manufacture medical “evidence” to sell products, cast doubt on real treatments, and distort public understanding of disease.

Who controls what counts as evidence?

Who controls what counts as evidence, and what happens when that control is abused? In the past week, we saw examples of this problem from government agencies and the private sector. Scientific reasoning requires understanding what a particular study can and cannot tell you, what the weight of evidence across multiple studies suggests, and where genuine uncertainty remains. That kind of reasoning is hard to do, easy to distort, and, as this week makes clear, under assault from multiple directions at once.

Until next week,

Jay

AI could help save lives by easing delivery of treatments that we know work

2026-04-10T11:00:00+00:00

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

According to tech leaders, artificial intelligence will be transformative for our health. AI could give us “the next 50-100 years of biological progress in 5-10 years,” declared Dario Amodei, CEO of Anthropic. “Maybe with 10 gigawatts of compute, AI can figure out how to cure cancer,” enthused Sam Altman, CEO of OpenAI.

Back in the clinic, our enthusiasm is more guarded. Part of it is the checkered history of health technology, too often extracting humanism in medicine for the pursuit of profits. Another hesitation is because so often, in the real world, the problem is not discovery but delivery. Cures that don’t reach the patients most in need; prevention that never makes it into practice. But what if AI could actually help us change that?

Take one of my longtime patients, whom I recently saw on his 45th birthday. We commiserated about the travails of middle age (I’m also turning 45 this year), and celebrated some progress he had made with his mental health in the last few months. And — with colon cancer affecting more young patients — I recommended a colonoscopy.

He acquiesced to a stool test, which screened positive, but declined the follow-up colonoscopy that might save his life. When I reached him to understand why, I learned that he had lost his job and his health coverage, and felt he had bigger fish to fry. “I’m feeling fine, doc” he said to me. His reassurance just reinforced my own powerlessness to reassure him.

My patient is far from alone: Roughly half of Americans with a positive stool test don’t complete follow-up within six months, despite the proven benefits of early detection and treatment.

This yawning gap repeats itself across American medicine. Less than half of patients with high blood pressure are on an effective regimen for it. Only about a third of patients who qualify for the medicines that could cure them of hepatitis C receive them. Fewer than 1 in 5 patients who would benefit from therapies like buprenorphine for opioid addiction get treated.

Even as we discover more effective treatments, we fail to deliver them to those most in need.

AI can help patients get through complex process to care

The discovery-delivery gap is not new. Three decades ago, health care pioneer Don Berwick highlighted “the gap between what we know and what we do.” But we now have a realistic opportunity to fix this failure, by thoughtfully harnessing AI to save lives.

Take my patient’s positive screen for colon cancer. Several steps are required after the stool test: notifying the patient, arranging scheduling, ensuring coverage, explaining the bowel prep. Sometimes the prep isn’t adequate, and we send patients back to square one.

The complexity of this process explains why many health systems employ patient navigators, and why people with greater means seek out concierge care to cut through the thicket. Artificial intelligence could help scale this kind of personalized, persistent engagement. Imagine a system that calls my patient in his native language, helps schedule his colonoscopy, and answers questions about the bowel prep. Nurses and social workers can focus their precious time on more complicated cases, like helping my patient enroll in Medicaid.

A test for AI apps is whether they enrich the human relationships at the heart of exceptional care. Too often, health technology has eroded relationships: reducing eye contact, depersonalizing interactions, making medicine transactional. Patients become less inclined to trust recommendations. In this environment, trusted intermediaries like community health workers become more important, not less, and technology must work for them.

Human relationships have always been a key to bridging innovations, like vaccines and cures, with implementation. The United States tamed tuberculosis, for example, through painstaking efforts to find and monitor cases in the community and provide subsequent support for completing treatment regimens.

AI can help cures reach patients who need them

Today we have a chance to eliminate modern scourges like hepatitis C, thanks to new therapies like curative antivirals. Hepatitis C is an insidious disease: Tens of thousands of Americans each year progress toward cirrhosis, their eyes yellowing and toxins clouding their minds as the liver fails. Yet a simple 8- to 12-week course of pills can eliminate the virus from the body. AI could help ensure that such breakthroughs actually reach patients.

Casefinding is especially important when people can transmit infection without knowing they are infected. Yet our tools for identifying these “silent carriers” are often blunt. Today, the national recommendation for hepatitis C is to screen every American between 18 and 79 at least once with a blood test. By contrast, a machine-learning algorithm tested in Israel was 100 times more efficient: yielding one diagnosis for every 10 tests instead of one for every thousand.

A similar opportunity exists for HIV prevention. As powerful new tools like the long-acting injection lenacapavir emerge, AI could help ensure that protection reaches those at highest risk.

Eliminating diseases like HIV and hepatitis C, just as we did for smallpox and polio, is within our reach — though it will take more than just technology.

What AI can’t do is solve our all too human problems, like the fact that high prices preclude broad access to some of our most consequential breakthroughs, from antivirals for hepatitis C, to the $28,000-a-year lenacapavir, to the new GLP-1 medications for diabetes and obesity. For this, we will have to work through our messy human systems to forge a better path.

Mere mortals have done it before. In Louisiana, a so-called “Netflix model” facilitated expanded access to hepatitis C medicines for a flat subscription fee. And the Congressional Budget Office estimated that a national subscription model for hepatitis C would save the federal government approximately $6.6 billion over 10 years, in part due to costs averted from hospitalizations and intensive care that would otherwise be borne by Medicare. We can save lives and money.

My patient ended up completing his colonoscopy after our social worker helped find health coverage he could afford. They found a small polyp that was precancerous, and he and I both breathed sighs of relief. But he’s due for another colonoscopy in five years. I hope we can make a century of medical progress by then. At the least, we can make it easier for patients like him to receive the care we already know saves lives.

Dr. Dave A. Chokshi is a physician at Bellevue Hospital and Sternberg Family Professor at the City College of New York. Previously, he served as health commissioner of New York City.

Where measles is spreading in the U.S.: Outbreaks fuel infections in states coast to coast

2026-04-09T21:27:09+00:00

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Measles infections continue to spread across the United States, largely fueled by outbreaks – large and small – in multiple states

Since January, there have been more than 1,670 confirmed cases of measles nationwide, with most states reporting at least one case to the Centers for Disease Control and Prevention.

States with 10 or more confirmed cases of measles since January include: Arizona, California, Colorado, Florida, Minnesota, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, Texas, Utah, Virginia, and Washington state, according to federal, state, and local data.

But health officials in multiple states have told Healthbeat they are concerned measles cases are going unreported because there are people who aren’t seeking diagnosis and treatment. They also are worried that recent spring break travel may contribute to more people falling ill with measles in the next few weeks. It can take two to three weeks for symptoms to appear after a person is infected.

The good news: South Carolina, the site of the largest U.S. measles outbreak in decades with 997 cases, hasn’t had a reported measles infection in more than three weeks and will be declared over if that trend continues through April 26.

The bad news: Utah’s outbreak – now the largest, still-growing outbreak in the country – is approaching 600 known cases.

The CDC defines an outbreak as three or more related cases. Here’s what to know about six places where measles has been spreading:

Utah: The largest outbreak that is still growing

Utah’s large outbreak, like others, began with just a handful of cases that started being identified last June. A few were in Utah County, around Provo. Others were in a rural area in the southwest corner of the state – where the virus continued to gain traction, becoming the focus of the outbreak throughout last year.

By the end of 2025, 197 people had been diagnosed with measles largely in that one corner of the state. Then in recent months the outbreak surged statewide. Since January, another 386 people have been diagnosed, bringing the outbreak’s total to 583 reported cases as of this week. At least 47 people have been hospitalized.

Dr. Leisha Nolen, Utah’s state epidemiologist, said the number of cases known to public health officials is an undercount. “I can say confidently that we are missing cases,” she said.

But it’s difficult to say how many.

In some communities that are particularly distrustful of government and public health, as few as 1 in 10 cases may go unreported, she said. Cases in remote rural communities, with limited access to health care, may also have higher rates of underreporting, while more cases may get counted in cities with easier access to doctors and hospitals.

One thing is clear: Utah’s outbreak is continuing to grow. In the last three weeks, state health officials have learned of 121 new cases.

“In the beginning of our outbreak, we did have mostly communities along the southwest border with Arizona affected, and we were really trying to contain it in that area and prevent spread,” Nolen said. “But as you know, people move around.”

A state high school wrestling championship in mid February contributed to the spread of the disease, health officials said. The state’s TriCounty Health District in northeast Utah, with 59 reported cases, has been particularly hard hit in recent weeks following the event.

Kirk Benge, TriCounty Health director, said the region’s outbreak has been centered around the city of Vernal, which is known as “Dinosaurland” because of the area’s rich deposits of dinosaur fossils and nearby Dinosaur National Monument.

“We started with quite a large number of cases in a school,” Benge said. “Now we’re seeing the household spread that comes from all of those cases started in a school setting.”

There are encouraging signs the outbreak in the Vernal area may be slowing, he said.

“We saw week over week doubling there for a little while, and I think it plateaued here this last week, and it may be declining right now. So hopefully that trend continues,” Benge said.

He said that since the local outbreak began, large numbers of parents are seeking vaccines for their children and the number of vaccines administered is up 500% over the same period last year.

“I think we have a lot more just hesitant people who have been confused by mixed messages on social media,” Benge said. This kind of vaccine hesitancy is different than the staunch opposition to vaccination found in some other communities in the state, he said.

Still, many other parts of the TriCounty area remain vulnerable to measles outbreaks because of low vaccination rates – something the county’s board of health warned in a December 2024 open letter to the community that cited an increase from 4.8% to 11.9% of local parents seeking to exempt their children from school vaccines. “We want all residents to understand that individual decisions regarding vaccination impact us collectively,” the letter said.

To prevent outbreaks of measles, 95% of people in a community need to be vaccinated against the disease.

Arizona: Measles outbreak from 2025 continues to grow

A measles outbreak has been underway in Mohave County, along the Arizona-Utah border, since August 2025.

Last year the county had 214 cases. This year, at least 61 cases have been reported, state data show. Officials with the Mohave County Department of Public Health did not respond to an interview request.

Oregon: ‘Worrisome’ infections without obvious source

There have been just 13 measles cases reported across the state of Oregon as of April 3. While not technically an outbreak, Dr. Dean Sidelinger, the state’s epidemiologist, is concerned about hidden spread of the virus.

While the source of some of Oregon’s known measles cases can be traced to travel to another state with an outbreak, disease investigators haven’t found a source for most of the cases.

“That’s very worrisome to us in public health, because that indicates a level of spread in the community that we’re not detecting,” Sidelinger told Healthbeat.

The state’s wastewater testing has also been intermittently detecting measles in areas that don’t correlate with where cases are being reported, he said.

While Sidelinger said 9 out of 10 parents in Oregon have chosen to fully vaccinate their children, the state has localized communities where there are concentrations of unvaccinated people.

“Many of our communities, not just in Oregon, but across the country, who have lower vaccination rates, often have various reasons for that. But some are in more close knit, often faith-based communities that don’t typically seek health care, or maybe have a little bit more of a mistrust or distrust of government,” he said. “We worry that if it gets into one of these communities that it could spread fairly quickly.”

Florida: Cases continue in county with university outbreak

A measles outbreak linked to Ave Maria University in southwest Florida’s Collier County has grown to 106 confirmed and probable cases through April 4, the most recent data available on the state health department’s website. Statewide, there have been 144 measles cases reported since January, including a handful of cases in Broward, Pinellas and Hillsborough counties, the data show.

In recent weeks, spring break travel has resulted in a surge of travelers prompting concerns about the potential for further spread of the virus. The state health department and Ave Maria University didn’t respond to interview requests.

North Dakota: Two outbreaks since February

Since March 23 there have been six cases of measles reported in Ransom County, North Dakota, a largely agricultural area in the southeastern part of the state with a population of about 5,600 people. One person has been hospitalized, according to state data.

Officials at North Dakota Health and Human Services issued a press release on April 1 about the first Ransom County case, saying that the person “likely acquired the infection within the state” and that the case was not linked to a measles outbreak in Pembina County.

A spokesperson for the department said staff were out of the office and unavailable to answer questions about the current status of the outbreaks and efforts to control the spread of the disease.

The outbreak in Pembina County, which is in North Dakota’s northeast corner, involves 23 cases reported in February and March, according to the state’s online data. Four of these people were hospitalized.

A total of 32 cases have been reported across the state since January.

California: An outbreak sparked by travel to South Carolina

In recent months the Sacramento, California region has been experiencing a measles outbreak that was sparked by an unvaccinated toddler who had recently visited South Carolina’s outbreak area.

The toddler’s illness was reported to Sacramento County health officials in late February, then nearby Placer County identified three more measles cases in siblings from a different household who had been exposed to the toddler, according to the California Department of Public Health.

Additional cases have continued to be identified in both counties.

This week, Sacramento County announced that two additional measles cases have been reported. Both are unvaccinated children, raising the county’s number of confirmed cases to five.

“These five confirmed Sacramento County measles cases in recent weeks show the disease is circulating in Sacramento County,” the county health department said in an announcement about the cases. “The overall risk to the general public remains low but residents, especially those who aren’t vaccinated against measles or whose vaccination status is unknown, should be hyper-aware and take steps to protect themselves and others.”

In Placer County, where there have been eight confirmed measles cases, officials also are concerned that measles is spreading in the community. “Nearly all of the measles cases thus far have some association with homeschool enrichment programs in the region, either directly or through family members,” the county health department said.

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

States face another challenge with Medicaid work rules: staffing shortages

2026-04-09T14:30:30+00:00

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Katie Crouch says calling her state’s Medicaid agency to get information about her benefits can feel like a series of dead ends.

“The first time, it’ll ring interminably. Next time, it’ll go to a voice mail that just hangs up on you,” said the 48-year-old, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”

She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.

Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.

Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.

Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.

Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.

KFF Health News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.

The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.

States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”

Long wait times for help

Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.

The Congressional Budget Office estimated the rules would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.

Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.

The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.

In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia took more than 45 days to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.

CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.

In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.

In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the Covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and more than 25 million lost their benefits.

Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.

“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.

After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride, a Delware Democrat. McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.

Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.

“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.

Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.

States short-staffed for Medicaid

Some states told KFF Health News in late March that they’ll need more staff to roll out the work rules effectively.

Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.

As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.

Missouri’s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made during a public meeting in November.

“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”

States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.

“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

States are paying government contractors millions of dollars to help them comply with the new federal law.

Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.

During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.

Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told KFF Health News.

The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.

Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.

People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.

“The human stakes of this are people’s lives,” she said.

KFF Health News correspondents Katheryn Houghton and Samantha Liss contributed to this report, which was originally published at KFF Health News, Healthbeat’s national reporting partner.

The next U.S. aid disruption: HIV, malaria drugs for Africa and Asia

2026-04-09T11:00:00+00:00

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Hello from Nairobi.

We had a lovely, long Easter weekend. (Both Good Friday and the Monday after Easter are national holidays here.) And later this week, I’m planning on driving some visiting family upcountry to the foothills of Mount Kenya, where we’ll see the last two northern white rhinos in the world.

This week’s stories cover some (déjà vu triggering) disruptions to U.S. medical aid, the rollout of a promising HIV prevention drug, the growing damage that war is inflicting on Iran’s health system, among a few other stories.

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

A proposal for more U.S. medical aid disruption

The United States is preparing a major, disruptive overhaul in how it delivers HIV and malaria aid, Reuters reports. The proposed changes represent an “upheaval likely to cause more medicine shortages” and risk “a second dislocation of life-saving services in just over a year,” across Africa and Asia.

Some background: For the last 10 years, the United States has routed a fairly astonishing volume of medical supplies through one large program called the Global Health Supply Chain Program – Procurement and Supply Management, which is run by the for-profit company Chemonix. Just how much? Between 2016 and 2024, that program “delivered a total of more than $5 billion of HIV and malaria products to 90 countries,” making the United States by far the largest funder of these tests and medicines worldwide.

But, according to the Reuters investigation, State Department leadership has asked “staff in 17 African countries and Haiti in an email [on March 31] to cease implementing the supply program by May 30.”

The program will theoretically be replaced by new systems set up under “bilateral agreements with other countries” and private distributors, which would have to be negotiated extremely quickly.

All told, the month-and-a-half timeline is raising concerns about “immediate risks to service continuity if the transition is rushed or incomplete,” with potential shortages of HIV drugs, malaria treatments, and other basic health supplies that millions of people rely on. As the article outlines, ordering and shipping medical supplies to remote clinics can take many months.

The directive “did not lay out a clear transition plan, instead asking each U.S. country office to set out how it would implement the handover, and to inform Washington of any risks or need for more time.”

I reached out to a senior, overseas State Department official with direct knowledge of the program, who agreed to speak on background to provide context.

My source confirmed the broader uncertainty around the transition. To their knowledge, even basic guidance on the proposed upheaval (including the email referenced in the Reuters report) has not yet circulated across all countries served by the program.

They echoed the strong concerns in the Reuters report that such a severe and rapid disruption could leave patients without lifesaving medicines. But what I found most interesting is that they noted that even if the United States ultimately shifts medical procurement to the international organization the Global Fund (an option that we reported on last week) simply purchasing medical supplies is only part of the coming challenge.

What remains dramatically unclear is the rest of the supply chain: warehousing, logistics, and actually getting drugs into clinics.

At the risk of getting too in-the-weeds: These risks may be especially acute in countries where the State Department did not inherit parallel supply systems from the now-defunct U.S. Agency for International Development that could temporarily absorb the shock. (In other words, some countries have backup systems to keep medicines flowing. Others do not.)

My takeaway: It’s still unclear how much of this proposal will actually move forward, or whether the State Department may walk back the plan or timeline. I’ll be following this story closely.

Is there enough of this game-changing HIV prevention drug?

Late last year, a new injectable drug to prevent HIV infection called lenacapavir began rolling out in several African countries. The drug has generated enormous excitement because a single injection protects people for about six months, and it provided close to perfect protection in clinical trials.

But that early rollout is already raising questions. In Eswatini, which received the drug first and has the world’s highest rate of HIV, clinics are already running through their tiny initial shipments, The Guardian reports.

One clinic only “received 130 doses.” Nationally, only a few thousand people have started the drug so far. (Keep in mind, a quarter-million people in Eswatini are HIV+). As one source in the story put it, “The coverage so far has been very, very, very low. But my impression is that interest is extremely high.”

The story raises an obvious question, and also had me wondering if this goes beyond one country: Is lenacapavir’s wider rollout already being hampered by supply limits? To ask, I reached out to Mitchel Warren, executive director of the AIDS Vaccine Advocacy Coalition, who we last spoke to about lenacapavir in October.

To start, Warren told me to pump the brakes. It is still early days. While “the initial deliveries are quite small to each country … it is actually too early to tell about the actual supply constraints (if any),” he said.

Warren noted that countries like Kenya, Nigeria, and Zimbabwe only just received their first shipments last month. “So we don’t yet know that demand is truly outstripping supply – yet.”

Still, Warren said the bigger picture for HIV prevention is far from reassuring amid the broader pullback in global health aid.

As he put it: “This continues to be a moment of cruelest irony – our best opportunity in HIV prevention coming at the worst time politically and economically.” While there is enormous potential for this new drug, “the foundational programs [which would deliver it] have been severely curtailed, and in some cases entirely decimated.”

Warren also left me with one note that’s often missing from lenacapavir coverage. HIV prevention, he says, “has always been more than a product — it is a program.” And without outreach, testing, and health systems that bring people back every six months, even a “miracle drug” (as the Guardian piece put it) won’t stop the epidemic.

Iran’s civilian health system under fire

For the third week in a row, we’re returning to the Iran war. Granted, it’s been evolving on a fairly volatile timeline, so much of what we know will likely change in the coming days.

Early Wednesday, a fragile cease-fire was holding after U.S. threats to attack Iranian power plants, bridges, and other civilian infrastructure if Iran did not reopen the Strait of Hormuz. Iran had threatened similar retaliation to neighboring countries. Under international law, these are war crimes, and the potential consequences for civilian health and survival could be enormous.

To some extent, that damage is already underway. Al Jazeera reports that U.S. and Israeli strikes have already hit major parts of Iran’s health system. This includes a psychiatric hospital, a pharmaceutical company, and the Pasteur Institute of Iran, “the oldest and most prestigious research and public health center in Iran,” which has “played a central role in fighting endemic diseases such as smallpox and cholera.”

The World Health Organization says it has verified “over 20 attacks on health care in Iran,” resulting in “at least nine deaths,” including an infectious diseases health worker and a member of the Iranian Red Crescent.

More broadly, WHO Director-General Tedros Adhanom Ghebreyesus warned that “the conflict in Iran, and the region, is impacting the delivery of health services and the safety of health workers, patients, and civilians present at health facilities.”

Argentina: easier monopolies for medicines?

After pulling out of the WHO last month, Argentina has made another significant policy shift. The government has scrapped guidelines that limited which medicines could qualify for pharmaceutical patents, according to an essay in Health Policy Watch by leaders in the affordable-medicines advocacy arm of Doctors Without Borders.

Put simply, the essay argues that Argentina has essentially made it easier for pharmaceutical companies to stretch out monopolies by re-patenting small tweaks to existing drugs. (Imagine a company simply rejiggering a new dose of an existing drug, and then re-patenting it just as the original patent was about to expire.)

Ultimately, these patent extensions push generic competitors out of the market for longer, and keep prices much higher. As an example, the authors reference a hepatitis C treatment that dropped from “$147,000 to $120 per person” once generics were allowed to compete.

You may be asking: Why is this (admittedly niche) policy shift for a single country worth covering?

Well, the authors argue that Argentina’s previous “more disciplined system” of patent rules showed how governments could apply strict standards, while still rewarding real innovation. By rolling those rules back, they warn, Argentina risks weakening a model other countries have looked to when trying to limit pharmaceutical monopolies.

As for my takeaway? This story touches on a tension I run into constantly covering global health. Alongside government-funded R&D, private companies are our greatest engine of drug innovation. The big question is how and where we should draw the line between incentivizing companies to invent lifesaving medicines … and demanding those medicines remain affordable once they exist.

Honestly, I’m reluctant to even, say, cast drug patents as a “necessary evil.” As uncomfortable as they are, monopolies ultimately allow companies to recoup the enormous cost of developing new medicines. And there’s nothing shameful in that. When there’s no profit to be made (as we see constantly with the entire field of “neglected tropical diseases”), the results often fall between grim and hopeless.

Human greed is a powerful force! Companies should see value in investing in the medicines we all rely on. But keeping that greed in check is just as important, and I think Argentina is failing in the latter to serve the former.

A ‘mysterious skin disease’ in Pakistan

We’ll finish on a small but worrying report out of Pakistan that’s worth flagging. At least nine children have died in the country’s southeast Sindh province from what officials have described as a “mysterious skin disease,” though the cause has not yet been identified, Pakistan Today reports.

On Monday, “samples from eight affected children had been sent to Karachi [the capital of the province] for testing,” but results have not yet been released.

It’s too early to know what this actually is, although the big worry is a novel outbreak. Local officials have suggested possibilities including chickenpox or mpox. (Although additional reporting suggests that while mpox has been detected in some of the cases, health officials say it was not the direct cause of the deaths.)

With no diagnosis yet and only local reporting so far, this may ultimately turn out to be a familiar disease rather than something new. Still, unexplained childhood deaths are always worth watching closely, and I’ll keep an eye out for further reporting.

I’ll see you next week!

William

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

How smoking fell to lowest level ever and other public health wins

2026-04-08T11:00:00+00:00

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

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

I often write about what’s not working in public health. This week, I want to focus on a few recent studies that show what is working in public health — from reducing tobacco use to preventing one of the world’s deadliest killers — and put it in the context of how we think about interventions to avert illness and death in large populations.

What interventions work best in public health?

When we are trying to improve the health of a population, we try to choose interventions that benefit the largest number of people for the longest amount of time with the least amount of effort required on a daily basis.

In a framework first promulgated by former Centers for Disease Control and Prevention Director Tom Frieden, the most effective interventions address the socioeconomic factors that have the largest impact on health and longevity, such as poverty, education, and housing. The second most effective are interventions that change the default context for how people make healthy decisions, e.g., clean water, safe food, smoke-free places, and seatbelt mandates. These work because the healthy choice becomes automatic.

Third most effective are long-lasting protective interventions, such as vaccines or colonoscopies, that confer durable protection from a single encounter with the health system. Fourth most effective are ongoing clinical interventions, such as medications to treat blood pressure or HIV. And, fifth, the least effective in a population, is counseling and education about health: telling people to eat better, exercise more, stop smoking. Trying to talk one person into changing their behavior is hard. Trying to talk millions of people into changing their behavior is even harder and often fails.

Even though we have a hierarchy of what works best in public health, each of these types of interventions has value, as shown by multiple recent studies.

Changing the context: Tobacco use at a historic low

Cigarette smoking just fell to its lowest recorded level in U.S. history. A study published this month in NEJM Evidence, using 2023 and 2024 National Health Interview Survey data, found that cigarette smoking among U.S. adults dropped from 10.8% to 9.9%, the first time it has ever reached single digits. Tobacco kills roughly 480,000 Americans each year. If this trajectory holds, the United States could meet the Healthy People 2030 target of 6.1% before the decade ends.

What drove this decline? While many people probably think it was because of better education about smoking’s harms, most of the gains in tobacco control came from years of investment in changing the default context: High tobacco taxes and comprehensive smoke-free laws that made smoking expensive to start and disruptive to continue.

Unfortunately, this progress is not guaranteed to sustain. The current administration has had virtually nothing to say about tobacco and even eliminated the CDC’s Office on Smoking and Health. Congress is trying to restore it, and so I remain hopeful that the United States will continue to drive tobacco use down.

Worth noting is that e-cigarette use has not declined and sits at 7% among adults, with rates among young adults running significantly higher than cigarette smoking. And we still do not know what the long-term consequences of vaping will be.

Long-lasting protective interventions: Flu vaccine still worth getting

Vaccines are among the most cost-effective tools in all of public health. Some, like measles or polio vaccines, are delivered in the first few years of life and protect people for decades. Others, like flu vaccines, work differently: Because the virus mutates rapidly, the vaccine has to be redesigned each year, and protection is partial rather than complete.

The CDC just published data showing both the benefits and challenges of getting a flu shot every year. The dominant circulating strain this year (influenza A[H3N2] subclade K) emerged after this season’s flu vaccine was already selected, a mismatch that predictably lowered effectiveness. Among children and adolescents, vaccine effectiveness against outpatient visits ranged from 38% to 41% and, among adults, 22% to 34%.

While those numbers are much lower than I would like, one of the most important axioms of public health is that a small number multiplied by a very big number is a big number. Even partial protection against a disease that infects tens of millions of people means that tens of thousands of people did not end up in a hospital from the flu. For example, during the 2022-23 flu season, when overall flu vaccine effectiveness was also just 30%, flu vaccines still prevented an estimated 71,000 hospitalizations and 4,300 deaths in the United States.

Clinical interventions: DoxyPEP and tuberculosis

While medical care is often seen as the most important part of health, it is often less effective than other public health interventions, because it requires accessing a clinic, getting the right diagnosis, and maintaining adherence to treatment. Public health’s primary role in medical care is making sure that people who need it most complete these steps.

Syphilis rates in the United States have been rising sharply for a decade. In 2023, King County, Washington began actively promoting doxyPEP: prescribing a single dose of the antibiotic doxycycline that patients can take within 72 hours of unprotected sex to prevent bacterial sexually transmitted infections. The intervention is recommended for men who have sex with men and transgender women who have sex with men, the populations at highest risk.

A study published last week in Clinical Infectious Diseases assessed the two years after doxyPEP was introduced in King County. Syphilis cases fell by 52.3% overall, an absolute reduction of more than 3,000 cases. Cases fell among cisgender women as well, likely through an indirect effect: As transmission declined in high-risk groups, it declined in their broader sexual networks, too.

The CDC also just released its provisional tuberculosis data for 2025. Cases declined slightly from 10,395 to 10,260, a 1% drop. Cases had been increasing for four straight years, a reversal of the CDC’s long-standing progress toward eliminating domestic TB transmission.

TB demands more from the health system than almost any other infectious disease, because it requires specialized testing and prolonged treatment. Diagnosis is often delayed, because the symptoms are burdensome but not debilitating, and most cases occur in immigrants and other groups that have limited access to high-quality medical care. Treatment requires months of strict adherence to multiple antibiotics. For this reason, most TB care is either provided directly by public health agencies or monitored closely by them.

I am worried that the United States will not be able to sustain this decline. Much of the progress against TB elimination in the United States has come from sustained investment in domestic public health services and in global TB control, both of which have been cut dramatically in the past year.

What these findings have in common

Tobacco control, flu vaccination, doxyPEP, and TB treatment sit at different levels of the public health hierarchy of interventions, but they share a common feature: None of them happened spontaneously. They required sustained government investment, functioning public health agencies, and the political will to keep at it year after year even when the gains seem small and the benefits invisible to the naked eye.

Until next week,

Jay

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

U.S. scientists sequence 1,000 genomes from measles, a disease long eliminated with vaccines

2026-04-02T19:08:46+00:00

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This week, the Centers for Disease Control and Prevention posted online its first large tranche of advanced genetic data from measles viruses spreading last year. Scientists with knowledge of the operation expect the agency to post heaps more in weeks to come, revealing whether the United States has lost its hard-won measles elimination status.

The CDC withheld the data for months as a team hit hard by mass layoffs and resignations sorted through the information. But now that scientists at the agency have posted their first batch of whole measles genomes — the genetic blueprint of the viruses — the rest should “start flowing more smoothly at a more rapid cadence,” said Kristian Andersen, an evolutionary virologist at the Scripps Research Institute who isn’t involved with the CDC’s effort but is following it.

The CDC did not answer queries from KFF Health News on its timeline for publishing measles data or analyses. However, once all the data is public, researchers can run quick initial analyses that will signal whether outbreaks across the United States last year resulted from the continuous spread of the disease between states, rather than separate introductions from abroad.

If there was continuous transmission for a year, that means the United States has lost its status as a country that has eliminated measles. That status, which the United States has held since 2000, reflects a country’s vaccination rates: Two doses of the measles-mumps-rubella vaccine prevent most infections and so stop outbreaks from growing.

More careful analyses take weeks.

“We should see a report in April,” Andersen said, “assuming no political interference.”

This is the first time that the United States has applied sophisticated genomic techniques to measles, which largely disappeared from the country a quarter-century ago because of broad vaccine uptake.

Declining vaccination rates, misinformation, and the Trump administration’s budget cuts and lagging response to outbreaks have fueled a resurgence of the disease. With at least 2,285 cases in 44 states, 2025 was the worst year for measles in more than three decades. This year is on track to surpass that, with 1,575 cases as of late March.

While welcoming the science, researchers say the government’s top priority should be to stop the virus from spreading.

“I think it’s incredibly important to do whole genome sequencing for outbreaks,” Andersen said, “but we shouldn’t need to do this for measles in the first place, because we have an extremely effective and safe vaccine.”

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

“That we’re even talking about this is nuts,” he added.

Health and Human Services Secretary Robert F. Kennedy Jr. and other government officials should sound an alarm about measles’ comeback and launch nationwide vaccine campaigns, said Rekha Lakshmanan, executive director of The Immunization Partnership, a nonprofit in Houston that advocates for vaccine access.

“I applaud the science,” she said, “but the more urgent need is to get measles under control as quickly as possible.”

Top officials have instead downplayed the seriousness of the disease, and false notions about vaccines have been granted new life in Kennedy’s CDC. This includes abrupt changes to vaccine information on CDC websites that medical associations say aren’t based on evidence and endanger lives.

Kennedy continues to promote unproven remedies that could mislead parents into believing that they can avoid vaccines without consequence. On the Joe Rogan Experience podcast in late February, Kennedy spoke at length about measures to improve America’s health but didn’t mention vaccines. He said preventive measures could entail “holistic medicine, or take vitamins, or take vitamin D, which is, as you know, it’s kind of miraculous.”

“The risk of measles remains low for most of the United States,” HHS spokesperson Emily Hilliard wrote. “CDC has made $8.5 million available to address measles response activities in seven jurisdictions experiencing outbreaks,” she wrote. “The CDC, HHS principles, and the secretary have been vocal that the MMR vaccine is the best way to protect yourself against measles.”

Genomic data hold clues to outbreak spread

In December, the CDC enlisted the help of one of the country’s leading centers for virus sequencing, the Broad Institute in Cambridge, Massachusetts. Major outbreaks in Texas, Utah, and South Carolina had been fueled by the same type of measles virus, labeled D8-9171. But since that type also circulates in Canada and Mexico, researchers need more data to discern whether it spread among states or entered the United States multiple times.

Whole genome sequencing provides that information because viruses evolve over time. The measles virus acquires a mutation every two to four transmissions between people, said Bronwyn MacInnis, director of pathogen surveillance at the Broad.

“There is enough signal in this data to tease apart questions at hand,” MacInnis said, “the main one being sustained transmission within this country.”

MacInnis’ team worked overtime to sequence the entire genomes of inactivated measles viruses that had been collected from states in 2025 and 2026.

“We’ve done about 1,000 samples and delivered the genome data back to the CDC,” sending it on a rolling basis since December, MacInnis said. “This is the CDC’s data to publish.”

The CDC didn’t post a single one of those genomes until late March, when eight appeared on a public database hosted by the National Center for Biotechnology Information. By Wednesday, an additional 154 had gone online.

“It should be on NCBI within a couple of weeks of being produced,” Andersen said, “and certainly not take longer than a month when you have an active outbreak.”

Dora Nabatanzi, a molecular biologist at the Broad Institute in Cambridge, Massachusetts, prepares chemicals needed to sequence the genomes of measles viruses.

Genomic data hold clues about how outbreaks start and spread. It allows researchers to develop tests, treatments, and vaccines — and detect variants that might evade them.

Such data was critical in the Covid pandemic. Chinese and Australian scientists posted the first SARS-CoV-2 genome online on Jan. 10, 2020, within a week of sequencing it. “It definitely shouldn’t take the CDC months,” said Eddie Holmes, the Australian virologist who helped publish the first coronavirus sequence.

One reason for the delay is that the CDC’s measles lab has been sorely understaffed amid mass layoffs and other turmoil at the agency over the past year, a CDC scientist told KFF Health News. Another reason, the researcher added, is a learning curve: The CDC and health departments haven’t needed to sequence hundreds of whole measles genomes before now. (KFF Health News agreed not to identify the scientist, who feared retaliation.)

In contrast with the CDC, the Utah Public Health Lab has shared measles genomes rapidly. Most of some 970 measles genomes posted online since Jan. 1, 2025, were sequenced by the state, hailing from Utah, Arizona, South Carolina, and other states willing to share them.

“We’ve only got a handful of samples from Texas that were collected kind of in the middle of their outbreak,” said Kelly Oakeson, a genomics researcher at the Utah Department of Health and Human Services. The genomes of the Texas and Utah measles viruses are similar but distinct, Oakeson said, meaning that intermediate versions of the virus are missing.

If the genetic code of viruses collected late in the Texas outbreak are a closer match to those from Utah’s, that will suggest that spread was continuous and the country has lost its measles-free status. The hundreds of genome sequences still sitting at the CDC probably hold the answer.

Evaluation of U.S. measles status delayed till November

The CDC expected to finish its analysis before April, said Daniel Salas, executive manager of the immunization program at the Pan American Health Organization, which works with the World Health Organization. That’s when PAHO was slated to evaluate the United States’ measles status.

He said PAHO delayed its evaluation until the organization’s annual meeting in November, partly because the CDC needed more time to do the genomic analysis and partly because the measles status of Mexico, Bolivia, and other countries is also under review, and holding staggered meetings for each country is inefficient.

The United States is the only country using whole genome sequencing to answer the elimination question, Salas said. Typically, countries classify measles viruses according to a tiny snippet of genes, then assume that large outbreaks caused by the same type are linked. Whole genomes provide a more accurate view.

CDC outbreak models warn about underreporting in S.C. measles outbreak

“If the U.S. can fill in the blanks with genomic data, that’s a sort of breakthrough,” Salas said. “That doesn’t mean other countries are going to be able to pull off this kind of analysis,” he added. “It takes a lot of specialized knowledge and resources.”

Equipment to sequence and analyze genomes costs upward of $100,000, and the cost to process each sample, including paying the researchers involved, typically ranges from $100 to $500 per sequence.

“I’m pro-science, but we shouldn’t have to do this,” said Theresa McCarthy Flynn, president of the North Carolina Pediatrics Society. “We don’t have to have a measles epidemic.”

Flynn said she regularly fields questions from parents concerned by misinformation spread by Kennedy and anti-vaccine groups, including the one he founded before joining the Trump administration. Parents have also pointed to changes in the CDC’s recommendations and to its websites that are at odds with the scientific consensus.

Before Kennedy took the helm, a CDC website said “Vaccines do not cause autism” in prominent type, and listed several large studies in premier scientific journals that refuted a link between vaccines and developmental disorders.

Last year, the website shifted to saying, “Studies supporting a link have been ignored by health authorities.” The high-quality studies were replaced with a report from a single investigator who has ties to anti-vaccine groups.

In an email to KFF Health News, Hilliard echoed the altered website’s claims about vaccines, disregarding extensive studies on the topic.

Flynn, of the pediatrics association, said, “The CDC itself is spreading misinformation about vaccines. I cannot overstate the seriousness of this.”

Although the acting director of the CDC, Jay Bhattacharya, says vaccines are the best way to prevent measles, he too has undermined vaccine policy. He said the controversial January decision to reduce the number of vaccines recommended to children was based on “gold standard science.” Hilliard wrote that the updated schedule was “aligning U.S. guidance with international norms.”

In fact, the new schedule makes the United States an outlier among peer nations.

A federal court temporarily invalidated the change last month in a lawsuit brought by the American Academy of Pediatrics and other groups.

Bhattacharya hasn’t held briefings with the public or the press on the surge of measles this year or activated the CDC’s emergency capabilities.

“Normally, we’d have a big push to get vaccination rates up in areas where it’s low. We’d do a big social media push, put out ads on getting vaccinated,” said another CDC scientist whom KFF Health News agreed not to identify, because of fears of retaliation. “People at the CDC want to do this, but political leadership at the agency has not allowed the CDC to do it.”

Further, the Trump administration’s cuts and delays to public health funds have made it hard for local health officials to protect communities. Philip Huang, director at Dallas County Health and Human Services in Texas, said the department lost over $4 million when the administration clawed back about $11 billion from health departments early last year as a measles outbreak surged in the state.

“We lost 27 staff and had to cancel over 20 of our community vaccination efforts, including to schools identified as having low vaccination rates,” he said. “There are simultaneous attacks on immunizations that are making our jobs harder.”

This story has been updated to include comments from Department of Health and Human Services spokesperson Emily Hilliard.

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

Iran war threatens systems that keep drinking water flowing in Gulf

2026-04-02T11:00:00+00:00

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Hello from Watamu.

I’m spending a few days on Kenya’s sunny Swahili coast with family and a few friends (it’s an easy one-hour flight from Nairobi). A highlight so far has been a sunset trip on an old wooden dhow, the sailing boats that merchants have plied the Indian Ocean with for over a thousand years.

This week’s newsletter, like last week’s, circles back to some of the biggest geopolitical crises shaping global health right now. We’ll look at more effects from conflict in Iran, the medical consequences of a fuel blockade on Cuba, along with a few other stories on broader global health funding and treaties.

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

What happens if the water stops flowing

The ongoing Iran war is leaving a lot of industry at risk. Like oil and fertilizer production, global shipping, and even (as we discussed last week) medicine. But an interview in Think Global Health last week highlights what is arguably the most vulnerable piece of infrastructure: the plants that turn seawater into drinking water.

It’s a fact that Arabian Gulf nations depend more on desalination than anywhere else on Earth. In total, they produce between “45% to 50%” of the world’s desalinated water. It’s a necessity in a broader Middle East that has “6% of the world’s population but less than 2% of renewable fresh water.”

That water, as the article notes, “underpins households, hospitals, schools, hygiene, and sanitation services.” And several early attacks and threats on desalination plants are raising alarms.

The article breaks down how Iran has accused “the United States of attacking a freshwater desalination plant on Qeshm Island,” Bahrain has said that “Iranian drone strikes damaged one of the country’s 103 desalination plants,” and “after President Donald Trump threatened to obliterate Iran’s power plants, [Iranian leadership] vowed to retaliate against Gulf water and energy facilities.”

And on Monday, Trump escalated further, threatening to blow up “possibly all desalinization [sic] plants” in Iran if no peace deal is reached.

Now to be clear, the vast majority of the desalination plants in the Arabian Gulf are currently unharmed. But the story, and taking seriously the threats that the war could spiral toward these systems, has me wondering: How bad could it get if this war starts knocking desalination offline?

To discuss, I reached out to Peter Gleick of the Pacific Institute, one of the world’s leading water resource experts, and Kaveh Madani, director of the United Nations University Institute for Water, Environment and Health, and a former senior Iranian policymaker. The conversations were grim.

“If major desalination plants are attacked and damaged,” Gleick said, “there will very quickly be serious ramifications for public health,” with the worst effects in “countries with the greatest dependence on desalination for public supply, especially Qatar, Bahrain, and Kuwait.”

The issue isn’t just the fragility of these systems, Gleick says. It’s that for many nations, there is no real Plan B if they are destroyed. “Very few nations that rely on desalination have sufficient storage or backup alternatives if those plants were to be attacked,” he says. The logical alternative is groundwater, which has “long been seriously overpumped and overdrafted,” and is now “limited, typically of lower quality, and often not easily accessed in the volumes and locations that would be needed.”

Madani was largely in agreement, and said that generally speaking, “the smaller the state, the more vulnerable it is in this situation.” In countries like Bahrain, where 103 desalination plants provide more than 90% of drinking water for the population of 1.6 million, “in some cases the smaller states have only a few days or few weeks of water reserves” available if those plants are forced offline.

And Madani said some of the most important risks are still being overlooked. For example, “to put a desalination plant out of service, you don’t have to directly attack it,” he said. A power blackout can cripple these systems just as effectively as a bomb.

“And another risk we don’t hear much about is water quality disruption,” Madani said. Few environmental disasters rival a major oil spill. If the conflict leads to more “oil tankers being sunk or attacked,” the resulting spills will contaminate coastal waters and could force desalination plants offline.

Together, the experts I spoke with had a few clear takeaways: First, this conflict must change future water supply planning. Many Gulf nations’ reliance on a small number of massive desalination plants creates an enormous vulnerability. As Gleick put it, the best way to reduce that risk in the future will be to sacrifice some of the efficiency of those large systems and build “smaller, decentralized, and redundant systems,” instead.

And of course, the rising threats to these facilities are also a reminder that drinking water systems are protected under international law. Under the Geneva Conventions, deliberately attacking civilian water systems (which is being actively threatened by both American and Iranian leaders) can constitute a war crime.

Stranded cholera aid

Last week we discussed how the Iran war is scrambling the movement of some global medicines.

This week a Reuters report shows those consequences already bubbling up. Cholera aid for countries across Africa is now snarled in the disruption.

According to the article, “emergency cholera medical supplies for several African countries have become stuck in a logistical quagmire," with vital “stocks stranded in Dubai warehouses.”

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. It largely spreads through water contaminated with feces, and thrives where basic sanitation has broken down. (Think conflict or flooding.) Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The timing here matters quite a lot. Cholera is a waterborne disease that often surges during rainy seasons. In some high-risk countries like Sudan and Chad, those rains begin around May.

What’s stuck? The supplies in Dubai warehouses are essentially “mini field hospitals … with rehydration treatments, as well as chlorine to treat sewage and drinking water to prevent further spread.”

The good news is that the cholera situation on the continent is no longer as dire as last year, so this delay is less catastrophic than it might have been even just a few months ago. Last year I reported on how Africa was facing “the worst cholera outbreak in a quarter-century, with cases surging in countries as disparate as Sudan, Burundi, and Angola.” But Reuters reports that “so far in 2026, the number of cases is down by about 50% versus 2025.”

Still, progress on cholera can reverse quickly without a sustained medical response. As one World Health Organization official told Reuters, "We’re talking [about] an explosive disease … If you don’t have the time or the resources to control it in a matter of days or even hours, you would have an extreme contamination."

The Global Fund: doing more with less

(Fair warning. We’re about to dive back into some well-trodden Checkup territory: the wonderfully boring budgeting mechanics of global health finance.)

According to an early report of several background sources in Devex, the Global Fund (the international organization that bankrolls over $11 billion in programs fighting AIDS, tuberculosis, and malaria in more than 100 countries) is being tapped to play an increasingly important role in stabilizing global health programs after last year’s funding shortfall.

As one advocate told the outlet, “Everyone now looks to the Global Fund to ensure the continuity of critical health services.”

At least rhetorically, even U.S. officials are boosting the Global Fund. Jeremy Lewin, the senior State Department official tasked with foreign assistance, has called the Global Fund a “critical partner” in advancing the “America First Global Health Strategy.” (For reference, Lewin has been notably critical of international aid organizations; casting the United States as “suckers of the global system for so long.”)

The report describes a few early examples of this dynamic. In several U.S.–Africa bilateral health negotiations, the Global Fund has been asked to join the negotiations to provide technical guidance on programs it supports. Some of those bilateral agreements also purportedly reference its procurement platform, wambo.org, suggesting the United States may increasingly look to the fund to purchase medicines and keep programs running.

What’s my takeaway?

It’s a bit of a surreal moment. As we covered in December, the Global Fund’s latest fundraising round came up nearly $7 billion short of its target (!) and “a quarter less money than the fund received in the previous cycle.” The largest missing chunk of that shortfall was American dollars. If the Devex report is accurate, donor countries like the United States could be increasingly leaning on the fund … even as they cut the money that powers it.

Cuba: no electricity, no health care

Cuba’s fuel crisis is grinding the country’s health system to a halt, according to reporting in The New York Times.

Some background: A tightening U.S. oil blockade (and the sudden loss of Venezuelan oil shipment) has nearly eliminated fuel shipments to the island, triggering rolling, multi-day “nationwide outages.”

The story opens with a vignette that’s really stuck with me over the last few days. Jorge Pérez Álvarez, a 21-year-old Cuban man with a genetic lung disease, survives only because a ventilator keeps him breathing. But power outages keep putting that machine onto a backup battery that’s repeatedly pushed to the brink. And when it dies … he does too.

“His life depends on electricity,” his mother says.

And what does Jorge’s story look like … expanded across an entire health system? (Excuse the length of the following quote, but it really shows how widely the blockade is unraveling basic medical care.)

“Hospitals are canceling surgeries and sending patients home because doctors and nurses can’t commute to work. Clinics are struggling to administer treatments like chemotherapy and dialysis because of power outages. Many ambulances are parked because drivers can’t find gas. Pharmacies are largely empty because the virtually bankrupt state is struggling to buy medicine. Production of medicine has been mostly halted because factories run on diesel. Vaccine makers are searching for ingredients because flights that once carried them are canceled because of a lack of jet fuel. And refrigerated vaccine stocks could soon spoil if the blackouts continue.”

It’s a brutal reality for the people living in Cuba.

What’s the takeaway? Over the weekend, my mind kept wandering back to Jorge (and how his family could possibly cope.) So, for me, the story is a reminder that cold geopolitical decisions always land on real people. Surprisingly, late Monday the New York Times also reported that the United States just allowed a Russian oil tanker to break the blockade, which hopefully keeps Jorge alive.

Stalled pandemic negotiations

We’ll end this week at the WHO headquarters in Geneva, where Health Policy Watch reports the negotiations over the final piece of a global pandemic treaty have stalled.

“A snail would have a faster passage,” the article quips.

The sticking point is one final, unresolved section known as Pathogen Access and Benefit Sharing. Basically an agreement on how countries will share bacteria/virus samples of the next pandemic, and how medicines and tests developed from those samples will be distributed.

At the risk of oversimplifying it, the concern from many poorer countries is a repeat of Covid-19, where these countries found themselves last in line for newly developed tests, vaccines, and treatments. As the article notes, they “want the assurance that if they share [information on the next pandemic], they will be able to benefit from any vaccines, therapeutics, or diagnostics that are developed as a result.”

Meanwhile, several wealthier countries, including “those with powerful pharmaceutical industries … argue that compulsory benefit-sharing will stifle research and development.” And, to put a bit more bluntly, they are also reluctant to lock themselves into binding rules that might limit supply of lifesaving medicines in the future.

So what now?

It’s not clear. Some civil society observers are floating an uncomfortable option: forcing a vote to break the impasse. (Rather than wrapping up the treaty with unanimous consensus among member states.) That could push the agreement forward ahead of the World Health Assembly deadline in May… but it would also risk splitting the fragile consensus behind the pandemic treaty.

I’ll see you next week!

William

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

Leadership disruptions at the CDC endanger American health

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

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

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

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

This week, I’m focused on what happens when we have no one leading public health in the United States. The Centers for Disease Control and Prevention has been effectively leaderless since President Donald Trump took office again, with vaccine policy mired in legal confusion and states fighting to keep funds they were promised.

Leaderless at CDC, and no easy fix in sight

The CDC still has no permanent director, and news outlets are reporting that the administration is struggling to find a suitable candidate.

The Trump administration’s only Senate-confirmed CDC director, Susan Monarez, lasted less than a month before she was fired by Health and Human Services Secretary Robert F. Kennedy Jr. for refusing to support vaccine policy changes in August 2025. She was subsequently replaced with political operatives until, on February 18, 2026, the administration announced that health economist Jay Bhattacharya, who is already the Senate-confirmed director of the National Institutes of Health, would serve as acting CDC director. This unusual and, frankly, absurd situation is time-limited by law, but there are bureaucratic tricks that could allow the White House to extend this situation almost indefinitely.

According to multiple reports, the White House has been considering at least three candidates — former Kentucky Gov. Ernie Fletcher, Mississippi state health officer Daniel Edney, and Johns Hopkins cardiologist Joseph Marine — but is struggling to settle on a nominee. Why? Politicians use a tactic known as triangulation when they need to make policy between competing and opposing factions. But are there any individuals in America with sufficient health qualifications who can triangulate between the groups most closely invested in the CDC director appointment?

First there is Kennedy’s Make America Healthy Again base, which views the CDC as “corrupt” and wants the agency to withdraw most, if not all, routine childhood vaccine recommendations. Second, there is the Senate committee that has to approve the nominee and has disparate views on how much reform is actually needed at the CDC. And, finally, there is the health community — professional societies, leading academic voices, and patient advocates — which desperately wants a return to the cautious administrative and scientific processes that made the CDC the most well-respected public health agency in the world.

The absence of steady, qualified leadership has torn the agency apart. The New York Times recently published an oral history of the CDC under the Trump administration drawn from interviews with 43 current and former employees. The remarkably poignant, sad story echoes everything I’ve heard from my former friends and colleagues: political appointees issuing orders without attributing the decision to any one leader or title, scientists told to communicate only verbally on sensitive topics to avoid any digital trail of deliberations, career staff taking phone calls outside out of fear that spyware on their computers is recording them.

The CDC and its parent agency HHS have long been considered a great place for federal employees to work, having ranked in the top five best federal agencies for workforce since 2016, according to the Federal Viewpoint Survey. This year, the administration refused to conduct that study, and an outside group (the Partnership for Public Service) stepped in to replicate it. They found that HHS now scores 20.4 out of 100, among the lowest of any large federal agency. Fewer than 3% of HHS employees report that Kennedy’s political team generates high levels of motivation.

On Wednesday, Bhattacharya held an all-hands meeting with CDC staff. Friends and colleagues of mine appreciated that he made statements that others in HHS have not, such as acknowledging the value of CDC employees, recognizing the challenges (a shooting!) they have had to endure, and pledging to address some workforce uncertainty, such as remote working agreements. They were not won over, however, by his inability to articulate what trust in public health and the CDC means and how he and this administration are working to strengthen it.

What does a new CDC director actually need to do?

If the administration nominates a candidate, I think there are three critical issues the nominee should be judged by.

First, what is their vision for the nation’s public health agency, and how will they restore purpose and direction to an agency that has been defamed and degraded? A complex science and policy organization like the CDC cannot function without clear and steady leadership. Career scientists need to understand how to prioritize their time, who has authority over what decisions, and how much they can communicate with the public.

Second, how will they bring order and scientific rigor back to vaccine policy? CDC vaccine policy has become an issue for the courts. In a lawsuit filed by the American Academy of Pediatrics, a federal judge in Boston temporarily blocked Kennedy’s January overhaul of the childhood vaccine schedule and stayed the appointments of 13 members of the Advisory Committee on Immunization Practices, ruling that Kennedy likely violated the Administrative Procedure Act. The judge noted that only six of the ACIP’s 15 panelists appeared to have any meaningful experience in vaccines, despite a legal mandate that they do.

In response to the ruling, the CDC canceled the ACIP meetings that had been scheduled for March. The former ACIP vice chair, Robert Malone, announced he is done with the committee entirely, citing, without any hint of self-reflection, "drama.” The United States now has no functioning vaccine advisory committee, and states, clinicians, and parents have no clarity about what the nationally recommended vaccine schedule is. The AAP lawsuit that produced the March 16 ruling could reach the Supreme Court before the year is out. A new CDC director needs to take a principled stand on returning to the evidence-based decision-making processes that have historically governed the CDC’s vaccine recommendations.

Third, will the new CDC director commit to restoring funding to state and local health departments? This is where the damage from the past year is most direct and most immediate. State and local governments are directly responsible, under the Constitution, for protecting the health of the American people. The Trump administration has sought to terminate CDC grants to states run by Democratic governors, including California, Colorado, Illinois, and Minnesota. In Illinois alone, the cuts would eliminate more than $100 million supporting local health departments, HIV programs, and chronic disease surveillance.

While a federal judge temporarily blocked the terminations, it is unclear what their long-term fate is and whether states are able to hire staff, purchase equipment, or do activities with these funds until the decision is resolved. A new CDC director must commit to restoring federal funding to all states, regardless of their partisan voting patterns.

Anyone nominated to be CDC director must be asked, clearly and publicly, what they intend to do about each of those problems. The Senate confirmation process exists for exactly this purpose. As of March 27, the measles case count is at 1,654, over two-thirds of last year’s total in less than three months, and outbreaks around the country continue unabated. The resurgence of once eliminated diseases are the unfortunate but predictable consequence of a year without functioning CDC leadership.

Until next week,

Jay

No new measles cases in South Carolina for a week, but CDC outbreak models warn about underreporting

2026-03-27T09:00:00+00:00

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For the first time since South Carolina’s record-breaking measles outbreak began last fall, the state has gone a full week without health officials learning of any new cases.

It’s an encouraging sign that the outbreak – which has 997 documented cases – may be nearing its end. However a report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, raises questions about how many measles infections have been going unreported.

“There are likely some undocumented cases of measles in the affected region, raising the risk of spread to other populations in the region or nearby regions,” according to the March 3 risk assessment from the CDC’s Center for Forecasting and Outbreak Analytics.

@healthbeatnews
Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
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The assessment says the extent of this underreporting is among several key uncertainties in predicting the future of the largest U.S. measles outbreak in decades.

Before the outbreak can be declared over, there must be a period of 42 days with no new cases – an important sign that chains of transmission of the virus have been broken. The last day of the outbreak would be April 26 if no more cases are reported, Dr. Linda Bell, South Carolina’s state epidemiologist, said Wednesday.

“We remain concerned about the possibility of unrecognized measles transmission, and we remain vigilant in monitoring any potential cases and spread,” Bell said.

State health officials worry spring break travel will spread measles as infections rise across the U.S.

Bell noted that the CDC’s modeling report was completed three weeks ago.

“Since that time, our measles case reports have continued to decline, our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” Bell told Healthbeat.

Tests of wastewater in the outbreak area are not detecting measles, nor is there any sign from people going to emergency departments for measles-like symptoms, she said.

CDC officials did not grant interviews, and the agency’s written statements did not answer Healthbeat’s questions about information in the agency’s measles outbreak forecast report for South Carolina.

Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, said he thinks the state health department is using the best data it has available in its announcements last Friday and again Tuesday that no new measles cases had been reported.

“I think it’s very unlikely we’re at zero,” Thorpe said. “One of the really challenging, frustrating things about measles is that there absolutely can be cases we don’t catch, mild cases in particular.”

The last time South Carolina’s health department reported zero measles cases was on Tuesday, Nov. 4, when the outbreak had just 34 cases. But by Friday, Nov. 7, a case was reported, department records show. State health officials provide case number updates only on Tuesdays and Fridays.

Thorpe said he continues to be concerned about the upcoming spring break travel period increasing measles cases in the area. Many schools in Spartanburg County, where the outbreak is centered, are scheduled to be off for spring break during April 6-10.

It’s a concern Bell has previously expressed as well. South Carolina’s outbreak surged after the winter holiday break period.

‘Inconsistent’ or ‘sub-optimal’ compliance with isolation, quarantine

Outbreak modeling teams at the CDC have produced three “outbreak scenario” assessments for the South Carolina measles outbreak, the first on Jan. 2, plus two updates on Jan. 20 and March 3.

“Throughout the outbreak, our assessment consistently indicated that a larger outbreak, lasting at least six months, with some spread beyond the affected community, is the most likely outcome,” the agency’s outbreak modelers said in a March 6 web post that detailed their assessments.

The South Carolina outbreak was first identified in early October with five known cases.

As of early March, the CDC modelers said positive signs for the outbreak were that the rate of new cases was declining and that there were zero or minimal cases “outside of the affected community in the affected region” and that exposure settings affecting the “general population” had become limited or infrequent. Another positive sign: The number of households, schools, churches, and health care facilities with ongoing measles transmission was limited – a significant improvement from mid- to late January when the outbreak surged.

But in addition to concerns about the likelihood of some underreporting of measles cases, the CDC modelers also wrote that compliance with stay-at-home recommendations by infected and exposed people was “sub-optimal or inconsistent,” and that there had only been low to moderate immunization with the measles-mumps-rubella (MMR) vaccine among unvaccinated people in the area.

“Currently, there is no evidence that unvaccinated residents of the affected region are receiving MMR vaccine in high enough numbers to substantially reduce transmission,” the CDC report said.

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

However, Bell, who is leading South Carolina’s outbreak response, credits increased measles vaccination in recent months as a key reason the number of new measles cases being identified has slowed to a trickle throughout March and to zero reported in the past week. She said that in addition to people who got vaccinated, it is important to also consider that the nearly 1,000 people sickened with measles in the outbreak also acquired protective immunity to the virus through their infections. “That is a very risky way to get immunity,” she said.

“I should also add that our disease containment strategies, our investigation of cases while they’re infectious, and making sure that people remain in isolation, and making sure that people have guidance about being in quarantine, also contributes to preventing ongoing transmission in communities,” Bell said.

CDC forecasts note ‘close-knit’ low-vaccination community

The CDC modelers noted that Spartanburg County, where the outbreak has been concentrated, “is home to a large, close-knit community of about 15,000 people with low vaccination coverage,” and that in schools countywide, just 88.9% of students are vaccinated against measles, compared to a statewide average of 93.7%.

To stop measles from spreading within communities, 95% of the population needs to be vaccinated.

Neither the CDC nor South Carolina’s state health department would identify the “close-knit” community referenced in the CDC outbreak modeling assessments. However state health officials have previously acknowledged outbreak cases and multiple exposure incidents at Slavic-language churches whose members speak Ukrainian and Russian, as well as schools serving students from those communities.

Vaccine hesitancy among Ukrainian and Russian-speaking communities in the United States has been fueled in part by historic distrust of the former Soviet government and its health system, health officials in other states have found.

The CDC’s outbreak assessment updated on March 3 says that the “size of close-knit communities with low vaccination coverage” in the outbreak area, as well as their level of connection to other similar communities across South Carolina is a key uncertainty in predicting the outbreak’s future path.

The assessment notes that much is unknown about the extent of measles vaccination coverage in the region, “particularly among close-knit, under-vaccinated communities.” Use of school vaccination data can be used to help estimate community-wide immunization rates, the report said, but rates vary widely in the region.

Some of South Carolina’s earliest known outbreak cases and exposures involved Global Academy of South Carolina, a public charter school in Spartanburg whose founders are Ukrainian immigrants. Only 21% of Global Academy’s students were up-to-date on their school vaccinations, according to state data.

The Way of Truth Church in Inman, S.C., was identified as the location of a measles exposure incident in early November.

One church, Way of Truth Church in Inman, S.C., was identified as the location of an outbreak exposure incident in early November that resulted in at least 30 measles infections during the weeks that followed, according to state outbreak updates. Over the Christmas holiday period, multiple Slavic churches were associated with measles cases and exposure incidents, according to state outbreak updates. School and church officials have declined or not responded to past interview requests.

‘Intrusion into your life’ when families seek care for measles

Another key uncertainty impacting the future of the outbreak, according to the CDC outbreak modelers, is how quickly people who are experiencing measles symptoms or who have been exposed get tested and seek health care.

The report says “avoidance of testing or health care could give the impression that transmission is slowing when that is not the case.”

The CDC outbreak modelers are not alone in their concern about underreporting of measles cases in the South Carolina outbreak.

Dr. Robin LaCroix, a pediatric infectious disease specialist with Prisma Health, one of the major health systems treating measles cases in South Carolina’s Upstate outbreak area, said earlier this month that underreporting is a “big concern.” LaCroix noted the potential “intrusion” of public health investigations after health care providers notify health officials, as required, about measles cases.

“I think that we have captured only a fraction of the people who have become infected with measles because if you were not ill enough to seek medical care, you are never captured in the numbers that are reported, “ LaCroix told the Why Should I Trust You podcast.

“When you began to see what happened when you sought medical care – you had a call from the DPH, who wanted to know everywhere you had been for the four days before you became ill, or your child became ill, and there was a lot of intrusion into your life and activities related to that,” said LaCroix.

In addition, she said, an infected child’s school also would get reported to public health and other unvaccinated children who were exposed would be sent home for 21 days of quarantine.

“There were big community consequences around coming forward that my child has measles, and so then you open yourself up for again some ostracization within the community, that you caused us to have to send all of our children home. So I do think that there is an underreporting,” LaCroix said.

Prisma Health spokesperson Tammie Epps said LaCroix was unavailable for an interview with Healthbeat.

While Bell said she remains concerned that there may be some unrecognized measles cases, if they are out there and aren’t seeking medical care, she doesn’t think there are currently many because there are no signs of them in wastewater testing and other surveillance systems.

“We don’t see indications there are large numbers of unrecognized measles cases because people are self-isolating,” she said.

“No surveillance system captures 100% of cases,” Bell said, “but with a highly infectious disease like measles, if ongoing transmission were occurring from many unreported cases, it is more likely to be detected by at least one of these means in addition to provider reporting.”

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

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

How the Iran war is disrupting the world’s medicine supplies

2026-03-26T11:00:00+00:00

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Hello from Nairobi.

This week we start with a reminder that the world’s conflicts rarely stay confined to the map. The Iran war is scrambling medical supply chains globally, because the Persian Gulf is not just an energy chokepoint but a critical transit hub for pharmaceuticals.

That said … we’re feeling the energy squeeze, too! Rumors of fuel rationing started circulating in Nairobi early this week, which was enough to send me out late at night to fill up my tank just in case.

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

The Iran war is a drug shipping fiasco

The starkest warning yet of how the Iran war could scramble global health comes from this must-read analysis in Think Global Health. The short version: The war is choking the movement of medicines around the world.

To be clear, it’s not that the Persian Gulf countries (like Saudi Arabia, Qatar, and the United Arab Emirates) are major drug producers. They’re not. It’s that these countries form “a critical pharmaceutical transit hub,” where drugs and their basic ingredients from India, Europe, and China routinely pass before heading to Africa, Asia, and the United States.

For reference, this is a region whose “pharmaceutical industry is worth $23.7 billion,” but where roughly 80% of that trade depends on medicines or pharmaceutical ingredients passing through.

And right now both ways these medicines largely transit, the sea shipping lane in the Strait of Hormuz and the Persian Gulf’s giant cargo airports, are badly disrupted. Shipping has dropped “90% below pre-war levels,” while air cargo capacity has fallen by “79% in the Gulf region.”

Where will the shocks be felt first?

I reached out to one of the authors, Prashant Yadav at the Council on Foreign Relations, who is a leading expert on global health care supply chains to ask.

Right now the biggest risk is cold-chain medicines, which he writes are “vaccines, insulin, biologics, and cancer therapies” with “short shelf lives” that have to move quickly and stay within a tight temperature range; largely “between 2°C and 8°C,” 35-46°F.

Most cold-chain medicines move by air cargo, Yadav told me, and airlines cannot simply add new capacity overnight if those routes stay disrupted. Even over the medium term, “I don’t think European airlines, or the two major African ones that have stepped in, will enhance their cargo carrying capacity by buying new planes just because this may continue for a few more months,” he said.

When shipments of these drugs are held up, those medicines can spoil. And even when they don’t, delays multiply. As the article notes, cargo carriers “need a week and a half to catch up for every week that air shipments are suspended.”

Also at risk is helium supplies, a gas that is “an essential input for cooling the magnetic resonance imaging (MRI) machines used worldwide for [over 95 million] medical scans,” each year. Qatar alone produces a third of the world’s helium. And the threat is not just constraints from the transit fiasco, but physical damage to the industry, including Iran’s March 18 attack on a major helium production site in Qatar.

Yadav believes we will ultimately see some “supply impact for MRI helium,” but exactly how severe it may become is too hard to untangle right now. Much will depend on how long Qatar’s production remains offline and how exactly limited supplies are allocated between industries, like semiconductor manufacturing (which is an enormous use for the gas).

Perhaps unexpectedly, the war has also put medical research under threat. Yadav’s article describes how the Gulf region was in the middle of a clinical trial boom, driven by “the area’s high chronic-disease prevalence and its lenient regulations allowing for fast-tracked trials,” and that supply chain chaos could interrupt ongoing trials.

The good news is that, for now, "short-term risks of drug shortages are low in most countries,” Yadav writes. But that’s because of “inventory buffers” that governments and pharmaceutical companies keep around the world. But those cushions are temporary. If shipping and air freight disruptions drag on, shortages will eventually work their way through the system.

I also asked Yadav whether the war could trigger a price squeeze for medicines made with petroleum products, which is more than you might think. “Most of our medicines have some kind of a chemical precursor, and a very significant portion of those chemical precursors are petrochemical derivatives,” he said. (For example, acetaminophen and ibuprofen are made using an oil-based chemical called propylene.)

But Yadav says, for now, that’s not a major concern. The petrochemical ingredients in something like a pill of ibuprofen only make up only around 5% of the cost, with the rest tied up in processing and manufacturing.

But other cost implications are coming fast. A combination of rerouted flights, rising air-cargo rates, and surging insurance premiums for ships mean that moving medicines are more expensive everywhere. And at least one supply chain logistics firm says that, “consumers could see drug costs affected within four to six weeks.”

Yadav’s article ends with a clear policy warning. Governments may need to temporarily loosen certain import regulations so medicines can move through alternate routes. Longer term, he says the world needs something bigger: a standing G20 coordination system that tracks where medicines are stuck and helps countries respond before shortages hit.

A rare campus outbreak

The UK is facing an outbreak of meningococcal disease among university students in Kent, which is in England’s southeast. It has already killed two people, the BBC reports. The outbreak has drawn serious attention in British media, because while the disease is rare, it strikes with a fairly shocking speed and quickly becomes deadly.

Disease breakdown: Meningococcal disease is an illness caused by a bacteria called Neisseria meningitidis. It spreads through respiratory droplets, similar to Covid, and often starts with flu-like symptoms, followed by patients developing a distinct red and purple rash. It is largely preventable through vaccination, and can be treated with antibiotics, although it can leave survivors with permanent disabilities. Confusingly, outbreaks are sometimes referred to more broadly as “meningitis” in mass media, which is a condition that refers to the often-deadly inflammation of the tissues surrounding the brain and spinal cord.

A Scientific American report on the situation framed the outbreak as a reminder of why vaccination programs matter. William Schaffner, an infectious disease physician at Vanderbilt University Medical Center, told Scientific American that “this outbreak is a very unusual event,” and underscored “how routine, comprehensive vaccination has had a profound effect on really dramatically reducing the occurrence of what was once an extreme, ordinarily feared infection.”

Reading that, my immediate question was if the UK outbreak might portend something broader: like a smaller equivalent of the measles resurgence, where slipping vaccination coverage is allowing outbreaks to return?

Ultimately, that seems unlikely. The Kent outbreak was caused by a rarer strain of meningococcal disease known as strain B. While many children are routinely vaccinated against it, vaccine boosters for strain B are often offered only selectively in places like the UK and United States because cases are so uncommon. That means the gap that appears on college campuses is usually not missed shots but fading protection as immunity wanes over time.

I also reached out to Schaffner directly, who told me that “the outbreak in Kent does not portend similar outbreaks elsewhere.” He emphasized that the disease holds “very little risk to the general public for two reasons,” he said. First, because it needs close, repeated contact to spread. The illness spreads “most readily amongst semi-confined populations such as university students” who share classrooms, dorms, and nightlife, he said. (The epicenter of this spread is believed to have been a bar).

Second, containment is relatively straightforward. In Kent, “the public health response has been brisk and comprehensive,” he said, with health officials quickly giving antibiotics to people who may have been exposed.

Vaccine side effects (... good ones!)

A senior infectious disease reporter I follow, Helen Branswell, just published an interesting article in STAT News that sits somewhere between op-ed and straight news. She walks readers through vaccine by vaccine to explain a simple but often overlooked point: Immunization programs rarely benefit just one person against one pathogen.

Pure speculation on my part, but I’m imagining this story originated as a sort of professional self-care for a veteran health reporter. After watching the maddening vaccine debate circle the bowl of conspiracy-land too many times, maybe you just need to reset the conversation. Anyhow, I’m here for it!

I won’t walk through the whole list here, but three examples really jumped out to me:

Rubella vaccination in kids has essentially eliminated a once-devastating birth defect in mothers that left many babies “deaf, blind, or with developmental delays.”

The meningitis vaccine has helped decimate gonorrhea infections, with surprising studies suggesting the shot offers about a “30% to 40%” spillover protection against the sexually transmitted infection.

And Human Papillomavirus vaccination has turned into what one expert called “one of the most elegant herd immunity stories that we have” in public health, reducing several cancer rates broadly… even in men who were never the original targets of the vaccine program.

Argentina, out of the WHO

Argentina has finally made good on its year-old promise to withdraw from the World Health Organization, Al Jazeera reports. It is the second country to ever do so, after the United States. It may sound symbolic, but the move cuts off Argentina from the United Nations agency which (as we’ve covered extensively) “monitors health trends, tracks disease, promotes health care access, and trains medical providers.”

So why’d they do it?

Argentina’s President Javier Milei has framed the move as a matter of national “sovereignty,” criticizing the WHO’s “health advice during the Covid-19 pandemic,” and saying Argentina will pursue “international cooperation in health through bilateral agreements” instead.

Do those arguments sound familiar? They should, as both the criticisms and the shift toward bilateral deals echo the exact complaints and policies we’ve heard from the Trump administration. So, it’s clearly Argentina’s model.

Not to quibble, but it’s worth noting one key point: The WHO does not control countries’ health policies, and its Covid-19 recommendations were never strong-armed on Argentina. It is an advisory body. (Just ask Sweden, or Argentina’s neighbor Uruguay).

My takeaway? Ultimately, unless this move somehow triggers further exits, I’m not seeing it as a dramatic new fracture in global health cooperation. It’s another aftershock of far-right domestic politics that have been spilling into health policy since 2025.

Secret jungle medical school

Let’s finish this week with a remarkable story from The Guardian, which followed a group of nursing students in Myanmar who just graduated from a “secret jungle school” of medicine built during the country’s civil war.

The background: After the military coup in 2021 destroyed large parts of the public health system, an underground network of clinics emerged. This “parallel secret health system” surfaced to treat injured pro-democracy fighters and “those who cannot risk government-controlled hospitals or who live in the vast areas of the country which are outside the regime’s control.”

Eventually, the effort expanded beyond treating patients to training the next generation of nurses. One nursing teacher “contacted colleagues in the U.K., and together nurses in Myanmar and Britain arranged video masterclasses,” for a full curriculum.

All told, “dozens of international academics recorded lectures for the 58 modules needed to cover Myanmar’s curriculum, and “the Phoenix Bachelor of Nursing Science” degree was born.

The article describes how lectures were “smuggled on memory sticks across the country,” and how the students completed their training under extraordinary conditions: like studying in remote classrooms while dodging drone surveillance and airstrikes. As one organizer put it, “safety is never guaranteed.” Another described bombs landing “right next to the classroom.”

It’s a powerful read, and the new graduates say the program represents something larger than medical training. “The name Phoenix itself is powerful for us. It symbolizes rising from the ashes of the destruction the coup has caused … We are the living proof that education and hope cannot be extinguished by violence.”

I’ll see you next week!

William

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

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

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

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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

How to win the war of narratives in global public health

2026-03-19T11:00:00+00:00

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

Hello from Nairobi.

This week we start with an incisive essay on how global public health might win back the narrative war around vaccines, trust, and misinformation. After that, well… let me just say that I really do try to take the “global” in global health seriously. I know that the United States is not the center of the world.

But several of the most important stories I’m tracking follow the health consequences of Trump administration policies playing out across Africa, the Caribbean, and Iran. So, buckle up for a red, white, and blue edition.

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

Global public health can win the narrative war

Measles is having a comeback. Vaccine skepticism is rising. And during the global pandemic, millions quickly turned against even basic public health protections. It’s pretty clear that somewhere along the way, public health started losing the narrative war.

The question is, how does the field fight back?

That’s the focus of a fascinating essay by Steve Hamill in Health Policy Watch, one which I haven’t been able to stop thinking about since I read it. Hamill is a senior marketing and comms executive at Vital Strategies, which is a nonprofit focused on global disease prevention.

Part of the problem, Hamill argues, is that for decades public health officials worldwide assumed that rational arguments, data, and scientific evidence would be enough to persuade the public. (And hey, for a time, it was!) But the era of institutional trust “dominated by elite opinion makers driving consensus” is over, he writes. And now, as we face a media landscape “driven by algorithms, influencers, and coordinated narrative warfare,” public health must take a new approach. And that includes borrowing several, highly effective tactics from public health’s worst detractors.

I reached out to Hamill about his essay, and we discussed what the field needs to do differently to win back trust and attention.

In our conversation, Hamill pointed to two realities about the modern media environment that ring especially true to me. One is that “we’re in an era of AI slop, where authenticity and trust in who the messenger is now matters even more than the message.” The other is that many persuadable people increasingly form their views about public health by “following culture, not evidence.”

Accepting those realities means recognizing that the battleground for public health is much less likely to be found in press conferences or government PSAs … and more likely to be found on TikTok, YouTube, or the broader “content creator sector.” And that, Hamill argues, is exactly where public health agencies need to start showing up.

Thankfully, Hamill says that engaging in this ecosystem is actually easier than ever. As advertisers have poured money into influencer marketing this decade, “the content creator sector has become much more formalized,” he says. Today, there are several platforms (like CreatorIQ, for example) that can connect public health agencies directly with a stable of appropriate influencers, at scale.

Now, you might ask: Will YouTubers deliver perfectly calibrated public health messages, the way officials might hope? Of course not. But Hamill argues that perfection isn’t the point. More important is that “we have to trust imperfect messengers who have social capital in the communities that we’re seeking to reach,” he says.

That gets to another of Hamill’s points: Public health organizations worldwide must begin staffing the experts and allocating the budgets needed to compete in this new media environment.

Specifically, that means staffing public health institutions worldwide with staff excelling in “public relations, community engagement, advertising and paid media, digital media production,” among other technical expertise, he says. For a field where “communications is rarely seen as a strategic competency,” that would be an enormous shift.

Hamill’s last point is that, offline, public health must stop broadcasting messages from the top down and start working through trusted voices inside communities. A major effort should be focused on “finding people in the communities that believe in the information that we are trying to propagate and working with them to give them the resources to bring that to scale within their community,” he says.

In many ways, this mirrors a key tactic of the MAHA movement: identifying communities that already share a concern and amplifying those voices until they dominate the conversation. The difference is that Hamill argues public health should use that same approach in service of accurate information and public good.

And crucially, he argues, these voices are in the majority. “There are more moms who are scared that their kids are going to go to school with unvaccinated people than there are moms who are scared that the vaccine is going to give their kid autism,” he says.

A battle over Cuban doctors

The Trump administration has been ratcheting up a pressure campaign on one of Cuba’s most valuable exports: doctors.

Guyana and Jamaica just announced that they will pull the Cuban doctors from their countries this year, the Miami Herald reports.

What’s the context here?

For decades, the Cuban government has sent hundreds of thousands of medical workers abroad through state-run medical missions. These programs have operated across the world but are particularly critical in parts of the neighboring Caribbean, where you can find Cuban clinicians staffing everything from hospitals to rural health clinics. Today, the program has more than 24,000 doctors working in 56 countries worldwide.

Why is the United States concerned about these doctors? Money.

Governments hosting Cuban medical missions typically pay Havana directly, with the Cuban state then passing along only a portion of the salary to the doctors. While the Trump administration is framing the issue partly about “labor exploitation” of the doctors, most observers see the campaign as an attempt to squeeze one of the (financially beleaguered) Cuban government’s most reliable sources of foreign currency.

Last year, the Trump administration began leaning hard on the foreign governments hosting Cuban doctors, threatening to cancel visas for anyone working with or supporting the Cuban programs, alongside other consequences. And the threats are working beyond just Jamaica and Guyana. Honduras also cancelled its program this year, and Guatemala has begun winding down its mission.

But the health care reality is brutal. As Al Jazeera reported last year:

“For many Caribbean nations, the short-term consequences could be devastating. Training local doctors takes years, and trained professionals often migrate to other countries, leaving behind a persistent shortage.”

That reality prompted unusually blunt pushback from Caribbean leaders. The prime minister of Barbados has called the U.S. pressure “unfair and unjustified,” and the prime minister of Saint Vincent and the Grenadines noted, “I will prefer to lose my visa than to have 60 poor and working people die.”

My takeaway?

The reporting suggests that this is a cold, geopolitical pressure campaign applied with little regard for the health care void it will create. (For example, the threats are not being paired with resources to replace those doctors.)

Two things can be true at once: Cuba’s medical missions may enrich a terrible government in Havana, while the Cuban doctors themselves provide lifesaving care to communities that will be worse off without them.

Black rain in Iran

New Scientist is reporting that recent strikes that set oil facilities ablaze near Iran’s capital, Tehran, have produced an unsettling phenomenon: black rain.

These “catastrophic scenes have raised concerns about threats to civilian health in Iran,” with “local people complain[ing] of their throats aching and their eyes burning.”

What exactly is black rain? It’s a byproduct of rain falling through heavily polluted air. Or, as Stanford University atmospheric scientist Mark Jacobson told me, it’s rain drops “filled with health-damaging, toxic air pollutants.” He says the drops themselves appear black because the concentration of “soot particles is so high in Tehran’s rain that no light penetrates” them, which is a sign of just how polluted the air above the city has become. (Keep in mind, this is a city with a population roughly equal to New York City’s.)

Ultimately, the toxic rain itself isn’t actually the biggest health worry for the city’s residents. As the article notes, “the biggest threat may be the smoke rather than the black rain.”

One researcher quoted in the article put it plainly: “If you get raindrops on your skin, yes, there will be some potentially carcinogenic compounds on your skin, but you can wash that off … but very fine smoke particles in the air can penetrate deep into the lungs and potentially get into the bloodstream.”

A flawed flu forecast

Two weeks ago, we talked about the strange annual ritual behind the flu shot. Which is how each year the World Health Organization tries to predict which flu strains will dominate in the upcoming winter, so that vaccine makers can aim for that educated guess.

Well, the Associated Press is reporting new data that shows that last year’s guess was … a bit of a flop.

U.S. health officials say the 2025 to 2026 flu vaccine was only about “25% to 30% effective” in preventing adults from getting sick enough that they needed to go see a doctor. All told, it was “one of its worst effectiveness rates in more than a decade.” For reference, “officials generally are pleased if a flu vaccine is 40% to 60% effective.”

What went wrong?

Oddly, this is actually a bit of good news. The culprit is exactly what we discussed two weeks ago: a fast-spreading branch of “the H3N2 flu strain,” which experts have already updated in next season’s vaccine. So, the problem has already been patched.

One final takeaway: It’s worth noting that even a mediocre flu shot still matters. In the United States, at least 101 children have died so far this flu season. Of the deaths where vaccination status was reported, about 85% weren’t vaccinated. That’s not a coincidence. As Vanderbilt University vaccine expert William Schaffner told the AP, that flu shot may not stop every infection, “but it can prevent people from becoming severely ill and dying.”

Health aid as a cudgel

Sorry folks, not ending on a happy note this week.

Two weeks ago, we covered the state of the Trump administration’ s new “America First” global health deals in Africa. I had spoken with Dr. Paul Spiegel, who directs Johns Hopkins’ Center for Humanitarian Health, who, as I wrote back then, “warned about turning health aid into what is openly described by Washington as a transactional exchange.”

Well, this week the New York Times published a staggering example of what that approach could look like in practice, in Zambia.

According to a draft State Department memo obtained by the paper, U.S. officials are considering withholding HIV assistance to Zambia unless the country expands access for American companies to its mineral sector. (For reference: Zambia is one of the countries most affected by HIV in Africa, with about 1.3 million people relying on daily treatment supported by the United States’ PEPFAR program.)

Here are two quotes from the memo (prepared for Secretary of State Marco Rubio) that really illuminate just how the officials view lifesaving HIV medicines as a raw, political cudgel.

“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale” … “sharp public cuts to American foreign assistance would significantly demonstrate to aid-receiving countries the seriousness of our interest in collaboration and our insistence on tangible benefits under our America First foreign policy.”

My takeaway? When we spoke with Spiegel, we talked about why transactional aid deals make for fragile and ineffective public health policy. That’s still true. But beyond the practical consequences for individual programs, he also made a broader point about what we lose when we treat lifesaving programs as bargaining chips: the trust and goodwill that once made global health “one of America’s most powerful forms of soft power,” he said.

I’ll see you next week.

William

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

Spring break 2026: Travel season risks spread of measles across U.S., state officials tell Healthbeat

2026-03-19T09:00:00+00:00

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The spring break travel season is underway, with tens of thousands of people every day clogging U.S. airports in their quest for sun, surf, theme parks, big city excitement, and other getaways.

It’s a scene that worries public health officials amid another bad year for measles across the country – and the potential for increased spread of the highly contagious disease during this busy travel period.

“It feels like whack-a-mole right now,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership. “Just as the numbers are dying down in South Carolina, you see this big jump in cases in Utah. Then you see cases starting to pop up in other places across the South.”

State health department officials in multiple states – including California, Utah, Colorado, Georgia, and South Carolina – told Healthbeat they are concerned about spring break travel and the potential for measles to spread within and between states.

Driving those concerns: Spring break is happening with the United States on a trajectory to exceed last year’s record-breaking number of measles infections – the worst since 1992.

This year the Centers for Disease Control and Prevention has already logged 1,362 confirmed cases of measles across the country through mid-March, mostly among unvaccinated children and teens. In less than three months, that’s more than half of the 2,284 measles cases confirmed during all of last year.

Since January, there have been at least 14 new measles outbreaks identified across the country, including in Florida, California, Washington state, Texas, and Colorado. These are in addition to ongoing outbreaks that began last year in South Carolina, Utah, and Arizona. Across the country, 30 states have reported at least one measles case this year, CDC data show.

Measles, which is one of the most contagious viruses for humans, is transmitted through the air when an infected person breathes or coughs. The virus can linger in a room for up to two hours.

The disease is preventable with vaccination. Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Most of those being infected with measles aren’t immunized. Nationwide, about 92% were unvaccinated or had an unknown vaccination status, according to CDC data.

“As vaccination rates have just broadly declined across all these communities, it’s just incredibly hard to stop. And that’s just going to get worse,” Thorpe said. “Short of something crazy happening, we’re absolutely going to blow through what our numbers were for last year.”

The contribution of spring break exposures to these national measles case counts won’t be known for several weeks.

After a susceptible person is exposed to the virus, it can take one to three weeks for them to start falling ill with initial symptoms that may seem like a cold or the flu. By the time the hallmark measles rash appears, they will have been infectious for four days – potentially spreading the virus to even more people.

“Everybody’s on high alert,” said Pat Endsley, president-elect of the National Association of School Nurses.

Top spring break destination Florida is No. 3 for measles

Dr. Rana Alissa, president of the Florida chapter of the American Academy of Pediatrics, told Healthbeat she’s very concerned about the potential for spring break travel to spread measles infections – especially in her home state, which already has measles cases in several communities, plus a large outbreak linked to a university.

Florida – with 116 confirmed measles cases since January – ranks No. 3 in the nation for 2026, behind South Carolina and Utah, which continue to battle outbreaks that began last year, according to the latest CDC data.

“Everyone wants to come to Florida,” Alissa said. “It’s always crowded. Orlando is going to be crazy, Daytona Beach, Clearwater, Miami.”

With these crowds comes an increased risk that some of the people are carrying measles. “It is very scary,” said Alissa, who is advising unvaccinated infants and children, as well as people with weakened immune systems, to avoid crowded areas because of the risk of measles.

Besides a fever and rash, measles can cause serious and sometimes life-threatening complications, including pneumonia and dangerous swelling of the brain, as well as “immune amnesia,” which increases a person’s susceptibility to other diseases in the future. Pregnant women and their babies are also at increased risk of complications from measles.

In addition to being a top state for measles this year, Florida is a perennial spring break hot spot. Cities throughout the state continue to be among the nation’s top spring break destinations, according to 2026 booking data from AAA and Booking.com.

At Tampa International Airport, the spring break travel surge is underway, with about 75,000 to 80,000 passengers a day expected through April 13. The biggest travel day, the airport predicts, will be this coming Sunday, when 90,000 travelers are expected to pass through the airport.

In Orlando, airport officials expect this week to bring some of their highest passenger volumes of the spring break period, with nearly 212,000 passengers arriving and departing last Sunday, plus another 205,000 passengers on Monday.

Florida health department won’t discuss large measles outbreak

Officials with the Florida Department of Health did not answer questions from Healthbeat since March 6 about the risks posed by spring break travel to and from the state, and what kinds of measles prevention and control activities the department is performing.

The department’s top official, Florida Surgeon General Joseph Ladapo, last fall announced plans to end all school-age vaccine requirements in the state, a move that has faced resistance in the legislature. In 2024, during a measles outbreak at a South Florida elementary school, Ladapo sent a letter to parents allowing them to keep sending their unvaccinated children to class, despite their risk of infection.

Most of Florida’s measles cases this year are part of a large outbreak linked to Ave Maria University in southwest Florida’s Collier County, about 35 miles northeast of Naples. At least 98 confirmed and suspected measles cases have been diagnosed in the county through March 7, according to state health department data. Five of those cases were reported during the first week of March, the data indicate.

Despite repeated requests, officials at the Catholic university did not respond to Healthbeat’s questions, including about the current status of the outbreak and any actions being taken to address the potential health impact of the school’s Easter break, scheduled for April 2-6.

Florida’s health department also wouldn’t discuss the university’s outbreak or answer Healthbeat’s questions about other locations in the state where ongoing spread of measles may be occurring, and how many people statewide are in quarantine because of measles exposures. While such information – which doesn’t involve identifying specific patients – is routinely made public in other states, the Florida health department’s media relations team said it was unable to discuss ongoing epidemiological investigations because of state confidentiality statutes.

The department’s data show at least 12 other Florida counties have reported confirmed or probable measles cases since January. They include the Tampa-St. Petersburg area, where six cases have been diagnosed in Pinellas County, and two more in Hillsborough County. In the Jacksonville area, Duval County has reported six cases; in the Pensacola area, Escambia County has identified five cases; and in South Florida, two cases have been diagnosed in Broward County and one in Miami-Dade County .

Concerns about measles extend beyond spring break hot spots

In response to interview requests and questions about rising U.S. measles cases and spring break travel sent earlier this month to the CDC, a spokesperson for the U.S. Department of Health and Human Services emphasized the risk of measles being imported from other countries.

“The risk of measles remains low for most of the United States due to high population-level immunity from MMR vaccination,” press secretary Emily Hilliard said in an email Tuesday night to Healthbeat. “That said, anyone who is not protected against measles is at risk if exposed. Since measles is common in many countries, unvaccinated travelers can bring measles to the United States at any time, and it can spread to other people who are not protected against measles.”

Hilliard said the CDC is supplying technical support and funding to states dealing with outbreaks and that vaccination is the best protection, “especially if you plan to travel internationally or to a place with a measles outbreak.”

While international travel can play a role in U.S. measles cases, according to CDC data, only nine of the 1,362 confirmed U.S. measles cases since January involved international visitors; last year just 25 of the 2,284 confirmed cases were international visitors. In both years, most of the measles cases across the country have involved outbreaks where the virus has spread from person to person within U.S. communities with low vaccination rates, such as those that have occurred in South Carolina, Texas, Arizona, New Mexico and other states.

As a growing number of states are already dealing with measles cases this year, officials at several state health departments expressed concerns about the risks posed by spring break travel.

This year California has had three outbreaks of measles – the first outbreaks in the state since 2020. Some of these California cases are linked to an unvaccinated toddler who had recently traveled to a measles outbreak area in South Carolina.

As of Monday, California has had 29 confirmed cases of measles; two have been hospitalized, according to the California Department of Public Health.

“International or domestic travel during spring break carries a risk of transmitting measles to Californians,” the department said in an email. “CDPH continues to closely monitor measles and to work with medical and public health partners to limit its spread during and after the spring break travel season.”

Georgia Department of Public Health spokesperson Nancy Nydam Shirek said that while people who are not immunized against measles are at high risk any time they are exposed to the virus, “that risk increases if they visit crowded tourist destinations, travel through airports, or go to areas with ongoing measles outbreaks.”

Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Two cases of measles have been reported this year in Georgia. One involved a baby too young to be routinely vaccinated who became infected during international travel. State health officials said they don’t know how the other case, a resident of Bryan County near Savannah, became infected and they cannot rule out unrecognized spread of the virus within the state, Healthbeat reported earlier this month.

In Utah, the spring break travel surge comes at a precarious time in the state’s measles outbreak, which began last year and has resulted in 443 reported infections as of Tuesday.

“What is concerning to me is we are seeing spread of this disease through our entire state,” Dr. Leisha Nolen, Utah’s state epidemiologist, said at a media briefing earlier this month. “For a while it was really limited to the southern part of the state, but it is now expanding, and we are having people diagnosed in every part of our state. And these are not just mild infections.”

Measles infections in Utah have resulted in more than 120 people going to emergency rooms, 31 needing to be admitted overnight, and three needing treatment in an intensive care unit, she said.

While the disease has spread in a variety of settings, Utah officials said cases involving school activities are noteworthy.

“We have definitely seen people get infected with measles from wrestling events, from dance-drill teams and from basketball. So we really encourage people to protect their children,” she said. “The measles vaccine is the best thing to protect your child. It is how we can stop this infection.”

In Colorado, where as of Monday 11 cases of measles have been identified along with multiple locations where infectious people potentially exposed others, state health officials said they are working to raise public awareness through media campaigns and provider webinars. The department also is doing direct outreach to families whose children are overdue for their MMR vaccines. In 2025 and 2026, this outreach resulted in 48% of the contacted families getting their children immunized, the department said.

South Carolina shows how holiday breaks can fuel outbreaks

“Measles is spread very easily to anyone who is susceptible,” said Dr. Linda Bell, state epidemiologist in South Carolina, where officials worry spring break travel could reignite an outbreak that has sickened nearly 1,000 people since last fall.

The outbreak has slowed to a trickle in recent weeks. After months of tracking cases, quarantining exposed people, and urging vaccination, the state health department announced Tuesday just one new measles case, bringing the total to four cases identified in the past week.

“The risk of spread is increased by the number of people exposed,” Bell said, “so things like air travel and people visiting tourist attractions during holiday breaks are a concern.”

It’s a risk South Carolina officials watched play out in mid-January, when measles cases surged to hundreds of cases a week after the winter holiday break period where gatherings with families and friends fueled the spread of the disease – not only within South Carolina, but to other states. The department’s measles control efforts were further hampered because outbreak investigators couldn’t get contact information from schools during winter break closures, delaying the quarantine of exposed students, an issue the department is trying to fix for spring break.

As infected South Carolina residents traveled the country during the winter break period, internal health department records show they exposed others to measles at travel convenience stores in Georgia and Florida, at a hotel and a youth conference in Kentucky, and at a hospital and a hotel in Florida, Healthbeat revealed last month.

Many schools in Spartanburg County, the epicenter of South Carolina’s outbreak, are scheduled to close for spring break the week of April 6-10.

State officials remain concerned there could be another surge in cases.

“It is far too early for us to let our guard down,” Bell said Wednesday. “We will see what happens with spring break.”

The problem is there are still many more unvaccinated people in South Carolina and across the country for the virus to infect.

To stop measles from spreading within local communities, 95% of the population needs to be vaccinated. But in most states, statewide vaccination rates among kindergartners have fallen below that “herd immunity” level, according to CDC data. And even where vaccination rates may seem high on a statewide or countywide level, pockets of unvaccinated children and adults within localized communities can still fuel outbreaks, experts said.

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

How ICE and hospitals are failing at infection control

2026-03-18T12:26:06+00:00

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

In the past week, I have been alarmed by the number of infectious disease outbreaks occurring at Immigration and Customs Enforcement detention facilities while the Trump administration is planning to expand their size even more.

It is not just ICE that is failing in infection control: A new survey reveals hospitals are under-investing as well. And we have interesting new data on a topic I covered a few weeks ago — longevity, or the science of living larger — and a further reminder that medications and tests are less important than who and what we surround ourselves with.

Infectious diseases spreading at ICE detention facilities

Elected officials in Maryland recently sent a letter to the U.S. General Services Administration raising alarm about Legionella bacteria detected in the water systems of the George H. Fallon Federal Building in downtown Baltimore.

Legionella is a waterborne bacteria that causes a severe pneumonia (known as Legionnaires’ disease) when contaminated water vapor is inhaled. It thrives in poorly maintained plumbing and ventilation systems and can be fatal, particularly for older adults and immunocompromised individuals, as happened in a large 2025 New York City Legionnaires disease outbreak.

The Fallon building houses an ICE regional office and detention holding rooms. According to the letter from two U.S. senators and seven House members, testing in November found Legionella bacteria in the building’s water system and contamination persists despite hyperchlorination treatment.

The lawmakers report that detainees are being held in overcrowded conditions for far longer than temporary holding rooms are designed to accommodate and that insufficient action is being taken to prevent an outbreak.

Unfortunately, Legionella is only the latest dangerous respiratory pathogen found at ICE facilities nationwide.

In early March, ICE confirmed that there have been, at least, 14 cases of measles at its largest detention facility: Camp East Montana, a tent city located on the Fort Bliss Army base in El Paso, Texas. An additional 112 people have been either quarantined or isolated. Four additional cases have also been diagnosed in the surrounding El Paso community.

Tuberculosis cases have been reported at ICE facilities in Alaska, California, Arizona, Colorado, Washington, and New York over the past year. Just like measles, TB spreads through the air, and outbreaks occur in precisely the conditions ICE facilities create: crowding, poor ventilation, and incomplete screening and testing.

Federal standards require that people be screened for TB within 12 hours of intake, but government investigators have found that is not always happening. Detainees with positive screening are often moved to solitary confinement, but these rooms lack the air filtration and ventilation needed to keep measles virus or TB bacteria from spreading outside a single room.

None of this should be a surprise. A 2021 study in JAMA documented over 2,600 cases of influenza, chickenpox, and mumps between 2017 and 2020 at 22 ICE facilities, including one with a varicella (chickenpox) outbreak that ran for 33 consecutive months. Another study published last October analyzed data about 20 ICE facilities from 2019 to 2023, and found 2,035 influenza cases, 486 hepatitis A cases, and 252 mumps cases across 128 separate outbreaks.

The authors’ recommendations were fairly basic: Reduce crowding, vaccinate detainees and staff against preventable infections, and improve infection control, such as air filtration and ventilation.

As ICE has dramatically expanded detention from roughly 39,000 detainees at the end of the Biden administration to more than 75,000 today, the conditions for outbreaks have worsened proportionally. Crowding intensifies transmission risk, and interfacility transfers seed infections across the system.

The administration is now planning to build even larger facilities. ICE’s “Detention Reengineering Initiative” calls for consolidating hundreds of facilities into approximately 34 regional mega-centers. One is planned for Social Circle, Georgia‚ a small city that would see its population nearly triple. The facility is projected to hold between 7,500 and 10,000 detainees for stays of roughly 60 days.

As the size of these facilities grows, the possibility of further illness and death from infectious diseases grows dramatically. Will ICE learn the lessons from the past few years about preventing measles, TB, and other respiratory infections in their facilities? I’m not, ahem, holding my breath.

Infection control also lagging in hospitals

Any indoor setting that brings a large number of people together in close proximity can lead to an infectious disease outbreak. Hospitals are particularly risky, because they bring two populations close together: people who have a high likelihood of already having an infectious disease and people who are highly susceptible, due to immune suppression or other issues, of becoming severely ill if they are exposed to an infectious disease. This is why federal and state regulations require hospitals to invest in infection control personnel, systems, and equipment.

Unfortunately, a new survey published in February by Infection Control Today reveals how badly hospitals continue to fall short. Infection preventionists are specialized professionals who track and stop pathogen transmission inside health care facilities. The survey found they are overwhelmed with problems to address, while simultaneously lacking the resources and authority to address those problems. According to one respondent, “Without investment, [hospital leaders] will only see the consequences when the patient impacts are already significant, and the costs are high.”

As with ICE facilities, the solutions are not complicated: increased staffing, increased authority and stature of infection prevention staff within leadership, and modernized technology to improve detection and response. Hospital-acquired infections cost the health care system billions annually, many times more than what prevention costs. Infection prevention in facilities, as in the broader community, needs to be framed as an investment, rather than a cost.

Your frenemies may be killing you

A few weeks back, I wrote about challenges with the field of longevity, but I wish I had been able to highlight a study that was just published in the Proceedings of the National Academy of Sciences. We all know toxic relationships - a colleague who undermines you or a family member who keeps score and makes your life worse. But is it possible they are also making you die sooner?

That is the intriguing hypothesis that a research team at New York University set out to test. Using a representative sample of more than 2,300 adults in Indiana, they studied what they called “hasslers”: people in your close social network who “occasionally or often” caused problems or made their life difficult in some way. Nearly 60% of people had at least one.

To measure aging, the researchers used DNA methylation, tiny chemical changes in the genome that accumulate predictably over a lifetime and may be read as a biological clock. Each additional hassler was associated with approximately 1.5% faster biological aging per year, the equivalent of roughly nine months of added biological age. People with more hasslers also had worse self-rated health, more anxiety and depression, and greater rates of cardiovascular disease and diabetes.

One finding I found particularly striking was that the most damaging relationships were not the purely hostile ones, but ambivalent ones, i.e., people who provide both support and stress. It’s easy to identify and exit entirely negative relationships. The ambivalent ones keep you close, keep you invested, and keep the stress going.

While I have some doubts about whether the biochemical changes measured in this study truly measure aging, I am inclined to believe these results, because health — whether it’s preventing infections or living longer — depends far less on medications and tests than on factors outside our body: air, water, food, and the people in our lives.

Until next week,

Jay

Doctors warn of a deadly complication from measles outbreaks

2026-03-13T15:57:15+00:00

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The first sign came when Deepanwita Dasgupta was 5 and started stumbling more while playing at her home in Bangalore in southern India. The girl was always up to something, so her parents figured extra bumps and bruises were just symptoms of an active childhood. Maybe, they thought, it was ill-fitting shoes.

Relatives described the unicorn-loving child as smart, affectionate, and occasionally rascally. Before she learned the alphabet, she had figured out how to find her favorite show, “Blippi,” on a phone. She was known to sneak butter from the fridge to enjoy a few finger licks.

But then her limbs started jerking. A spinal tap revealed measles in her cerebrospinal fluid. The virus she probably had as an infant had secretly made its way to her brain. Now 8 years old, Deepanwita is paralyzed, unable to talk.

Measles causes complications — ranging from diarrhea to death — in 3 in 10 infected people, according to the Infectious Diseases Society of America. Some are immediate, while others take weeks or months to appear. The one Deepanwita is experiencing, subacute sclerosing panencephalitis, or SSPE, typically takes years to rear its head.

“People think, ‘Oh, you know, if we get measles, then we’ll be fine, because I know my neighbor had it and they’re fine,’” said Yasmin Khakoo, who leads the national Child Neurology Society but spoke to KFF Health News in her capacity as a New York City doctor with expertise in neurologic conditions.

South Carolina wants to avoid a spring break measles outbreak surge, enlists school help during closures

Measles, though, can be dangerous: A 7-year-old in South Carolina will have to relearn how to walk after enduring one of the more immediate complications, brain swelling. And every so often, the virus plants a ticking time bomb in the nervous system. A person can recover from measles and continue life as usual, no longer contagious and without any identifiable symptoms — sometimes for a decade or more — before problems appear. While some patients end up severely disabled for a while, Khakoo said, the condition is almost always fatal.

Before the advent of widespread and effective vaccines, the complication occurred enough in the United States that in the 1960s a doctor created a national registry of SSPE patients. Researchers now estimate about 1 in 10,000 people who get measles will develop SSPE, but the risk is significantly higher for those who contract measles before age 5. Populous nations where the virus is endemic, including India, see cases routinely.

Now, doctors and researchers fear that as vaccination rates drop and measles spreads in the United States, cases of this debilitating complication will also rise here. Since the start of 2025, the Centers for Disease Control and Prevention has recorded over 3,500 measles cases — more than in the entire preceding decade — mostly people who were unvaccinated. Many were children. Last year, Connecticut doctors diagnosed a 6-year-old with SSPE, and in California, a school-age child who’d had measles as an infant died of it.

“We are likely to see SSPE cases going forward, especially if we don’t get this under control,” said Adam Ratner, a member of the American Academy of Pediatrics’ Committee on Infectious Diseases and author of the book "Booster Shots."

Concern about SSPE was great enough that in January, the Child Neurology Society published a video to educate U.S. clinicians about the condition, and doctors who have seen such cases are warning their peers.

“We don’t have a way of knowing who’s going to get it, and we don’t have a way of very effectively treating it,” said Aaron Nelson, a professor of neurology with the New York University Grossman School of Medicine. “The one best thing that we can do, ideally, is to prevent children from having to go through it in the first place.”

The recommended two-dose measles vaccine slashes an exposed person’s risk of getting the contagious virus from 90% to 3% — and thus reduces the chance of SSPE. The vaccines carry small risks of febrile seizure and a bleeding condition, but measles itself has a higher risk of causing both.

Researchers find some missed SSPE cases

A 2017 study of California children who developed SSPE after a measles outbreak there years ago determined that 1 case is diagnosed for about every 1,400 known cases of measles in children under age 5, and 1 for every 600 infected babies.

The researchers also found that, over the years, doctors had missed some cases among patients who had died with undiagnosed neurologic illness.

The possibility that future cases could go undiagnosed spurred Nava Yeganeh and her colleagues to publish a news release in September when a Los Angeles County child died of SSPE.

Deepanwita Dasgupta and her mother, Anindita Dasgupta, celebrate the child’s fifth birthday in 2022.

“We’ve had very few cases of measles in the last 25 years in this country,” said Yeganeh, who is the medical director with the Vaccine Preventable Disease Control Program at the Los Angeles County public health department and has had two patients with SSPE. “Unfortunately, that’s changing, and so we wanted to make sure that everyone was aware of this long-term complication.”

The California child who died had gotten measles as an infant, Yeganeh said, before the child could receive the vaccine. Measles is highly contagious, so at least 95% of the population must be immune to it to protect vulnerable people — including babies too young to vaccinate and people who are immunocompromised — from infection.

“This is an example of someone who did everything right, wanted to protect their child against this infection, and unfortunately ended up losing their child because we didn’t have herd immunity for them,” Yeganeh said.

Shortly after Yeganeh’s group published the news release in California, Nelson was working to get the word out, too.

He had recently seen a 5-year-old whose family had traveled to the United States for medical care after the child started stumbling, jerking, hallucinating about bugs and animals, and having seizures. The child had contracted measles as an infant and had been too young to be vaccinated. Nelson diagnosed the child with SSPE.

“Imagine that: Having a child who is healthy and happy, moving to talking less and less, eventually not able to walk,” Nelson said. “It’s a very sad thing.”

He thought he would encounter the condition only in medical school textbooks, as a relic of the past. Instead, in October he found himself presenting the case at the Child Neurology Society’s national conference and participating in the society’s video about the condition. “I’ve now seen something I shouldn’t have ideally seen ever in my career,” he said.

Warning signs come from India

Globally, the number of measles outbreaks has increased in recent years, and physicians in places including the U.K. and Italy have recently seen clusters of SSPE.

The high human cost of measles’ spread is especially evident in India. While total cases aren’t tracked, about 200 families caring for people with SSPE, including Deepanwita’s, are in a single chat group in the Bangalore area.

In New Delhi, Sheffali Gulati studies SSPE and sees about 10 new patients a year with the condition, what she calls the “delayed echo” of measles outbreaks. The youngest she has seen was 3 years old.

“The ages are coming down, and a death or a vegetative state can develop as soon as in six months to five years of onset,” said Gulati, who leads the pediatric neurology program at the All India Institute of Medical Sciences and until recently led India’s Association of Child Neurology.

Gulati hasn’t found any treatments that reverse SSPE’s course, only some that slow its progress. She’s found herself counseling parents: It’s catastrophic, it’s not their fault, and they can do nothing but accept it.

Deepanwita’s relatives try to find joy where they can. They think they noticed the girl smiling when her favorite cousin called recently. Anindita Dasgupta, her mother, said Deepanwita moves her hands and feet on her own and sometimes turns her head, especially when her father enters the room. The girl communicates with her parents through her eyes and a few sounds.

But it’s far from where she was in 2022: At a cousin’s birthday, a few months before noticeable symptoms started, Deepanwita started the birthday song and sang the loudest.

At her own 8th-birthday gathering last year, Deepanwita, wearing a pink eyelet dress and a nasal tube, could only blink and move her eyes as she sat propped up before two cakes that she would not be able to eat. She can no longer swallow, so her mom dabbed a bit of icing on her tongue.

‘The problem could be solved with vaccination’

Roberto Cattaneo, a molecular biologist at the Mayo Clinic in Rochester, Minnesota, has been studying SSPE for years. He recently used postmortem brain tissue to map how the measles virus can spread from the frontal cortex to colonize the entire brain. Still, he said it’s a “black box” what exactly measles is doing in those dormant years between the initial infection and when the symptoms of neurologic damage crop up.

It’s possible the virus replicates in the brain that whole time, undetected, killing off neurons. But with so many neurons in the human brain — 10 times as many as people living on the planet — the brain may find a way to adjust, Cattaneo said, until finally it can’t anymore.

He’s applying for funding to continue research on the disease and possible treatments, though ultimately, he wishes he didn’t have to. The tools to obliterate the condition already exist.

“The problem could be solved with vaccination,” Cattaneo said. The United States should have no cases of SSPE, he said. “It’s just painful.”

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

South Carolina wants to avoid a spring break measles outbreak surge, enlists school help during closures

2026-03-12T21:28:16+00:00

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Amid concerns that spring break could reignite South Carolina’s measles outbreak, state health officials are trying to avoid a repeat of the communication gaps that delayed measles exposure investigations when schools were closed for winter break.

Healthbeat revealed last month that the South Carolina Department of Public Health was hamstrung in late December in its efforts to quickly warn and quarantine students and staff who had been exposed to measles. The problem: Schools were closed over winter break and they had nobody available to provide contact information to outbreak investigators.

The result was that people who were unaware they were infectious continued to interact with others in the community during the busy winter holiday season. In the weeks that followed, cases of measles surged dramatically and the South Carolina outbreak became one of the largest in decades.

“We are concerned that we may see another surge in cases,” Dr. Linda Bell, South Carolina’s state epidemiologist said. “So we have actually been in contact with schools to work with them more closely, to make sure that we have points of contact.”

Bell said Thursday that the department has sent letters to schools in South Carolina’s 11-county Upstate region asking them to identify a person who will be available during the spring break vacation period – when schools and administrative offices are closed – who can provide school attendance and contact information if it is needed for measles exposure investigations.

Here's how the S.C. measles outbreak grew after the holidays

“We’ve been receiving steady responses from the schools for those points of contact,” she said.

The health department said late Thursday that the letters, which requested contact information by March 10, were sent to all public school superintendents in the Upstate region. Only 11 of the 23 superintendents had supplied contacts as of Thursday. “DPH has previously established contacts at private and charter schools that have been impacted by the outbreak,” the department said.

Of the 993 measles cases recorded since the outbreak was identified in October, 936 have been in Spartanburg County and most of the others in nearby Upstate counties, according to state data. Almost all of those who have been infected were unvaccinated and most have been school-age children and teens.

In recent weeks, the number of new measles cases being reported to the department has slowed to a trickle. On Monday, the health department said just two new cases had been identified since Friday.

In Spartanburg County, spring break is scheduled for April 6-10 for many schools, but dates vary throughout the state.

“We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said. School holiday break periods pose an increased risk for the spread of measles because they often involve people traveling and socializing more.

The winter holiday break was a time of significant spreading of measles in the Spartanburg area.

Between early October – when the outbreak began – and Dec. 22, when Spartanburg County schools closed for winter break, there had been a total of 144 measles cases during the nearly three-month period. Then, in just the three weeks after schools reopened in January, there were more than 500 new cases of measles, state data show.

When Healthbeat asked South Carolina’s health department last month why it hadn’t reached out to schools to have contacts in place before winter break, the department said: “DPH cannot direct school employees to come to work to assist with outbreak investigations.”

Bell on Thursday said the new outreach to schools is an example of the department incorporating lessons learned into its outbreak response. “DPH has made the ability to communicate with school officials who have access to the information needed for case investigation a priority ahead of the upcoming spring break,” she said.

Measles is highly contagious and spreads through the air when an infected person breathes, coughs, or sneezes. The virus can linger in a room for up to two hours after an infectious person has left. Because a person is infectious for four days before the telltale measles rash appears, and initial symptoms may seem like a cold, many people spread the disease before they know they have it.

While two doses of the measles-mumps-rubella vaccine is 97% effective in preventing measles, those who are unvaccinated are at high risk of infection if they are exposed.

Christian school refused to share student information

Based on internal health department records, Healthbeat reported last month that during winter break there were delays quarantining people who had been exposed to measles – just prior to the holiday recess – at three public schools and one private Christian school.

In most cases, the schools were closed and didn’t have anyone available to provide information.

But when outbreak investigators reached Westgate Christian School in Spartanburg, the principal refused to provide information required to ensure those at risk of spreading the disease knew of the need to stay in quarantine, according to a health department warning letter to the school that Healthbeat recently obtained under South Carolina’s public records law.

According to the Jan. 9 letter, Westgate Christian School Principal Gail Grab responded to requests for information about exposed students by sending an email on Dec. 30 that said in part: “We will not provide personal details and immunization status information for the students in our school.”

Then when Grab sent outbreak investigators a list of exposed students on Dec. 31, the only names on it were the siblings of the person who had measles.

The department’s “final warning” letter on Jan. 9 gave the school until 1 p.m. the next day to provide the required information about all students who were had contact with the person with measles or the department would issue a public health order, under which the school could face fines of $1,000 per day for each exposed student’s name left off the list.

“Your continued failure to comply with this lawful demand has significantly impeded DPH’s ability to conduct mandatory case investigation, contact tracing, and quarantine monitoring,” the letter said. “This lack of cooperation places quarantined students, school staff, and the families of your students at increased and unnecessary risk of measles exposure, a highly contagious and serious disease.”

The school did comply before the deadline, Bell said.

Grab did not respond to requests for an interview on Wednesday. Pastor James Wooten, Westgate Christian’s president, replied Wednesday to emailed questions about the letter by saying he was traveling. He previously told Healthbeat that the school thought it had provided all necessary information on Dec. 31. He did not previously disclose that the school’s principal had sent an email refusing to provide required information.

Plans unclear at schools with past delayed measles investigations

Officials at the other three schools where state investigations of measles exposure incidents were delayed during winter break did not answer Healthbeat’s questions Wednesday and Thursday about any changes they have made for the upcoming spring break period.

Mark Robertson, principal at Global Academy of South Carolina, a public charter school where state records show only 21% of students are up-to-date with school immunizations, said he had no comment.

A vaccination rate of 95% is needed in communities to stop the spread of measles.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

Cynthia Robinson, a spokesperson for Spartanburg County School District 6, did not respond to emails and calls on Wednesday and Thursday. Delays investigating measles cases over winter break occurred at the district’s Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on vaccines.

Other schools that had delayed measles exposure investigations over winter break were in Spartanburg County School District 2: Sugar Ridge Elementary, where state data show 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines, also had delays investigating measles exposures during winter break, Healthbeat previously reported.

Adrian Acosta, a District 2 spokesperson, did not answer Healthbeat’s questions about what the district will do differently during spring break to avoid the winter break problems providing health officials with measles contact tracing information.

Acosta first sent a statement saying a district nurse supervisor is available 24/7. Then when asked if this person will be available during the spring break vacation period, Acosta emailed another statement saying school administrators are “always on the job.” Acosta added: “If an administrator knows they will be out of touch or unreachable, then it is expected that they have a communication plan in place.”

But Acosta did not respond to questions about what the district will do differently during spring break to prevent a recurrence of the delays.

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

How new weight-loss drugs may offer hope for curbing addiction

2026-03-12T11:00:00+00:00

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Hello from Nairobi.

Last week was an interesting one for me, as I had the chance to moderate a panel hosted by the French Chamber of Commerce here in Nairobi. I focused on a question I’ve been circling in my reporting for months: As global health aid retreats, who fills the gap? The panel included development experts and health care businesses, all wrestling with how and where the private sector can realistically step in.

On to the news: This week we take a look at an unexpected (and unexplained) benefit of GLP-1 weight-loss drugs, a reality check on artificial intelligence tools hunting down antibiotics, and a few other stories on social media bans, the Iran war, and … a drug trial for turkeys?

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

A shot at fighting addiction

It’s hard to overstate how much GLP-1 drugs like Ozempic have upended weight-loss treatment and sparked an ongoing pharmaceutical gold rush.

Drugmakers are racing to develop ever newer versions of the drugs, and regulators around the world are approving them at an equally rapid clip. (China, for example, just cleared Pfizer’s newest injection Xianweiying last week.) But their explosive popularity aside, what I find most striking about this moment is just how little we actually understand about the ways these drugs affect our bodies and brains.

Take, for example, results from a new study of health records from more than 600,000 patients in the United States. As reported by the Associated Press, patients taking these GLP-1 drugs showed something remarkable and seemingly unrelated to weight loss: lower rates of substance use disorders.

Background: GLP-1 drugs like Mounjaro, Wegovy, and Ozempic mimic a natural hormone that regulates blood sugar and appetite. In general, they influence the body’s hunger and digestion signals, though researchers are still working to understand exactly how these effects unfold in the brain and body. The “GLP-1” name is an abbreviation for the molecule it mimics, which was originally developed as a treatment for diabetes.

The study found that those on the drugs were less likely to develop addictions “to alcohol, nicotine, cocaine, opioids, and other substances” as compared to patients on other diabetes medications. And for patients already struggling with addiction, the drugs were also “linked to lower risks of [addiction-related] hospitalization, overdose, and death.”

What is going on here? Why would a drug designed to control blood sugar and appetite also seem to affect cravings for alcohol, nicotine, or other drugs? To find out, I reached out to two addiction science researchers not involved in the new study to help me parse the connection.

First, the idea that these drugs might affect addiction did not appear overnight, Dr. Joseph Schacht, an addiction scientist at the University of Colorado told me. Animal studies going back to last decade have found that drugs in this class can reduce alcohol consumption. And as millions of people began taking the drugs this decade, similar reports kept surfacing with doctors. “I became interested in this area when a medical colleague told me that some of her patients [taking GLP-1 drugs] for weight loss had reported they found themselves drinking less alcohol and experiencing less craving for it,” he said.

Still, scientists don’t fully understand the basic biology behind “exactly how these drugs affect the brain’s reward pathways,” he said. What we do know is that the brain contains specific docking points for GLP-1 molecules in several regions involved in motivation and craving. “It is possible that GLP-1 [drugs] cross the blood-brain barrier and bind directly,” to those sites, he said. But that’s not actually been proven yet. Another possibility, he said, is that the drugs act elsewhere in the body and send some other signals that ultimately influence how the brain processes cravings. We simply don’t know yet!

I also reached out to Dr. Anna Lembke, an addiction medicine specialist at Stanford University, who said the research raises the possibility of new, preventative therapies.

After all, if these drugs truly quiet the brain signals tied to craving, they might reduce the risk of the disorder developing in the first place. “But lots of questions remain, including whether short- and long-term benefits outweigh the risks, especially when you’re thinking about giving the drug to people who don’t yet have a disorder,” she said.

Still, “addiction is a massive and growing problem across the globe. We need more tools to help combat it. The GLP-1s hold promise for a novel strategy to combat addiction, and we need all the help we can get,” she said.

AI: An antibiotic breakthrough … or dead end?

One issue I keep returning to is a coming crisis in antibiotic resistance: Essentially, existing antibiotics are failing faster than scientists are discovering new ones.

This is both a “today” and “tomorrow” problem. Already, antibiotic resistance is linked to roughly 5 million deaths a year worldwide as routine infections become harder to treat. And if nothing changes, we will eventually reach a failure point where we no longer stop many common infections … with enormous implications for everything from cancer therapies to simple surgeries.

Now, as we’ve covered before, there are reasons to be optimistic. A big one is artificial intelligence, which is speeding up the earliest stages of antibiotic discovery, as covered in a new essay in STAT News. The authors, an antimicrobial researcher and a drug developer, cite a study from last October in which AI tools discovered “hundreds of [new] molecules with promising anti-bacterial activity.”

That said, this essay is not one of optimism.

As the authors write, even as these early leaps in AI dramatically improve new antibiotic discovery, the economic incentives for actually developing them remain heartbreakingly weak. Put simply: “The antibiotic market does not reward innovation — it often punishes it.”

Why? Because the way we use antibiotics makes it extremely difficult for companies to recoup the enormous costs of clinical trials and later-stage development.

Consider that antibiotics are meant to cure infections over a matter of days instead of, say, lucratively managing a chronic disease for years. And because doctors want to slow resistance, the newest drugs are often used sparingly and held in reserve. It’s “a practice known as stewardship”, which “benefits future patients but crushes commercial prospects. Even a truly novel, lifesaving antibiotic will be used sparingly, priced modestly, and ultimately displaced by generics.”

What’s the takeaway? If “no amount of algorithmic brilliance or predictive learning can overcome a business model that guarantees financial failure downstream … only policymakers are empowered to remedy what ails antibiotic R&D,” the authors argue.

They propose a few solutions, including “subscription-style reimbursement models, in which governments pay for access rather than volume,” or lump-sum government payments “that provide predictable returns for truly innovative antibiotics.”

The alternate solution, they say, is watching helplessly as “world-class laboratories … keep generating promising AI-sourced discoveries that end up in the dustbin of academia.”

Two conflicts with hospitals under fire

We have a few updates on two not-so separate crises, in Iran and Gaza.

First, the World Health Organization says at least 13 hospitals and health facilities in Iran have been hit since the U.S. and Israeli bombing campaign began, The Guardian reports. While the WHO has not provided many details (nor attributed blame), Director-General Tedros Ghebreyesus has gone on record to say that “under international humanitarian law, health care must be protected and not attacked.”

Meanwhile, in Israeli-occupied Gaza, Reuters is reporting that “medical supplies [are] running critically low despite Israel’s reopening of a key crossing.” How low? “Supplies of some items such as gauze and needles have already run out,” and “fuel shortages continue to limit hospital operations.” Hospitals without needles and gauze? It’s a fairly condemnable state of affairs, especially considering that there has been a ceasefire for two months now.

What’s the connection? As Reuters is also reporting, “key humanitarian air, sea, and land routes are being constricted ‌by disruption from the [Iran war], delaying life-saving shipments to some of the world’s worst crises,” which includes Gaza. As the report puts, quite pointedly: “Aid to Gaza and Sudan is grinding to a halt and costs are soaring for help to the hundreds of millions suffering hunger crises around the world.” And that we should expect care to get even worse.

The takeaway? Honestly, I’m worried. If the past two years in Gaza have shown anything, it is that the Israeli and American-backed bombing campaign displayed a total disregard for humanitarian protections around hospitals and medical infrastructure.

That record should make the world prepared for the possibility of a similar humanitarian crisis unfolding in Iran’s health care system, if this war escalates.

Share, like, and subscribe to social media bans?

India’s state of Karnataka has become the latest government to move against youth social media use. It just announced a ban on social media platforms for children under 16, Reuters reports. (The tech-hub state is home to 61 million people and the capital city of Bengaluru, widely known as the “Silicon Valley of India.”)

The policy follows similar efforts across the world: Australia recently approved a nationwide social media ban for under-16s, and several European and U.S. jurisdictions are likewise debating or testing age restrictions.

What does the most up-to-date research actually say about the effects of limiting social media? Well, let’s look at two separate ways researchers combine results across lots of studies. (Fair warning: We’re about to go full data-nerd.)

We can start with an “umbrella review” of youth social-media research from 2025, organized by researchers in Canada, Ghana, and Ireland. (An umbrella review is basically a review of reviews, looking across dozens of previous research summaries to see what the field as a whole is finding.) In this case, they looked at 43 reviews that covered over 1,000 papers.

What did they find? Broadly, higher social media use among adolescents is linked with worse mental health outcomes, particularly on depression, anxiety, and other “psychological distress.” But the picture is complex. The harms appear strongest with heavy or “problematic” use (like passive scrolling or addictive behavior), and some studies found clear benefits for teens, including social support and reduced isolation.

It’s also worth looking at a recent “meta-analysis,” which is when researchers pull out data from many separate papers, and then crunch it all together. In a 2025 meta-analysis, Australian researchers combined 10 randomized controlled trials to understand what really happens when people (adolescents and adults) reduce or stop using social media.

The results? They found that people who cut back on social media have a small but statistically significant drop in depressive symptoms. The effect was modest, but research shows that limiting social media use can improve mental health … but reduction in use was about as effective as total abstinence.

(Honestly, together it’s less of a slam dunk case against social media than I would have thought!)

Turkeys on trial

We’ll end this week with a funky story. Scientists in the UK have launched what is essentially one of the world’s first clinical trials on turkeys, the BBC reports.

Researchers will vaccinate thousands of turkeys and monitor them for about six months, in an effort to see whether a new bird-flu vaccine can safely protect the poultry from the virus.

It’s big news for birds, but don’t just take it from me. Here’s an incredible quote from Mark Gorton, the founder of Traditional Norfolk Poultry, which is leading the trial:

“This is probably one of the biggest days in my poultry life and I think this is one step for poultry but one giant step for poultry kind."

So … why turkeys?

Well, chickens are already vaccinated against bird flu in many parts of the world, and France has been vaccinating ducks for several years. But British researchers chose turkeys for this study because they are particularly susceptible to the disease. In other words, if a vaccine can protect a turkey, it’s a pretty good sign it could work for other poultry, too.

And there’s significant money on the line. “Annual bird flu outbreaks cost the UK government and industry up to £174m each year,” or about $230 million. And as Gorton told the BBC, “it could be a huge economic cost to [turkey farmers] if we catch this disease and we have to have all of our birds culled.”

I’ll see you next week!

William

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

When evidence and policy don’t align: Medicaid cuts and a failed cancer test

2026-03-11T11:00:00+00:00

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

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

In this week’s issue, the federal government is finding new ways to cut the programs that keep the sickest and poorest Americans alive, while a celebrated cancer screening test marketed to healthiest and wealthiest just failed its first big trial.

Medicaid under attack

As part of the most recent budget bill passed by Congress (“The One Big Beautiful Bill”), Congress made large cuts to Medicaid, the federal government’s health insurance program for low-income people. Public health experts decried these cuts, because people on Medicaid are also the most likely to have health conditions that require intensive medical care and cause the most overall illness and death without treatment, such as diabetes, coronary artery disease, and HIV.

Unfortunately, the latest news is that federal officials are targeting another way to cut Medicaid: suspending payments to some states over allegations of fraud.

In Minnesota, the Trump administration froze $259 million in Medicaid payments, citing previous instances of fraud in social services programs. To be clear, hundreds of millions of dollars were stolen through state social service programs, and dozens have been convicted. But the recent Medicaid suspension appears intended not to punish those who committed fraud, but to withhold essential medical services to “turn the screws on [Minnesota] a little bit,” according to Vice President JD Vance. The state’s attorney general, Keith Ellison, has sued to restore the funds, calling the freeze “weaponized Medicaid against Minnesota as political punishment,” and Gov. Tim Walz has called it “targeted retribution.”

New York is next up. Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz sent New York Gov. Kathy Hochul a letter demanding information within 30 days or risk deferred payments, citing what he called a “high proportion” of beneficiaries receiving personal care services like bathing, grooming, and meal preparation. New York’s Medicaid program is the most expensive per-enrollee in the country, at $115.6 billion in fiscal year 2025, covering roughly 1 in 3 New Yorkers.

What Oz’s letter omits is that the underlying Medicaid data can be challenging to analyze accurately: It excludes hospital spending, lacks procedure and diagnosis codes, and a single personal care billing code can represent anywhere from 15 minutes to a full day of care.

Government officials must be rigorous stewards of the public’s money. That was one of the first lessons my supervisors taught me when I began working for the Centers for Disease Control and Prevention in 2001. At the same time, I worry that the suspension of Medicaid payments are guided by political animus, rather than fiscal responsibility, and do not consider the immense potential consequences to Americans that depend on Medicaid.

Fraud exists in all sectors, public and private, and public programs must always balance their legitimate interest in minimizing fraud against the real and immediate harms of suspending funding. When it comes to programs that people’s lives literally depend on, such as Medicaid, I believe that the bar for a complete suspension should be extremely high — the evidence incontrovertible, the scope vast — and funding should continue until an investigation clears that bar.

Cutting HIV and other safety net clinical services

The cuts to publicly funded health services, unfortunately, are not just to the larger Medicaid program. A separate federal government program provides HIV care and treatment funding for people who are not covered by other public or private insurance programs. The Ryan White HIV/AIDS Program is the payer of last resort for about 25% of the 1.2 million Americans living with HIV. The Ryan White program covers medications, laboratory monitoring, and related services for people who fall through the gaps of Medicaid and private insurance.

About 18 states have tightened eligibility or cut covered HIV medications under the Ryan White-funded AIDS Drug Assistance Program, with five more considering changes. The starkest example is Florida, home to the largest ADAP in the country. On March 1, Florida cut off more than 16,000 clients, roughly half its caseload, by dropping the income eligibility threshold from 400% of the federal poverty level ($63,840) to 130% ($20,748), and removing Biktarvy, the most prescribed HIV medication in the country, from its formulary.

With HIV, the harms are particularly worrisome. Effective antiretroviral therapy suppresses the virus to undetectable levels, keeping patients healthy and, crucially, making them unable to transmit the virus to others. Interrupting treatment also risks drug resistance that can itself be transmitted. If HIV treatment disruptions push the United States back toward 2018 infection rates, this will mean an estimated 4,500 additional HIV infections and $3.8 billion in lifetime costs.

We are also seeing cuts in other public safety net health care services. Counties and municipalities across the country, such as Los Angeles, are cutting clinical programs from immunizations to sexual health to behavioral health, as federal funding reductions ripple down to local budgets.

When I began leading infectious disease programs for New York City in 2011, we had to drastically cut back our clinic hours and services because of the Great Recession. We hoped that patients would continue to be able to receive some of these services at other facilities — such as federally qualified health centers and the public hospital system — but we also understood there’s a reason it is called a safety net and not a safety blanket: The net has holes that people fall through.

The other long-term consequence of public health agencies cutting their clinics is that they lose a direct connection to the community. It is difficult for people to advocate for public health when most of the work of public health is not visible to them. Clinics are a tangible way for them to see what public health agencies do for them, ensuring that they are more likely to trust public health officials during emergencies, and providing a constituency that will oppose budget cuts in the future.

Update on blood tests for cancer detection

In a previous newsletter, I discussed how companies were marketing blood-based multi-cancer detection tests to consumers who are eager for any way to find cancer early. The results are now in from a large, rigorous clinical trial of the best-known of these tests, called Galleri, developed by a company called Grail. The Galleri test looks for tiny fragments of tumor-associated DNA in the blood and screens for more than 50 types of cancer. The test has been sold in the United States since 2021 for $949, without Food and Drug Administration approval, under a regulatory framework that permits certain laboratory-developed tests to be marketed without prior review.

The company ran a trial in partnership with the UK’s National Health Service on 142,000 healthy adults aged 50 to 77. It was exactly the kind of rigorous, large-scale prospective study that the field needs. The hope was to show a 20% reduction in advanced cancer diagnoses among people who received the test. The study failed to meet that primary endpoint. There was no statistically significant reduction in Stage 3 or Stage 4 cancers in the group that received Galleri testing compared to the control group.

Most experts interpreted this study to mean that the Grail test should not be funded as part of routine cancer screening for adults in either the UK or the United States. That said, I believe there may be benefit to this and similar tests in selected populations, such as those already at higher risk of cancer due to family history or known genetic abnormalities.

The broader lesson here is how we, as a society, decide what to invest in. The evidence is clear that screening for cancer in adults using a blood-based test does not work. The evidence is also clear that cutting Medicaid and HIV services will lead to more sickness and death. How we get policy and practice to align with evidence is the most difficult challenge in public health.

Until next week,

Jay

Controversial federal vaccine advisory committee: Deadline is Thursday to comment on March ACIP meeting

2026-03-09T15:51:20+00:00

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

A controversial federal vaccine advisory committee, which is scheduled to meet next week to discuss Covid-19 vaccine injuries and Long Covid has set a Thursday deadline for the public to submit comments.

The Advisory Committee on Immunization Practices has disclosed few details about its agenda for the meetings on March 18-19 at the Centers for Disease Control and Prevention in Atlanta. The committee was supposed to meet last month, but cancelled its sessions amid an ongoing lawsuit and after failing to post agenda information, as required.

The formal notice for the March meeting published in the Federal Register says the committee’s agenda will include updates on the committee work groups and “discussions on COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology. Recommendation votes may be scheduled for COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology.”

No additional details were provided about these topics and the notice also says that the group’s agenda items “are subject to change as priorities dictate.” The ACIP meeting webpage also did not provide any additional details as of Monday morning.

The public can submit written comments online through the Federal Register meeting notice. Comments must be received by Thursday, the notice says.

The committee will also provide time for members of the public to make oral comments. The notice says: “Oral public comment will occur before any scheduled votes, including all votes relevant to the ACIP’s Affordable Care Act and Vaccines for Children Program roles.” Priority will be given those who file a request to speak at the meeting by Thursday. Details on how to make a request to speak at the meeting are found on the ACIP meeting webpage.

The committee, which meets three times a year, had all of its members replaced last summer by Health and Human Services Secretary Robert F. Kennedy Jr. and has come under fire from major medical professional associations that have said the reconstituted committee has been making changes to vaccine recommendations that lack scientific merit.

An ongoing lawsuit brought by American Academy of Pediatrics and other medical groups over the Trump administration’s vaccine changes has sought to stop ACIP’s next meeting because of concerns the committee will take a vote that will result in removing funding for certain vaccines for children from low-income families or who lack adequate insurance. Several state attorneys general are also suing HHS over recent changes to the childhood and adolescent vaccine schedule.

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

Trump’s cuts to Medicaid threaten services that help disabled people live at home

2026-03-05T16:24:30+00:00

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OTTUMWA, Iowa — Leisa and Kent Walker recently received a disturbing notice: The private company managing their son’s Medicaid coverage intends to cut nearly 40% of what it spends for caregivers who help him live at home instead of in a nursing home.

Sam Walker, 35, has severe autism and other disabilities. He is deaf and cannot speak. Sometimes when he’s frustrated, he hits himself or others.

Medicaid provides about $8,500 a month for health workers who visit his apartment in the basement of his parents’ home. The staffers help him with everyday tasks, including dressing, bathing, and eating. They also take Walker on outings, such as dining at restaurants, volunteering at Goodwill, and exercising at a recreation center or on park trails. They stick to a strict routine, which soothes him.

His parents say that without the in-home services, their son would need to move to a specialized residential facility in another state. Sending him away would break their hearts and cost taxpayers much more money. They strive to keep him home because they know change makes him anxious.

“The last thing I want is to put him into some kind of care facility, where he’ll just get kicked out,” said his mother, Leisa. The Iowa Department of Health and Human Services did not respond to KFF Health News’ questions about the Walkers’ case.

Federal cuts raise pressure on services

Patient advocates say state administrators in Iowa appear to be reining in Medicaid spending by cutting what are known as home and community-based services for people with disabilities, and they’ve heard of multiple families facing battles like the Walkers’.

Disability rights advocates expect the pressure to intensify as states respond to reductions in federal Medicaid funding called for under the Trump administration’s signature tax and spending law, which passed last year.

June Klein-Bacon, CEO of the Brain Injury Association of Iowa, said the cuts and proposed rule changes appear to be part of a quiet attempt to save money in response to the state’s budget deficit and expected reductions in federal Medicaid funding.

Medicaid, jointly financed by the federal and state governments, covers people with low incomes or disabilities. Walker is one of nearly 2 million people served by “Medicaid waiver” programs, which pay for care that allows people with disabilities or who are at least 65 to live at home.

Unlike most parts of Medicaid, waiver programs are optional for states. Idaho’s governor noted that fact in January, when he suggested legislators consider cutting them. Disability rights groups fear other states will do the same. Leaders in Colorado, Missouri, and Nebraska have considered such cuts this year.

Leisa Walker has heard Trump administration officials claim the national Medicaid cuts are intended to reduce waste, fraud, and abuse. That’s not how it will play out, she said. “These are real people, real families, and this causes real suffering when you do this to people,” she said. “It’s a very scary time.”

Iowa Total Care, a private insurance company that manages Sam Walker’s Medicaid benefits, intends to cut his in-home care coverage by about $3,200 per month, his mother said. Company leaders told a judge they are following state officials’ direction, but they did not dispute Leisa Walker’s math.

Walker has been on the waiver program for three decades. It covers assistance from workers known as “direct service providers” — one of whom has been with him for 25 years. His parents receive no pay for the hours they spend caring for him when the aides aren’t working.

On a February morning, Leisa and Kent Walker drove an hour and a half to Des Moines for an appeal hearing. An administrative law judge sat behind a wooden desk in a conference room as the Walkers and their lawyer faced off against three representatives from Iowa Total Care, a subsidiary of the national insurer Centene Corp.

Leisa testified that her son is 6 feet tall and weighs 230 pounds. Although he knows some sign language, he has trouble communicating, she said. When he becomes frustrated or his routine is interrupted, he sometimes wails and hits himself or other people. “It’s devastating to watch,” she testified.

He’s not a bad person, she said. “He doesn’t understand how strong he is.”

She said her family would try to keep his main caregiver employed under the planned Medicaid reduction but would have to drop others who cover nights and weekends. She said no residential facility near their southern Iowa home could address her son’s complicated needs. She said a case manager told her that a Florida facility might be the closest one that could safely handle him.

Leisa Walker testified that the state’s Medicaid program would pay about $22,000 per month to put him in an institution, more than double what the program spends on his home care.

Sam Walker’s longtime psychiatrist, Christopher Okiishi, testified that Walker’s family and their support staff spent years developing a “fragile” but stable existence for him.

Lori Palm, a senior manager for Iowa Total Care, testified that Sam Walker gets about 16 hours of daily assistance financed by Medicaid. Palm said much of that time amounts to “supervision.” She said state officials recently advised her company that the program should pay mainly for “skill-building” time, not supervision.

The Walkers showed the judge a 2018 document in which a previous Iowa Medicaid director stipulated that supervision of people with disabilities is an allowable service for workers paid under the program.

Sam Walker, who is deaf and has severe autism, uses sign language to communicate with his mother, Leisa Walker, at a recreation center in Ottumwa, Iowa.

Judge Rachel Morgan asked the Iowa Total Care representatives if the recent policy change was made in writing by the state Department of Health and Human Services. They said it was not and that they couldn’t specify who at the department had given them the new guidance.

The judge suggested during the hearing that for someone like Sam Walker, learning to regulate emotions could be an important form of skill-building. Three days later, the judge ruled in the Walkers’ favor, writing that the insurer’s attempt to cut care hours was improper. The insurer appealed the decision to the director of the Iowa Department of Health Human Services, who could overrule it. The dispute could eventually wind up in district court.

Iowa Total Care and the state Department of Health and Human Services did not respond to questions about the reports that many other Iowans with disabilities face reductions in care hours covered by Medicaid. Department spokesperson Danielle Sample said in an email that the agency supports home and community-based services, which, she noted, help “states save money by avoiding expensive long-term facility care.”

Spokespeople for the federal Department of Health and Human Services, which oversees Medicaid nationally, did not respond to a request for comment on the issue.

Medicaid waiver programs started in the 1980s, after President Ronald Reagan heard about an Iowa girl with a disability who was forced to live in a hospital for months because Medicaid wouldn’t pay for home care. The Republican president thought it was outrageous that the girl, Katie Beckett, had to live that way, even though home care would have been cheaper.

Members of Congress approved allowing states to use their Medicaid programs to pay for in-home care. But they made the change optional, to offer states flexibility and encourage innovation.

Designating such spending as optional “waiver programs” also made the change more politically palatable, said Kim Musheno, senior director of Medicaid policy for The Arc of the United States, which represents people with intellectual and developmental disabilities.

Prospects were much different for babies born with serious disabilities before the change, Musheno said. “Doctors instructed families to forget they existed, and to put them in an institution.”

Waivers have been cut before

All states have Medicaid waiver programs, but benefits and the number of people covered vary significantly. Applicants often wait months or years to get into the programs because of limited funding. More than 600,000 Americans were on waiting lists or “interest lists” for waiver services in 2025, according to KFF, a health information nonprofit that includes KFF Health News.

Disability rights advocates and care providers have fought for decades to maintain funding for the programs, but a national leader said the threat feels especially severe now.

“When Medicaid is cut, people with disabilities are at the center of the impact,” said Barbara Merrill, CEO of the American Network of Community Outcomes and Resources, which represents agencies that care for people with intellectual disabilities or autism.

That’s what happened after Congress reduced Medicaid funding in 2011, according to a recent paper published by Health Affairs.

States could again rein in waiver programs by limiting enrollment, reducing covered services, or cutting pay for caregivers, who already are in short supply.

However, states that try to cut the in-home care programs could face legal challenges, Musheno said. The U.S. Supreme Court declared in 1999 that people with disabilities have a right to live outside of institutions if possible. The decision, in the case of Olmstead v. L.C., has been cited in lawsuits against states that fail to provide care options apart from nursing homes and similar facilities.

Several Iowans who belong to a Facebook group for Medicaid participants have posted in recent weeks that their families were notified of impending cuts in coverage of home care services for people with disabilities.

Sam Walker’s main caregiver, Andy Koettel, has worked with him since Walker was in fourth grade. Koettel, who works full-time, knows how to keep Walker calm in most situations and soothe him during a blowup. Their relationship took years to build, and it is a key reason Walker can continue to live at home with his parents, Koettel said.

“If I was not there, it would be incredibly difficult for all of them,” he said.

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

‘Maximum disruption, minimal clarity’: How ‘America First’ aid deals are playing out in Africa

2026-03-05T12:00:00+00:00

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Hello from Nairobi.

We’ve begun the long rainy season here (we get two each year), which means three months of brisk mornings and muddy shoes. Unfortunately, an influx of mosquitoes will soon follow. But this city sits at a higher elevation than Denver, Colorado, so the malaria risk is extremely low. (It’s too cool for the parasite to reliably develop inside mosquitoes!)

Today we’ve got a hodgepodge of news: from the fragile state of America’s new health deals in Africa, to a one-pill breakthrough, and the latest chapter in the story of the woman whose cells changed medicine. We’ll close with a story whose comedic headline left me no choice but to include it.

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

America’s health pivot, finally coming into focus

First up: The United States and the Democratic Republic of the Congo “signed a $1.2 billion health partnership” on Feb. 26, the Associated Press reports.

While the full text of the agreement is not public, it’s noteworthy because this is the 19th one-on-one health agreement the United States has signed directly with an African government since dismantling the U.S. Agency for International Development last year.

It also follows news from last week, with Zimbabwe and Zambia backing away from similar deals.

Some background: Generally speaking, these country-by-country agreements are meant to move U.S. health funding away from non-profit aid organizations and United Nations agencies, and into an “America First” framework of direct partnerships with national governments. While these deals represent a dramatic cut in funding from previous years (at least 25%, but potentially more, depending on how many countries end up without deals), the United States nevertheless remains the largest global health donor on paper.

I covered the first of these deals with Kenya back in December (which is still mired in a legal dispute about the data-sharing demands imposed by Washington). But I’ve largely held off on covering the rest.

Why? Because it’s so early and the implementation has been so chaotic that even my sources inside the State Department struggle to explain how these agreements will (or are) functioning in practice.

Thankfully, I was able to speak with Dr. Paul Spiegel, who directs Johns Hopkins’ Center for Humanitarian Health for some much needed context. Few people have a clearer view of how global health systems are actually working in today’s crisis settings, and we discussed what he’s seeing and how to make sense of these deals so far.

I started by asking Spiegel frankly: Are these 19 deals a sign of stabilization from the chaos of 2025? While he acknowledged some upsides (which we’ll get to) his overall assessment of the deals, and the year ahead of us, was grim. “No. I think things are going to get a lot worse before they get better,” he said.

Spiegel described “maximum disruption right now with minimal clarity,” and that reality on the ground for lifesaving aid programs is still chaotic, with supply chains disrupted and local partners unsure whether funding will continue month to month. He blames the rushed transition “from the old architecture to something so new, so quickly,” he said. “In the meantime, so many people are going to die and suffer.”

We also zeroed in on what worries us both most. The new U.S. strategy is publicly built around channeling major funding directly to governments that (at best!) lack robust oversight and, in some cases, rank among the worst globally on corruption. And the admittedly cumbersome bureaucracy that once helped curb fraud, waste, and abuse has been functionally stripped of many of its guardrails. (That said, let me acknowledge that it’s difficult to judge the concrete risks, because so few of the agreements’ terms have been made public.)

Spiegel also warned about turning health aid into what is openly described by Washington as a transactional exchange. Beyond the moral argument that “humanitarian assistance should follow need and evidence,” Spiegel said there is a hard practical reality. These programs take years to build, and when funding becomes contingent on unrelated political demands or can be withdrawn overnight, systems unravel quickly. As we’re seeing now, the human cost is immediate, and rebuilding takes years.

What are the upsides? Spiegel acknowledged a “kernel of truth” behind the new strategy, which requires both parties to pony up funds. For years, he said, donors failed to ensure governments built the capacity to manage their own systems. Requiring countries to put in more of their own money is “hugely necessary.”

This is (no longer) spinal tap

Europe has approved a new and simple oral medicine that may finally help win the fight against sleeping sickness, the AP reports.

Disease breakdown: Human “trypanosomiasis” is a highly fatal parasitic disease that’s spread by blood-sucking tsetse flies. Symptoms start flu-like, but as the parasites multiply and attack the nervous system, victims often find their sleep-wake cycle flipped (hence the illness’ common name). Without medicines, coma and death usually follow. Thankfully, treatments developed in the early 2000s slashed infections from many tens of thousands a year to today, where fewer than 600 cases are reported annually.

The new, single-dose pill is called acoziborole. To understand why it could be a game changer, it helps to understand two things: Why we don’t just have a vaccine, and the limits of the treatments we’ve relied on for two decades.

First, the worm-like sleeping sickness parasite has long evaded vaccine efforts thanks to its tricky and unique ability to alter the makeup of its “skin” (technically, its outer protein layer). This shapeshifting both helps the parasite stay ahead of immune defenses, and creates a frustrating, moving target for a hypothetical vaccine.

Second, current treatments for the illness are burdensome. They “can take 10 days,” and “require difficult trips to hospitals from remote villages,” with many patients needing to “undergo spinal taps to help doctors understand the stage of infections,” and which drugs to treat them with.

Keep in mind, many of the people affected by this illness live in incredibly rural or remote areas in equatorial Africa. So, when your nearest hospital is a 10-hour drive away, and may not even have the diagnostics you need … you can see the issue.

The new pill (technically three medicines compounded together) obviates spinal taps, and is highly effective against the disease at a range of stages. The most recent study found that “95% of treated patients were considered cured 18 months later.”

Granted, one powerful drug is not enough on its own to meet the WHO’s elimination goal for the disease of 2030. Ending sleeping sickness also means continuing to find new cases quickly, reducing the number of infected tsetse flies, and stopping the disease from spreading again through animals.

Still, the pill may be the breakthrough needed to make that deadline.

The immortal settlement(s) of Henrietta Lacks

In 1951, doctors at Johns Hopkins Hospital took cancer cells from Henrietta Lacks, a young Black woman in Baltimore, Maryland. They were taken without her knowledge or consent, and she would die months later.

Those cells, dubbed HeLa (for her name), became the first human cells to be grown indefinitely in a lab. It is a fascinating story, one detailed in Rebecca Skloot’s best-selling book The Immortal Life of Henrietta Lacks. Which, if you have not read it yet, this is your reminder.

Lacks’ cells helped unlock the polio vaccine, advance cancer therapies, and grounded decades of other biomedical research. (There’s an obvious benefit to having a standard set of cells you can use to compare or replicate work in various labs worldwide.) And they are still used today: I actually have a personal friend in the UK whose cancer research right now is entirely underpinned by this woman’s cells.

Why is this relevant today? Some 75 years later, Novartis, the Swiss multinational pharmaceutical company, has settled a lawsuit brought by her estate over the use of those cells, the AP reports.

The terms of the settlement were not disclosed. But the case is part of a broader reckoning over who profits from the scientific discoveries that followed Lacks’ death. While “Johns Hopkins said it never sold or profited from the cell lines … many companies have patented ways of using them,” including Novartis.

The settlement follows another “in 2023, [when] Lacks’ estate reached an undisclosed settlement with the biotechnology company Thermo Fisher Scientific Inc.” And the AP reports that “there are other pending lawsuits by the Lacks estate.”

The flu vaccine’s own annual booster

Every year, the World Health Organization convenes a panel of flu experts to make a high-stakes prediction: which versions of the virus are most likely to dominate next winter. Once the experts make their call, vaccine makers lock in that recipe and get to work.

But … it’s a strange ritual when you think about it. We do not rewrite most vaccines annually.

That’s because unlike most viruses, flu evolves gradually *and* abruptly. Flu doesn’t just slowly accumulate small mutations as it spreads. It can also trade whole chunks of its genetic material when two different strains infect the same person, creating entirely new combinations almost overnight.

That brings us to the news: Last week, the expert panel updated the recipe for the Northern Hemisphere’s 2026 to 2027 flu shots, Health Policy Watch reports. And it’s a fuller reset than usual. (Although like last year, the panel is recommending three different flu variants targeted in each shot.)

The biggest shift is in one of the three targets from last year, the H3N2 strain, where a newer genetic branch has taken over globally. As I’ve covered previously, in these strains, the “H and N numbers refer to the shape of two important proteins on the outside of the virus.” Hemagglutinin, or “H,” helps the virus latch onto cells. Neuraminidase, or “N,” helps it break free and spread.

It’s news worth noting for two reasons. One, “there are around a billion cases of seasonal influenza annually,” so hitting or missing the mark on the vaccine, while a (let’s be honest) boring bureaucratic process, could prevent millions of cases or fail to address tens of thousands of deaths. That is not small stakes.

Second, it’s a reminder of something important. No matter where you live, the flu will touch you, your family, or your workplace this year. And experts are clear: Vaccination remains a safe and effective way to blunt the damage.

I applaud you, headline writers

Ok, ok. Please allow me to end on a story whose incredible headline alone forced its way into this report.

It is: “Chimp urine test study bolsters ‘drunken monkey’ theory,” Reuters reports.

(Right? How could I not include it!?)

What’s the story? Actually, something rather fascinating. Researchers studying wild chimpanzees in Uganda’s Kibale National Park have found evidence supporting the so-called “drunken monkey” hypothesis: the idea that primates, including early human ancestors, may have evolved a taste for alcohol because it helped them find calorie-rich ripe fruit.

In tests of 20 urine samples from chimps, collected from puddles on the forest floor, nearly all contained a metabolic marker of ethanol. This is a compound that both chimps and humans produce after drinking alcohol. Some of the ethanol levels were roughly equivalent to having thrown back a few beers, or a single cocktail.

Narrowly, the findings suggest that at least some chimps, our closest primate relatives, regularly consume naturally fermented fruit and metabolize the alcohol in it. More broadly, the study adds support to the speculation that our attraction to booze may precede the human inventions of beer, wine, cider, or spirits.

What’s my takeaway? Ultimately, this story is not just about tipsy chimps. It is about why we are drawn to alcohol in the first place, and how deep that relationship runs in our evolutionary wiring. I brew and adore craft beer (and have no plans on stopping), but we know that alcohol use and abuse today drives millions of deaths annually, from liver disease to injuries to cancer. Understanding whether our attraction is cultural, biological, or both is not just trivia.

But also… tipsy chimps!

I’ll see you next week.

William

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

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

2026-03-04T23:49:23+00:00

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South Carolina has spent an estimated $1.6 million so far on public health efforts to combat its huge measles outbreak, according to information the state’s health department provided to Healthbeat on Wednesday.

The outbreak, which began with just five known cases in October, surged in January following the winter holidays, and has slowed in recent weeks. The total number of people infected in the outbreak, which is centered around Spartanburg County, reached 990 this week.

Most of the estimated $1.6 million spent so far on the outbreak response has been for personnel, the South Carolina Department of Public Health said in response to Healthbeat’s questions.

As the outbreak grew, the number of staff assigned to work full-time on the outbreak grew to as many as 90 people, said Dr. Linda Bell, the state epidemiologist.

Most of these staff, Bell said, have been involved in doing investigations of individual measles cases and tracing their contacts to help identify and quarantine those at risk of infection and further spread of the disease.

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

Funding for some of the outbreak’s public health costs has come from the Centers for Disease Control and Prevention, through an immunizations cooperative agreement, which helps with outbreak response activities, the South Carolina DPH said. Additional funding has come from a H5N1 Public Health Crisis Response Cooperative Agreement, which funds influenza and other public health emergency preparedness and response, the department said, as well as some other state and federal funds.

Although the number of new measles cases being detected each week has dropped significantly, the outbreak continues. The department said that final costs will be calculated once the outbreak is over.

But the threat the outbreak could surge again remains – especially with the potential for the virus to spread during the upcoming spring break travel period, Bell said.

“We remain concerned and must be mindful of the fact that we can see cases increase again from the low number that we’re seeing now,” she said. In recent weeks, the outbreak has slowed to about 10 new cases a week amid increases in measles vaccination in the Spartanburg County area and across the state.

The increased travel during school spring break raises the potential for the kind of increased spread of measles that South Carolina experienced over schools’ winter break period. “In the two consecutive weeks following the Christmas holidays, we had over 200 cases reported in each of those weeks,” Bell said.

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

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

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

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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

Anti-vaccine polices may be slowing, but the damage could be lasting

2026-03-04T12:00:00+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 have been watching signs that the federal government’s rollback of vaccines may be slowing, although the detrimental impact on public health may be long-lasting.

Is the rollback of U.S. vaccines ending?

In the 12 months after Robert F. Kennedy Jr. was confirmed as secretary of the U.S. Department of Health and Human Services, the federal government took dramatic steps to stop the development and delivery of vaccines that protect children and adults against infectious diseases. Is it possible these efforts are slowing or even stopping?

Media outlets have recently reported that RFK’s anti-vaccine actions represent a big political risk for the GOP heading into the midterm elections and that he has been instructed to delay or stop anti-vaccine activities — at least for now. According to Politico, President Donald Trump’s own pollster, Tony Fabrizio, found that Kennedy’s moves to downsize the childhood vaccine schedule are broadly unpopular. A White House official summarized the administration’s new posture with striking bluntness: “I think we’re largely done with vaccines.”

Indeed, despite the increasing prominence of the anti-vaccine movement on social media and in politics, polls conducted in the past few months show that the American public still thinks highly of vaccines, favors mandatory vaccination for school attendance, fears the return of vaccine-preventable infections, and believes recent vaccine policy changes will harm children’s health.

How experts and institutions have pushed back

Prominent experts and professional organizations in public health and clinical medicine — including pediatrics, general adult medicine, obstetrics and gynecology, and infectious diseases — have taken strong public stances opposing the administration. Notably, the American Academy of Pediatrics, a longstanding partner and adviser to the Centers for Disease Control and Prevention on childhood vaccines, just published its own independent pediatric vaccine schedule for 2026. At the bottom of the webpage is a pointed note that the CDC has a different vaccine schedule that “is not currently endorsed by the AAP.”

While the pharmaceutical and biotechnology industry has been largely muted in its public statements, one notable exception is Pfizer CEO Albert Bourla. Speaking at the World Economic Forum in Davos in January, Bourla called Kennedy’s rhetoric and policies on vaccines “anti-science” and described his opposition to vaccines as being “almost like a religion.”

The strongest institutional pushback is coming from states. Fifteen states just filed suit against HHS to reverse the administration’s decision to reduce the number of diseases children are routinely immunized against from 17 to 11. The lawsuit also challenges the “unlawful replacement” of members of the Advisory Committee on Immunization Practices and asks the courts to nullify Kennedy’s January revision to the childhood vaccine schedule.

As researchers at Georgetown University’s Commonwealth Fund document, states are working to delink their vaccine and preventive care standards from federal entities that they no longer trust. States are joining together in regional scientific bodies to independently review vaccine evidence and publish their own recommendations. An umbrella organization, the Governors Public Health Alliance, has been created to coordinate across the different regional state coalitions.

Are there positive signs in vaccine policy?

I have some hope that the pushback from experts, professional societies, industry, and states is working. Here are a few important signs from the past month.

On Feb. 11, the Food and Drug Administration surprised the pharmaceutical and biotechnology world with an unprecedented “refusal to file” response to Moderna’s application for an mRNA flu vaccine. Then, a few days later, the FDA suddenly reversed that decision. The FDA’s reversal on Moderna’s vaccine has been widely attributed to White House pressure on the FDA, suggesting that even within an administration that is skeptical of vaccines, they are still reluctant to block vaccine companies from even having their products reviewed by FDA.

The CDC’s ACIP meeting originally scheduled for February has been postponed to March 18, and the agenda is, to say the least, unusual. Rather than proposing revisions to the vaccine schedule, reviewing the efficacy of existing vaccines, or reviewing new vaccines, the ACIP meeting will focus instead on the methodology of how ACIP makes recommendations, on Long Covid, and on vaccine injuries. That is a meaningful retreat from where this panel was six months ago.

The administration also suffered a loss in its effort to find data to support its opposition to the hepatitis B vaccine. A few months ago, the administration directed the CDC to fund a randomized controlled trial of birth-dose hepatitis B vaccine in Guinea-Bissau conducted by the University of Southern Denmark. The protocol proposes to withhold the vaccine from half of 14,000 newborns in Guinea-Bissau, where nearly 20% of people already carry chronic hepatitis B infection and where up to 90% of babies exposed to the virus at birth will go on to develop chronic infection.

The World Health Organization called withholding the vaccine from newborns in Guinea-Bissau “serious and potentially irreversible harm” and raised significant concerns about the study’s scientific justification and ethical safeguards. The government of Guinea-Bissau announced last week that it would not permit the trial to go forward. “It’s not going to happen, period,” the country’s foreign minister told Reuters.

And, perhaps most remarkably, the CDC’s recently appointed principal deputy director, Dr. Ralph Abraham, abruptly resigned after less than two months on the job. Abraham is a prominent skeptic of vaccines and his appointment seemed to signal that the agency was going to completely realign itself in opposition to vaccines. After assuming his position, Abraham shocked the public health community by saying that the ongoing measles outbreaks, including child deaths, and the loss of the United States’ measles elimination status was, in his words, the “cost of doing business.”

Abraham’s departure leaves the CDC without a permanent director or deputy director. (The administration has taken the unusual position of appointing NIH Director Jay Bhattacharya also to be the acting director of the CDC, a move that Yale public health professor and activist Greg Gonsalves says means he can now “do two jobs terribly.”)

U.S. immunization programs face death by a thousand cuts

While I am optimistic that the vaccine rollback is slowing, I am fearful of the damage that’s already been done. Even if HHS slows down or halts future anti-vaccine efforts, the administration has already pursued a “death by a thousand cuts” strategy: defunding basic vaccine science and clinical trials, raising the regulatory bar for FDA approval, stocking advisory committees with self-described anti-vaxxers, and cutting resources for public education and outbreak response.

The damage from 2025 will not be undone by a midterm-driven political pivot. While many states are doing heroic work to preserve vaccine access, some states are moving in the opposite direction, adopting their own anti-vaccine statutes that could outlast any particular administration.

In 2026 and beyond, we are likely to be left with fewer vaccines in development, uneven standards from state to state, confused providers and patients, and the slow erosion of the unified national infrastructure that once made the U.S. childhood immunization program the envy of the world.

Wishing you a healthy week,

Jay

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.

How milder winters are luring mosquitoes – and the diseases they carry – beyond the ‘tropics’

2026-02-26T12:00:00+00:00

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Hello from Nairobi.

This week’s news is heavy on drug trials and some groundbreaking scientific research – two subjects I try to cover cautiously, because scientists, research institutions, and others have incentives to hype early findings. Anyhow, in global health terms, it is a good issue to be grappling with. It means there wasn’t some new outbreak I had to research.

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

Mainland Europe: a mosquito’s tropical getaway?

There’s a whole rogues gallery of tropical, mosquito-borne diseases that have long been relegated to the warmer and poorer parts of the world. For example: malaria, dengue, Zika, and chikungunya virus.

But global warming and roving mosquitos are rapidly blowing up the traditional boundaries of what counts as “tropical.” A new study in the journal Royal Society Interface finds that many of these diseases can now be transmitted by mosquitoes across most of southern and central Europe, The Guardian reports.

To be clear, the study isn’t just a speculative forecast. For some of these diseases, the shift has already happened.

Take chikungunya. “Up until last year, France had recorded 30-odd cases of chikungunya over the last 10 years or so. [In 2025], they had over 800,” said Steven White, one of the scientists at the UK Centre for Ecology and Hydrology that was behind the new study.

Disease breakdown: Chikungunya (a particular focus of the new study) is a virus first identified in Tanzania in the 1950s. Its name means “that which bends up,” a nod to the symptomatic contortions caused by terrible joint pain and fever. Although there’s no cure, death is rare, with fewer than 1 in 1,000 perishing from the illness. The real cost is in long-term pain: chronic arthritis that can last for months or years.

One of the study’s most unsettling findings for chikungunya was that the virus can incubate inside the increasingly invasive Asian tiger mosquito at much lower temperatures than previously believed. Specifically, “the study found the cut-off temperature for transmission is 13 degrees C - 14 degrees C,” or about 55 to 57 degrees F.

That dramatically expands the map of where outbreaks are possible, “meaning infections can occur for more than six months of the year in Spain, Portugal, Italy, and Greece, and for three to five months of the year in Belgium, France, Germany, Switzerland, and a dozen other European countries.”

What’s the takeaway?

First, it’s increasingly hard to see the northern spread of these tropical diseases (across North America, too) as anything but inevitable. As winters grow milder and warm seasons stretch longer, the conditions that allow these viruses to circulate are expanding … and exponentially!

I reached out to Flavia Riccardo, an independent infectious diseases researcher at the Italian National Institute of Health. She shared a recent study she co-authored that adds an important nuance. For now, the main risk is not these viruses becoming permanently established in Europe. It is infected travelers bringing them in during mosquito season, and triggering local outbreaks that can flare out of control.

My second takeaway is this: If there’s a morbid upside, it may be that once these diseases begin affecting wealthier countries, they could finally attract the sustained research funding and political urgency they need.

Guinea-Bissau stomps out a controversial vaccine trial

Last week, I mentioned in passing that World Health Organization Director-General Tedros Ghebreyesus publicly condemned a controversial U.S.-funded vaccine study on infants in the West African nation of Guinea-Bissau. Now, the country has shut it down, Reuters reports.

Guinea-Bissau’s foreign minister ultimately said, “It’s not going to happen, period,” after scientists, health bodies, and U.S. lawmakers raised alarms.

The trial, backed by the U.S. Centers for Disease Control and Prevention, would have tested the timing of the hepatitis B vaccine in newborns. Some “critics had said it was being used to test theories linking vaccines to autism,” and others (including the WHO chief) decried it as unethical because only half of infants would receive the life-saving shot at birth.

The threat here is clear: “90% of babies exposed to hepatitis B at birth or in their first year of life develop a chronic infection, and 15% to 25% of these die early of related liver failure or cancer as a result.”

To be perfectly fair to the researchers, “under the [proposed] trial, half the infants would receive [the vaccine] at birth,” and “the remainder at 6 weeks,” which is when infants normally receive the vaccine in the formal health care system in Guinea-Bissau. So the researchers hadn’t planned on taking anything away from vulnerable infants. The African nation “plans to introduce the dose at birth only in 2028.”

Still, at 6 weeks, “many infants whose mothers have hepatitis B are already infected,” and as I wrote last week: It is just hard to imagine a similar trial within the United States surviving legal/ethical challenges.

Magic mushrooms go mainstream

Magic mushrooms are having a bit of a clinical moment.

Compass Pathways, a British pharmaceutical company, announced that its synthetic psilocybin (which is the psychoactive chemical found in magic mushrooms) treatment hit its “major goals” in a large, late-stage trial for hard-to-treat depression, Reuters reports.

The report says that the company now plans to meet with the U.S. Food and Drug Administration and could seek approval for the treatment as early as 2027. (Keep in mind, this would be the first approved psychedelic therapy cleared in the United States.)

What’s my takeaway? Before we all start penciling psychedelics into the next generation of antidepressants, I’d strongly recommend reading this thoughtful essay published in STAT last week.

Erica Rex, a writer who participated in an early magic mushroom trial, warns that the rush to commercialize psychedelics is stripping away the therapy, community, and careful supervision that made those early studies feel safe and transformative. She argues that the drug alone is not the treatment. And profit incentives may directly clash with the slow, human elements that made psychedelic therapy work for her.

A ‘clock’ for Alzheimer’s symptoms

A new study published in the research journal Nature Medicine suggests we may soon be able to do something Alzheimer’s researchers have long dreamed of: Detect Alzheimer’s disease early and estimate when symptoms will begin, the Washington Post reports.

The study describes how to use blood draws to “build a ‘clock’ for Alzheimer’s disease that could roughly predict when symptoms will develop.” The core of the work revolves around tracking the levels of “one specific protein, called p-tau217,” in the blood.

This protein is important, because it is a hallmark sign that Alzheimer’s has started. More specifically, it shows that “clumps of misfolded proteins called amyloid plaques [have] begun to build up in the brain.”

Now just measuring that protein in blood draws isn’t enough on its own.

The bloodwork data has to be fed into a computer model that contains information about the patient, such as their age, which is then used to “forecast symptom onset within a margin of three to four years.”

So, yeah… it’s a wide error range. And practically speaking, this kind of prediction isn’t precise enough yet to guide individual treatment decisions.

But (and here’s the important part!) it could matter enormously for the potential, future use of novel drugs. That’s because two big Alzheimer’s studies underway are testing if newly developed “anti-amyloid” drugs can slow or prevent the disease if they’re given early enough.

If those drugs truly work best early, then knowing when “early” begins would be incredibly important.

The quest for a universal vaccine

I want to tread very, very carefully here. This next story is genuinely fascinating, but I’ve covered enough “breakthroughs” to know how easy it is to get carried away. The bigger the claim, the more skepticism we should hold.

The journal Science has just published a paper describing a provocative new approach to developing a “universal vaccine,” the BBC reports. That is, a vaccine that doesn’t just target one virus, but puts the entire immune system on high alert against many.

The paper is not theoretical. Stanford University scientists developed a nasal spray vaccine that they tested on mice against infections that attack the lungs. The end result was a “three-month effect” in which the mice’s immune systems were in a “heightened state of readiness” that “led to a 100- to -1,000-fold reduction in viruses getting through the lungs and into the body.”

This included effective immunity against a medley of cold and flu viruses, among other would-be invaders.

That is big news! So what’s the actual science here? To understand it, it helps to step back and look at what traditional vaccines are actually designed to do.

Traditional vaccines all use different strategies to teach the immune system to recognize a specific virus or bacteria. This is done by either by exposing the body to a weakened, dead, or fragmented germ … or by delivering instructions for the body to make a harmless piece of it (this last one is the new mRNA method, developed during the Covid-19 pandemic.)

This even newer approach is totally different. Instead of teaching the immune system to identify attackers, the vaccine artificially mimics the signals “immune cells [use to] communicate with each other” in the midst of an infection. Normally, when an infection begins, immune cells send out chemical signals that trigger a system-wide defensive response. And when on high alert, immune cells become more active and better able to contain invading viruses or bacteria.

This vaccine recreated that early alarm. It did this by introducing a molecule that flips the sensors inside some immune cells, pushing them into that heightened state of readiness.

Yes, it absolutely does sound like an incredible breakthrough. So … let’s move on to my beloved caveats.

First: This has not been tested in humans. It worked on mice, which is not nothing, but many, many fascinating mouse studies have failed to translate into people.

Second: The researchers now have to run the clinical trial gauntlet. That starts with Phase 1 trial to test safety, Phase 2 to figure out dosing and immune response, and Phase 3 to see whether it actually works in large numbers of people. Historically, only about 10% of drugs that start these trials end as an approved drug. Most are found to be unsafe or ineffective. Even at Phase 3, roughly half still fail.

Still, it’s promising.

I’ll see you next week!

William

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

Huge S.C. measles outbreak slows, fueling cautious optimism it may end earlier than predicted

2026-02-25T21:56:44+00:00

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South Carolina’s huge measles outbreak has slowed significantly in recent weeks, raising hopes among health officials that the disease’s spread might end sooner than expected, the state’s epidemiologist said Wednesday.

Since Feb. 17, the South Carolina Department of Public Health has documented 17 new measles cases. That’s far fewer than the 100 or more new cases being identified every few days during mid-January, when the outbreak spiked following the winter holidays.

“We’re encouraged with the downward trend, particularly in the last two weeks,” said Dr. Linda Bell, who has been leading the state’s response since the outbreak was identified in October with an initial five cases.

Since then, 979 people – mostly school-age children – have been sickened with measles. All but 52 of the cases have been in Spartanburg County; about 95% have been among people who were not vaccinated.

“No one should underestimate the hard work and long hours that front-line, often entry level epidemiologists have put into this response, and [who] are largely responsible for this downward trend that is actually occurring a bit earlier than previously projected,” Bell said.

Earlier in the outbreak, Bell said that modeling had suggested the outbreak might last for as long as six months.

“The case counts per week now are really down to the level that we were seeing at the beginning of December,” she said. “We are now 22 weeks into this and we hope, with that continued downward trend, in parallel to the hope that vaccination coverage will increase, will help us end this sooner than was originally projected.”

Bell said the department has asked the Centers for Disease Control and Prevention to assist the department in the coming weeks to do studies to help learn from the outbreak, including studies that examine chains of transmission and the costs associated with the public health response to the outbreak, as well as health care costs.

Officials remain concerned, however, that the outbreak has the potential to spike yet again. “This is not over yet. It’s not nearly over yet,” Bell said. “It is these pockets of under-vaccinated people who remain susceptible. That ongoing susceptibility in our population may continue to fuel ongoing spread.”

To stop measles outbreaks from spreading in localized communities, at least 95% of people need to be vaccinated. But in Spartanburg County, state health officials have said measles vaccination rates for school children across the county are just 90% – and they are even lower within some individual schools and communities.

“Many of the schools in Spartanburg County have some of the lowest vaccination coverage rates in the state,” Bell said. “So all of those are contributing to the reason that the outbreak has been focused in Spartanburg County, because of higher risk there, because of lower coverage.”

This is also a likely contributing factor for why measles cases identified recently in a few other South Carolina counties haven’t spread widely in those locations, Bell said. Of the 979 cases in the South Carolina outbreak, 927 involve people in Spartanburg County.

“Even if we are only seeing a dozen or so cases per week, the risk we can surge remains,” Bell said.

Bell noted that schools will be going on spring break in the coming weeks, bringing with it the risk of people who have been exposed to measles becoming infectious and spreading the disease to others at tourist attractions and while traveling. “This is a great concern,” she said.

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

AI can be a transformative health tool. It can also cause harm.

2026-02-25T12:00:00+00:00

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

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

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

This week, I’m focusing on a question that sounds like science fiction but is increasingly being asked in serious policy circles: Will artificial intelligence kill us all?

AI can help health agencies avert illness and death

Let’s start with my bias. I believe that AI is a transformative tool that can help public health agencies avert illness and death in their communities if used responsibly and ethically. It can help epidemiologists process, analyze, and interpret surveillance data. It can assist health officials in tailoring communications, particularly in emergencies, and improving programs for immunizations, sexually transmitted infections, tuberculosis, and maternal child health.

As AI systems grow more capable, many experts are wondering, however, whether the risks could outweigh the benefits. Some of those risks are distant but catastrophic. Others are happening right now at a smaller scale.

An AI safety leader warns the ‘world is in peril’

Earlier this month, a senior safeguards researcher at the AI company Anthropic resigned, warning that the “world is in peril.” In his resignation letter, he cited concerns about AI, bioweapons, and interconnected global crises.

Anthropic has positioned itself as a safety-oriented firm in the race to build increasingly powerful generative AI systems. The New Yorker just published an in-depth investigation into Anthropic and the inherent tensions people in the company feel trying to build advanced AI systems while safeguarding against risks to humanity. Curiously, the U.S. Defense Department just took the view that Anthropic may be a risk to the U.S. government, because it’s too focused on ethics and protecting human health.

(Full disclosure: I’m a big fan of Claude Code, one of Anthropic’s premier products. Read an excellent review of that product by widely respected AI expert Ethan Mollick here.)

The departing Anthropic researcher had led work on reducing risks from AI-assisted bioterrorism and on understanding how AI assistants could distort human judgment. His concerns are shared by others in the field.

As AI models become more proficient in synthesizing scientific literature and solving technical problems, they may lower the barrier to designing or modifying pathogens. Biology is already digitized. Genome sequences are publicly available. Laboratory protocols are published in journals and databases.

Recent research has tested advanced AI models on graduate-level virology problems, demonstrating that they can perform at or near expert level on tasks involving viral genetics and pathogenesis. While such capabilities can help humanity by improving vaccine design or antiviral discovery, they could also be misused to enhance the infectiousness or immune evasion of pathogens.

Having led outbreak responses in Asia, Africa, and the United States, I still believe that we need to worry most about nature — “spillover” of viruses from animals into humans — when trying to prevent the next pandemic. Nevertheless, the pace of AI development is extraordinary, which means my risk assessment is changing daily as well. An intentionally engineered pathogen designed for maximum spread could have far greater consequences than even the Covid pandemic.

Proposals to reduce biosecurity risks

Researchers and policymakers have outlined approaches to mitigate risk.

One proposal is to secure closed-source biological AI models, restricting access and subjecting users to rigorous vetting and monitoring. Companies can conduct exercises in which they deliberately probe their own systems for vulnerabilities before malicious actors do.

A second approach is to protect high-risk biological datasets from being used to fine-tune open-source models. If detailed genomic data on high-consequence pathogens or advanced laboratory protocols are easily accessible for model training, they can amplify the capabilities of otherwise general-purpose systems. Tighter access controls and clearer publication norms could reduce misuse.

A third area is to restrict AI agents that interface with biological tools. As AI systems move beyond generating text to interacting with laboratory equipment or ordering synthetic DNA, systems need to be in pace to ensure there is a human that is screening DNA synthesis orders and auditing AI-designed workflows.

In the AI era, biosecurity will require multiple layers of defense that protect humanity at the level of algorithms, data, and laboratory infrastructure.

The near-term mental health risks

While headlines often focus on existential threats, I am most concerned at the moment about a more immediate hazard: AI’s impact on mental health and suicide.

Millions of people now interact daily with AI “companion” chatbots designed to simulate friendship, empathy, or therapeutic dialogue. Some users, including minors, disclose suicidal thoughts to these systems. In multiple lawsuits, there are allegations that AI chatbot interactions led to people committing suicide.

In response, California enacted Senate Bill 243 in 2025, the first law in the nation regulating AI companion chatbots. The law requires clear disclosure when a user is interacting with AI rather than a human, mandates protocols for responding to suicidal ideation, and imposes additional rules for known minors, including periodic reminders that the chatbot is not human, and restrictions on sexually explicit content. It also creates a private right of action, allowing civil lawsuits for violations.

California’s law is an important milestone. It acknowledges that emotionally realistic AI systems can foster attachment and dependence, particularly among adolescents. It also recognizes that AI systems need regulation to ensure they do not severely harm mental health and promote suicidal thinking.

We do not know if these regulations, however, will even work. Disclosure that a system is “not human” may not counteract emotional realism. Protocol requirements do not guarantee effectiveness. Operators may avoid collecting information about users’ ages, limiting their obligations to minors.

From a public health perspective, these debates remind me of the challenges with social media platforms. Almost 16 years after Instagram was released, we are now seeing possible the company be held legally liable for its impact on mental health.

Last week, Mark Zuckerberg, CEO of Meta, had to testify in court about whether Instagram (which Meta owns) was designed to addict and harm teenagers. Social media technologies optimized for engagement have amplified loneliness, misinformation, and depression, and AI systems could likely do the same at an ever larger scale.

Evaluating the uncertainty

So back to the original question: Will AI kill us all? I believe the probability of an extinction-level event is low today, but low is not zero, and the consequences would be catastrophic. At the same time, the mental health risks of emotionally persuasive AI systems have already appeared and need to be addressed.

Public health agencies must always prepare for rare catastrophic events while addressing everyday harms. Now, with AI, we must do both simultaneously as well.

Until next week,

Jay

Chaotic federal vaccine committee meeting: It’s off, now it’s on again. But still no word on agenda.

2026-02-24T20:53:32+00:00

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The federal Advisory Committee on Immunization Practices now plans to meet March 18 and 19, according to updated information posted on the committee’s website at the Centers for Disease Control and Prevention.

No information had been posted Tuesday about what topics or votes will be on the meeting’s agenda, how the public can comment on agenda items, or even what time the meetings will start and end.

The committee, which meets three times a year, had long planned to meet this Wednesday through Friday in Atlanta. But as the meeting date approached, the committee failed to make public – as required – its planned agenda, jeopardizing its ability to meet legally, Healthbeat reported last week.

The cancellation also followed efforts in a lawsuit filed by the American Academy of Pediatrics and other medical groups that have sought to stop the group’s next meeting because of concerns that ACIP will take a vote that will result in removing funding for certain vaccines for children from low-income families or who lack adequate insurance.

Officials at the CDC and the U.S. Department of Health and Human Services did not immediately respond to questions about the rescheduled meeting.

Federal advisory committees are required to give the public advance notices about their meeting agendas and other basic information about how the public can attend or watch the meetings. Historically committees were required to give at least 15 calendar days notice before a meeting, but in December the Trump administration reduced that to seven calendar days.

On Tuesday, the American Academy of Obstetricians & Gynecologists announced that it was withdrawing as a liaison member of the vaccine advisory committee, citing an array of concerns, including what it said was ACIP’s cherry-picking of data and unilateral changes to childhood and adolescent vaccination schedules without expert input.

“The recent reconstitution of the committee; the removal of ACOG experts from ACIP workgroups; and HHS’ unilateral changes to vaccine recommendations, which bypassed established scientific and clinical processes, represent a fundamental departure from the scientific rigor and impartiality that have been the hallmark of this committee for 60 years,” said ACOG President Dr. Steven J. Fleischman.

The committee had all of its scientific advisers replaced last summer by HHS Secretary Robert F. Kennedy Jr.

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

Hospitals fighting measles confront a challenge: Few doctors have seen it before

2026-02-24T15:10:14+00:00

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ASHEVILLE, N.C. — At around 2 a.m., 7-year-old twin brothers arrived at Mission Hospital in Asheville. Both had a fever, a cough, a rash, pink eye, and cold symptoms.

The boys sat in one waiting room and then another. Two hours and 20 minutes passed before the two were isolated, according to Centers for Medicare & Medicaid Services records obtained by KFF Health News. Then two more hours ticked by.

As the sun rose, an emergency room doctor called the state epidemiologist and described the symptoms. The public health official told him to keep the kids in the hospital and quarantine them. Shortly after that call, the patients were diagnosed.

It was measles.

Hospital staff gave the father instructions on how to quarantine the family and sent them home.

The virus exposed at least 26 other people in the hospital that January day, federal investigators determined. Health inspectors for CMS investigated the measles infections and other failures in care and concluded that the twins’ symptoms should have triggered an isolation procedure for which Mission Hospital staffers had trained seven months earlier. CMS designated Mission in “Immediate Jeopardy” for the exposures and other unrelated issues, one of the most severe sanctions a hospital can face, threatening to pull federal funding unless it remedied the problems.

A spokesperson for Mission said its staff was trained to manage airborne sickness and is following federal rules.

As U.S. hospitals face an increasing risk of encountering measles, and pressure to immediately spot it, health care workers face an unusual barrier: Many don’t know what it looks like.

How the South Carolina measles outbreak grew from 5 to 973 cases

“There’s a word, ‘morbilliform’ — it means measles-like, and there are lots of viruses that can cause a rash that looks like a measles rash in children,” said Theresa Flynn, a pediatrician in Raleigh and the president of the North Carolina Pediatric Society. In 30 years in health care, she’s never seen a measles case, she said.

North Carolina has reported more than 20 cases since mid-December, and more than 3,000 people nationwide have been infected since the beginning of 2025.

Children in areas with low immunization rates have been especially susceptible to outbreaks, triggering public health campaigns to promote the measles vaccine. CMS Administrator Mehmet Oz encouraged vaccination in a CNN interview on Feb. 8.

With two doses of the measles, mumps, and rubella vaccine, a person has a 3% chance of getting the virus after exposure. If exposed, an unvaccinated person has a 90% chance of being infected, according to the CDC. It can take a week or two before someone infected with measles shows symptoms.

But for the past year, the Trump administration has sown doubt about vaccine effectiveness. Health and Human Services Secretary Robert F. Kennedy Jr. was a longtime anti-vaccine activist before taking office, and under his leadership the Centers for Disease Control and Prevention has reduced the number of shots recommended to children.

After measles erupted in West Texas last year, Kennedy publicly recommended unconventional and unproven treatments for the virus, including steroids, antibiotics, and cod liver oil.

Infectious disease experts and doctors said federal policies have left health care workers to lean on their own experience or guidance from their state public health systems to fight a disease that many are preparing to see for the first time and that initially may behave like the common cold.

“As measles becomes more common, all of us are leveling up in our ability to recognize and immediately respond to suspected measles,” Flynn said.

Staff trained to look for three C’s: cough, coryza, conjunctivitis

Officially, the United States has maintained “measles elimination status” since 2000, meaning the United States has avoided significant spread of the virus. After outbreaks in Texas, Arizona, Utah, and now South Carolina, the nation is on track to lose that designation before the year is out. Its own adopted regulations tie elimination status to a lack of a continuous viral spread persisting for 12 months.

One county in South Carolina, an hour’s drive from Asheville, has had more than 900 cases in the current outbreak — more than Texas reported in all of 2025.

Symptoms of measles, a virus that attacks the lungs and airways, can include fever, cough, a blotchy rash, and red, watery eyes. Researchers consider measles among the most contagious diseases, and the virus may remain active for up to two hours after an infected person leaves a room.

It can be lethal, with 1 to 3 deaths per 1,000 cases in children.

In 2025, two children in Texas and one adult in New Mexico died of measles.

Along with tracking data, the CDC provides detailed summaries on its website for diagnosing measles. State public health agencies and some counties have developed dashboards tracing the disease as it surfaces in such places as hospitals, schools, grocery stores, and airports. Large hospital systems developed staff training protocols last year and shared them with area clinics.

Look for the three C’s, that guidance said: cough, coryza (cold symptoms), and conjunctivitis (pink eye). According to CMS inspection records, HCA Healthcare, which owns Mission Hospital, trained Mission staff on the three C’s early last year. On top of failing to isolate the twin patients right away, Mission staff didn’t have a designated area for patients with respiratory symptoms, federal inspectors found.

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

The CDC advises health workers to immediately place patients with measles or suspicious symptoms in a special isolation room, where airflow is controlled inward. The Mission patients were separated from other patients only by plastic partitions, according to the CMS records.

Mission spokesperson Nancy Lindell said the hospital was equipped and staffed to manage airborne illnesses like measles.

“Our hospital has been working with state and federal health officials on proactive preparedness, and we are following guidance provided by the CDC,” Lindell said.

(Dogwood Health Trust, a private foundation established as part of HCA’s purchase of Mission Health, helps fund KFF Health News coverage.)

Most U.S. clinics and hospitals have never experienced measles cases, said Patsy Stinchfield, a former president of the National Foundation for Infectious Diseases and a nurse practitioner. She called CMS’ Immediate Jeopardy penalty for Mission “extreme,” given the virus can be so difficult to identify.

“In the middle of winter right now, measles looks like every other viral respiratory infection that kids come in with,” Stinchfield said.

The CDC has been less communicative in the past year with clinics about their response to outbreaks, said health workers and infectious disease experts. This disconnect began soon after Trump took office, according to a KFF Health News investigation finding that health officials in West Texas were unable to talk with CDC scientists as measles surged last February and March.

“We certainly do not feel the support or guidance from the CDC right now,” said Brigette Fogleman, a pediatrician at Asheville Children’s Medical Center, where staff members have come up with their own method of staving off the virus: screening patients over the phone and in their cars before a visit.

In response to questions about how the CDC is supporting health care organizations during the measles resurgence, spokesperson Andrew Nixon said that “state and local health departments have the lead in investigating measles cases and outbreaks” and that the CDC provides support “as requested.” He pointed to numerous guides and simulation tools the agency has developed as the virus has spread.

Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University, acknowledged that diagnosing measles is a major challenge, emphasizing that coordination among public health agencies is critical in overcoming that challenge.

Stinchfield attributed the spread of measles to CDC leaders’ lack of communication to clinics and to the public — no ads on buses, no social media campaigns, no sense of urgency. “When you are at the highest level of measles cases in 30 years, we should be seeing lots more from our federal government,” Stinchfield said. “And I think it’s harming kids and causing an inordinate amount of work and expense that really doesn’t belong in health care right now.”

State prepares for more measles cases

In North Carolina’s Buncombe County, home to Asheville and Mission Hospital, health officials had counted seven measles cases by mid-February and anticipated many more, according to state epidemiologist Zack Moore. It’s unclear how many of those are connected to the Mission exposure.

“We are preparing for a future in which we follow a trajectory like South Carolina,” Moore said, “where we see sort of a gradual accumulation of cases, and then all of a sudden it reaches kind of a tipping point, and we see a more explosive growth in the outbreak and spread across the state.”

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

Fogleman, who is also a pediatrician, and Buncombe health department director Jennifer Mullendore spoke during a recent Facebook livestream hosted by the county, urging families to get their children vaccinated, debunking vaccine misinformation, and updating parents on local case numbers.

Days before, a local private school had quarantined about 100 students after an exposure. Only 41% of students there were immunized, according to state data.

At Fogleman’s clinic, parents are asked to wait in their vehicles with their children, and staffers come out to screen them there. Some parents resist vaccination and note recently weakened federal recommendations around measles vaccines for children under 4, she said.

Kennedy handpicked the committee members who made those recommendations, with several members having spread medical misinformation in the past.

One parent recently told a nurse, “It’s only measles. It doesn’t kill anybody,” Fogleman said.

That’s not true, her team must explain.

As the clinic holds families in the parking lot, trying to figure out whether symptoms point to the dangerous virus, it’s difficult to get the message across, Fogleman said, especially when the nation’s top disease agency hasn’t conducted a widespread information campaign about the risks from measles — or the vaccine’s ability to almost entirely prevent it.

“We can’t change the past,” Fogleman said. “All we can do is try to educate and move forward.”

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

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

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

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

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

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

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

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

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

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

Programs moved over the federal health department include:

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

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

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

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

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

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

Chalkbeat National Editor Erica Meltzer contributed reporting.

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

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

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

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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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

AI therapy can help in countries with scarce care, but experts urge regulation

2026-02-19T12:00:00+00:00

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

Hello from Nairobi.

This week we’ve got interesting news about AI therapy, new gene-editing medicines, and other topics … but before that, I have to mention that TIME magazine just published its 100 most influential people in global health. It’s great for a laugh!

The list includes Chris Hemsworth, for being exceptionally good looking while talking about Alzheimer’s, and some very stilted wordsmithing around Robert F. Kennedy Jr., who is labeled a “Titan of Health.” Conspicuously absent are any of the heroes who responded to last year’s Ebola outbreak. But hey, there’s always next year.

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

Your therapist, ChatGPT

The Guardian just published a fascinating article on the global use of artificial intelligence chatbots as therapy tools, featuring vignettes from Nigeria.

As the story states, “AI platforms offering first-line mental health support have proliferated over the past year.” And for Nigeria in particular, there is an obvious appeal in easing access to mental health care in a country with just “262 psychiatrists for 240 million people” (!).

The article starts with a very compelling story about a woman named Joy Adeboye in the capital, Abuja, who turns to an AI chatbot out of desperation and need. The result? “For the first time in months, Adeboye says, she felt less alone.”

Still, in most countries regulation on this use of AI is basically nonexistent, and that makes several basic, open questions all the more pertinent: Do these tools actually work as therapy, are they safe, and should they be trusted with vulnerable people?

I reached out to Briana Vecchione, a researcher who studies this topic at the Data & Society Research Institute, a nonprofit focused on social implications of automation and AI. Vecchione provided some striking insight on both the history of chatbots for therapy (which, surprisingly, dates back to the 1960s), and how to think about the tension between potential harm and help.

We covered much more than I can fit here, but luckily for you, she’s moderating a talk on this very topic on Feb. 26.

On how or if these tools actually work: Vecchione was careful to balance where the research stands (outside of a few narrow contexts, “I don’t believe chatbots are as effective as talk therapy,” she said) with what many users report their lived experience to be. “We have definitely seen that people feel some sort of relief after using these systems,” she said.

“But you need to really be careful about what forms of other care you’re displacing,” and ultimately, she says, “I do not think it’s a replacement for therapy."

When it comes to potential harms, she points to the incentive structures of many of the companies making these AI systems. “These [tools] are typically optimized for engagement. They’re not typically optimized for helping you close the loop and step away, which is actually bad for the companies. They want you to come back,” she said. In Vecchione’s research, she hears users frequently say they “feel unsure when to stop,” or at worse, “feel overly dependent on these systems,” and feel significant shame about that dependence.

Another potential harm is privacy, which I acknowledged to Vecchione I’ve always thought of as an abstract or general concern. But Vecchione points out that the risk here is extremely acute. “These things have no fiduciary duty in the same way that therapists do. They are not protected by HIPAA,” the U.S. Health Insurance Portability and Accountability Act, which protects a patient’s sensitive information, or patient confidentiality, she said. This means that in many countries (the United States included) there is nothing stopping an AI therapy tool from immediately selling your data to a prospective health insurer.

Still, with the prospect of AI therapy filling what would otherwise be an incredible void in many developing countries, Vecchione is clear that “these kinds of supplements to care can be useful,” she said. “Is it better than nothing? Maybe, if it’s being used responsibly.”

What’s the takeaway? At least in the United States, Vecchione and her colleagues have authored a detailed public comment to the U.S. Food and Drug Administration on their recommendations for the future of these technologies. They argue that relevant AI systems should fall within the FDA’s “medical-device” definition for mental health, should be treated as such, and regulated as such.

Diet, exercise, and… gene editing?

We cover a lot of tropical diseases on the Checkup. But zoom out to the global picture, and the biggest threat to health is far less exotic. Heart disease remains the top killer.

As a disease, it’s a bit of a catch-all. A range of factors like high blood pressure, diet, and smoking can damage the heart in different ways. But all told, the major risk for heart disease lies in high LDL cholesterol, which is made by your liver. With too much of this waxy fat, it can build up in blood vessels and block blood flow.

But in what feels like a glimpse of science fiction, clinicians are increasingly experimenting with new gene-editing techniques to reduce LDL cholesterol production, the AP reports. These trials are early, but are showing shocking improvements in patients who did not respond to regular medicines.

How does it work? Basically, a patient is injected with an IV of microscopic fat bubbles, which the liver naturally absorbs from the bloodstream. The trick is that these bubbles are carrying a clever DNA-cutting protein (part of the gene-editing tool CRISPR) along with a short RNA “instruction” that tells it exactly what piece of DNA to cut out.

The clinicians are specifically targeting a gene called ANGPTL3 to edit away, and only in specific cases. In some people this gene goes haywire, and causes an overproduction of “LDL cholesterol and another bad fat, triglycerides.”

It’s a one-time therapy, because when the edited liver cells reproduce … the deleted gene can’t carry onward. These are of course early trials, and the article does a great job couching the caveats.

There are major safety questions to be answered, cautioned Dr. Joseph Wu of Stanford University, who wasn’t involved in either study. CRISPR-based therapies for any disease haven’t been used enough to know long-term safety — and the particles carrying the gene-editing tool can irritate or inflame the liver, he said. Another unknown is whether gene-editing hits only the intended target. That’s why for now, studies largely target people at very high risk.

The who’s who of the next WHO

The World Health Organization director-general’s term does not expire until August 2027, but the race to succeed Tedros Ghebreyesus is already heating up. Nominations formally open in April, and Health Policy Watch is tracking the top contenders circulating in the “rumor mill.”

These include would-bes from the reform-minded Budi Gunadi Sadikin, Indonesia’s minister of health, all the way to Sania Nishtar, the CEO of Gavi.

I’ll be honest, seeing this much speculation so early is a little funny. (The article has some strong “The Bachelor” season premiere vibes.) Still, this is a five-year term that often turns into 10, and is the most important job in global health. So, if we’re being fair, the early speculation is more a la papal conclave than reality TV.

Jokes aside, the job earnestly matters more now than ever. Even beyond the global funding shortfall, the article paints a rough picture of the current state of affairs inside the WHO:

“Internally, the organization is struggling with a 25% cut in staff following the loss of United States support, leading to a low in staff morale. The layoffs, a lack of transparency, sexual abuse scandals, and a fear of retaliation among staff who have raised claims of harassment and damaged trust in the organization’s leadership.”

The real question is, who can right the ship? We will see.

(One last note on the incumbent: It’s too early to assess Ghebreyesus’ tenure. He will be remembered for steering the WHO through Covid and the 2025 wave of austerity. How well did he do? Hard to say. Still, credit where it is due. This week he publicly condemned a controversial U.S.-funded hepatitis drug trial involving newborns in Guinea-Bissau. It is hard to imagine a similar trial within the United States surviving legal/ethical challenges.)

A new polio vaccine

The WHO has cleared a new polio vaccine for global use, Reuters reports.

Disease breakdown: Polio, or poliomyelitis, is a gut virus that spreads largely through feces. While most infections pass without symptoms, the worst cases can wither limbs or invade the spinal cord to cause paralysis or death. Importantly, the disease can’t hide in animals, and vaccines stop it cold. Although polio is ancient enough to have been carved into Egyptian hieroglyphs, two strains of the virus were eliminated in 1999 and 2020, and only two more remain.

We covered this back in October. Despite a 30% cut to the effort, humanity is on the verge of eliminating this disease altogether. (That would make it only the second disease eradication, after smallpox in 1980.)

As I wrote then, “the last wild strain of the virus (still hanging on in Afghanistan and Pakistan) is now expected to be stopped by 2027,” and a second “strain of the virus that bubbled up from earlier vaccine drives, and which is largely pocketed across the African continent,” is on track for elimination by 2029.

What’s the focus of this new, oral drug? It targets that second variant, the vaccine-derived strain behind the African outbreaks. The key upgrade here is that this new vaccine is far more stable, so it’s less likely to mutate and accidentally seed new outbreaks while we work to stop existing ones.

And it can’t come fast enough.

Last week, Malawi launched a new campaign with about 1.7 million doses of the older oral vaccine, after the second variant showed up in sewage in the country’s second largest city, Blantyre, ABC News reports. (You have to love sewage sampling for both its grossness … and its effectiveness at monitoring hundreds of thousands of people to catch diseases early.)

I’ll see you next week.

William

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

Longevity has become big business. But it’s public health that’s driving gains.

2026-02-18T12:00:00+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 the stories shaping public health in the United States.

This week, I’m focusing on one of the hottest topics in U.S. health care: longevity. Much of today’s longevity industry focuses on expensive medical interventions, even though the largest gains in life expectancy have come from public health and social conditions.

Longevity is now a big business

I am increasingly bombarded with advertisements for pills, scans, and tests that can help me live a longer and healthier life. The way these are marketed and the absence of high-quality evidence for their benefit indicate that these ventures are, fundamentally, about creating new lines of business, rather than helping people live longer.

Take a look at the news that the founder of Spotify, Daniel Ek, has founded a new company focused on full-body imaging and will be opening his first clinic for this near my home in New York City. While the price has not yet been announced for this “health check for your future self” (Ek’s words), this company will be competing against other start-ups that charge nearly $4,000 for similar scans.

In the food sector, it seems as if every grocery store, restaurant, or even coffee shop I visit sells items “packed with protein.” Cardiologist Eric Topol and ex-National Institutes of Health nutrition researcher Kevin Hall have written extensively about the lack of evidence for a high-protein diet, arguing that the average American already consumes all the protein that their body can safely use.

One of the people they both have pushed back against is Peter Attia, a physician and best-selling author of a book about longevity. Attia argues that Americans should consume roughly double the standard recommended daily allowance of protein, 1.6 grams per kilogram of body weight rather than 0.8. To help Americans up their protein intake, Attia has been serving as an investor in and chief science adviser to David Protein, a company that sells a popular high-protein, low-sugar supplement bar.

If you want more than just generic recommendations about protein intake, you can also pay for personalized advice. Attia says he is “neither a primary care physician nor a provider of concierge care,” yet charges between $100,000 and $500,000 per year for personalized longevity advice.

One of the people Attia appears to have been advising was human trafficker and convicted pedophile Jeffrey Epstein. Attia’s correspondence with Epstein provides a small window into the type of services wealthy clients pay for, such as blood tests for a wide range of analytes that no primary care physician would routinely order, as well as prescriptions for metformin, a first-line treatment for diabetes that some believe may have anti-aging properties.

Many other physicians and prominent practitioners in the longevity field appear to have the ear of the current federal government, despite extensive, inter-locking financial interests in companies that market supplements, tests, and other longevity and wellness products.

For example, according to a report from the consumer advocacy group Public Citizen, the nominee to be surgeon general, Dr. Casey Means, has extensive financial connections, many of which have not been fully disclosed by her. Means — who, like Attia, never completed residency training — is connected to companies that market basil seeds, algae, and a protein powder that has been found to have extensive lead contamination.

The real longevity experts work in public health

When I think about experts in longevity, I think first of my field: public health. In clinical medicine, we measure vital signs such as temperature, heart rate, respiratory rate, and blood pressure in an individual. In public health, we measure vital statistics: births, deaths, and causes of death in a community. Public health agencies count who lives and who dies, support analyses on why people die, and implement programs to avert those deaths.

Given all the public and commercial interest in longevity, I was dismayed that my news and social media feeds weren’t overflowing with the most important recent news about longevity: Americans are living longer than they’ve ever lived before. In the Centers for Disease Control and Prevention’s annual report on longevity, life expectancy for the U.S. population in 2024 rose 0.6 years to 79 years.

The top three causes of death remained the same as in previous years: heart disease, cancer, and unintentional injuries. There was a substantial decline in overdose deaths, and Covid-19 was no longer among the 10 leading causes of death.

From a public health perspective, the main reason humans live longer than they did a century ago have only partly to do with medical care. The biggest gains came from improvements in water, sanitation, and hygiene, which were then followed by medical interventions, such as vaccines and antibiotics.

Even today, the best estimates suggest that medical care accounts for only 5%-15% of improvements in life expectancy, with most of the rest driven by social, behavioral, and environmental factors.

My advice on longevity

So what does this mean for individuals? I don’t want to be too dismissive of the importance of health care. For people with underlying diseases, health care can be life-saving. Too many Americans still die from inadequate care for diabetes, high blood pressure, asthma, HIV, and many other conditions. I screen adults for breast, cervical, and colon cancer because strong evidence shows that early detection improves both length and quality of life.

That said, my advice to my friends and family about longevity is based on what we know from the public health and medical literature. Keep your BMI between 18.5-24.9. Exercise every day. Do not smoke cigarettes. Limit the amount of alcohol you drink.

And, if you have the means, get a good education, and find a career where you make a decent income and live in an area with lower air pollution and fewer traffic accidents.

Wishing you a long life,

Jay

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

School nurses, staff often not paid to work over breaks

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Records show quarantine delays at five Spartanburg schools

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hello from Nairobi.

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

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

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

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

9.4 million: the death toll of aid cuts

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

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

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

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

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

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

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

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

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

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

Can philanthropy save us?

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

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

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

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

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

A resurgence of cholera … vaccines!

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

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

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. (Think conflict or flooding.) Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

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

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

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

Taking ‘addictive’ snacks seriously

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

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

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

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

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

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

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

Just enough WHO funding

Let me end on a bit of good news.

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

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

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

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

I’ll see you next week!

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

‘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

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Hello and welcome to Healthbeat’s new weekly report that aims to provide context about important topics in public health from around the United States.

My name is Dr. Jay K. Varma, and I am a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a national nonprofit focused on economic mobility and well-being for vulnerable communities. (The views expressed here are my own and do not represent Fedcap.)

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

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

CDC not updating data on vaccine-preventable diseases

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

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

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

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

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

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

Early detection of cancer through blood tests? Buyer beware

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Jay

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ivermectin approved for worms, lice, rosacea

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

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

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

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

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

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

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

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

Cancer patients regularly asking about ivermectin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He also aimed to temper expectations.

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

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

Public Health Service workers are quitting over assignments to Guantánamo

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

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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.

When conspiracy theories dictate global vaccine policy

2026-02-05T12:00:00+00:00

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Hello from Nairobi.

The realities of public health hit home for me this weekend. My daughter just started pre-K, a touching milestone I was repeatedly warned would bring more illness into our home. (I took this to mean perpetual sniffles.) Instead, after about a week, she shared a lovely bout of norovirus with me.

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

Vaccine conspiracies as global health policy

Gavi, the global organization that finances and distributes vaccines in poorer countries, finds itself in a funding standoff with the United States, Reuters reports.

For reference, “the U.S. previously contributed around 13% of Gavi’s funding,” and still has outstanding funds owed to the organization from the Biden era.

The issue at hand?

You might assume this is tied to America’s broader reworking of the global health budget, but… it is not. Instead, the Trump administration has told the global vaccine group “to phase out shots containing thimerosal as a condition of providing the group with funding.”

If you (like me) have made it this far in your life without needing to know what thimerosal is, let me present you with the disappointing news: It is a benign preservative at the center of several vaccine/autism conspiracy theories.

I reached out to Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, and one of the world’s foremost experts on vaccine development and vaccine misinformation to get his take.

He cautioned against “sanewashing” conspiracy claims or even detailing them next to mainstream vaccine science, which creates a “false equivalency,” as if both sides deserve equal weight.

“The thimerosal/autism link was debunked many years ago through both large epidemiological studies and even nonhuman primate neurodevelopment studies,” Hotez said, with the overwhelming fatigue of somebody who has explained this several hundred times before. “Many of these false links were popularized by [U.S. Health and Human Services Secretary Robert F. Kennedy Jr.’s] discredited 2005 article published in Rolling Stone and Salon magazines, since retracted by the editors.” As for the ultimate impact on Gavi, it remains to be seen whether the administration follows through, or whether Gavi decides to cave to the anti-science demand.

But “it’s tragic for the world’s children that now their access to vaccines and immunizations could be imperiled by this kind of pseudoscience,” Hotez said.

We’re winning the worm war

Guinea worm disease is on the verge of eradication, with just 10 infections reported worldwide last year, the Washington Post reports.

Disease breakdown: Guinea worm (also known as Dracunculiasis) is a parasite that spreads through drinking contaminated water, or eating infected animals. I’ll spare you the gory details (because this one is a true stomach turner), but it forms a terrible worm-filled blister. Though not lethal, at its peak in the 1980s, it was endemic across 20 countries and infected about 3.5 million people per year. Four decades later, there is still no treatment beyond pain meds.

The global effort to eliminate the disease has been led by the Carter Center since the 1980s. Last year’s total caseload is a drop from 15 cases in 2024 and consists of “four human cases … reported in Chad, four in Ethiopia, and two in South Sudan.”

The organization reports that the global aid pullback “has not stopped the Guinea worm program at ground level.”

What’s particularly incredible about the ongoing elimination project is that there is no vaccine or cure for guinea worm. This global effort’s success is largely the byproduct of sustained, committed gruntwork, with decades of programs to “educate the public, train volunteers, and distribute water filters in affected areas.”

I have two takeaways: First, we are clearly winning this war against the worm. If Guinea worm cases reach zero, it would be only the second human disease ever eradicated, after smallpox. (That said, I’m still hopeful we’ll first eliminate polio before the decade is out.)

Second, the last mile will be the hardest. Unlike polio or smallpox, Guinea worm also has animal hosts. Officials say the grunt work must continue, even after zero human cases. The disease can bounce back unless animal transmission (including dogs, domestic cats, and freshwater fish) is stopped, too.

Still, if Guinea worm fades into history, the credit belongs to the community health workers and volunteers who kept at the slow, quiet work for decades, moving village by village.

ChatDNA

Last week I was admittedly a bit flippant about a story on artificial intelligence helping pharma companies speed up the “unsexy” side of drug trials. Well, this week brings a more humbling piece on AI’s promise in driving real medical advancement.

Smithsonian magazine reports that researchers at Google DeepMind have unveiled a new artificial intelligence tool called AlphaGenome.

The tool leverages what AI does best (processing and learning from enormous datasets) to crunch the full book of our DNA. Essentially, it’s meant to help scientists predict how the parts of DNA we still cannot fully explain help tell our cells what to make, and when and how to make it.

The piece has a world-class explainer on the fundamental science:

“DNA is made of four different units called nucleotides: adenine (A), cytosine (C), guanine (G), and thymine (T). These letters pair up and act as an instruction manual for cells, yet only 2% of human DNA tells our cells how to build proteins, the building blocks of life. The remaining genetic code was long dismissed as “junk DNA,” but now, scientists know it plays an important role in regulating gene activation. Certain variants and mutations in the genome can lead to disease — and AlphaGenome’s goal is to predict what those changes are.”

So what’s the promise? The designers of the AlphaGenome believe the tool “can help experts develop new genetic therapies and ways to diagnose rare diseases.” Especially by pointing human researchers toward complex genetic links that are hard to spot on their own. Best of all: “The new resource is freely available to other researchers, who can modify the program based on their own needs.”

The tool has limitations, of course, including issues predicting the impact of DNA regions that influence each other at a great distance (meaning the segments are several hundred thousand letters away).

Still, I will be looping back in the coming months. As Pushmeet Kohli, vice president of science at Google DeepMind, put it: “I think we are at the start of a new era of scientific progress, and AI is going to enable a number of different breakthroughs.”

I have to admit … I believe it.

We. Declare. ‘Water bankruptcy!’

The United Nations says the world has entered a new kind of water crisis, one it calls “global water bankruptcy,” Health Policy Watch reports. That means rivers, lakes, and underground sources that once bounced back after droughts or heavy use are being drained faster than they can recover.

Perhaps the starkest example is the Aral sea in central Asia. In the late ’80s it was still the world’s fourth-largest lake. Today it barely exists.

Not to lay it on thick, but the report hits you with some staggering facts:

“More than half of the world’s large lakes have lost water since the early 1990s, over 30% of glacier mass since 1970 has disappeared in certain regions, while about 410 million hectares of natural wetlands — a land mass nearly equal to that of the European Union — have been destroyed over the past five decades.”

And the human impact?

Today about “4 billion people — nearly two-thirds of the global population — face severe water scarcity for at least one month every year.” The report particularly points to farmers in dry regions who pump groundwater for irrigation year after year, a practice that physically cannot continue indefinitely.

What’s my takeaway?

I find these reports largely overwhelming, because the solutions are not mysterious. National governments across the world need to act to protect water sources, manage them better, and plan for scarcity. Will they? Not anytime soon.

Tangent here, but I’m reading What We Can Know by Ian McEwan, which is set in a future Britain after a climate collapse. In the book, historians look back on our current era as a period they call “The Derangement,” when people had clear knowledge of climate change but failed to act at the needed scale.

With this report it is, uh … uncomfortably on the nose.

Mosquitoes keep moving

I’m leaving you this week on a story with a somewhat fascinating twist.

Chile is on high alert after finding an Aedes aegypti mosquito in the capital of Santiago, reports El Mercurio, the country’s largest newspaper.

Why is this such bad news? The mosquito, which is still absent from large parts of the country, is known as a major vector for a host of highly transmissible diseases including dengue, chikungunya, Zika, and yellow fever. Enough so that it’s commonly called the “dengue mosquito” or “yellow fever mosquito.” It also particularly thrives in cities, breeding in locations like flower vases, plastic bottles, gutters, and even old tires.

As we reported in October, this is an insect that sticks around. “Once Aedes aegypti mosquitoes establish themselves in an area warm enough for them to survive the winter, it becomes extremely difficult to eliminate them,” Dr. Marietjie Venter, an animal-borne virus expert, told me last year.

Granted, this is not the first time the mosquito has appeared in Chile. But as climate change makes the country increasingly habitable for it, health officials are worried sightings this year could signal the mosquito establishing a foothold … and introducing a perpetual risk of terrible tropical diseases. It would not take much. After all, as Chile’s head of health emergencies, Ester Alywin, warned on Friday, “a single female mosquito can lay up to 1,500 eggs in her lifetime.”

What’s the twist?

The singular mosquito was identified by eye by an airport staff member at a warehouse in Santiago International, then caught and then sent for analysis at a public laboratory.

Readers, I’ve searched for more detail on how staff could possibly be trained well enough to recognize and capture a single, specific mosquito (!) rather than just swatting it … but I’ve come up empty. Apparently, someone took their annual public health briefings seriously.

Anyhow, you’re my hero of the week, anonymous Chilean airport warehouse worker.

I’ll see you next week.

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

S.C. hospital system with maternity unit measles exposure to require masks

2026-02-04T23:51:32+00:00

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South Carolina’s measles outbreak is prompting Prisma Health, one the state’s major health care systems, to begin requiring masks for anyone entering its hospitals’ labor and delivery units and other birthing areas, as well as its emergency departments.

Prisma Health’s announcement on Wednesday came two days after Healthbeat revealed measles exposure incidents in the labor and delivery unit at Prisma Health Greer Memorial Hospital and in the emergency department of Prisma Health Greenville Memorial Hospital, as well as at some of the system’s other urgent care and private practice offices.

At a press conference, Prisma physicians said the new masking requirements are an additional safety measure being taken in response to the growing outbreak, which has had a spike in new cases since the holidays. As of Tuesday, state health officials had confirmed 876 measles cases, mostly in and near Spartanburg County.

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

“There is no incident that has prompted this,” said Dr. Kendreia Dickens-Carr, a Prisma Health OB-GYN. “This is a public health concern, and the measures that we are taking is to prevent any more [cases].”

Dickens-Carr said obstetric floors at Prisma Health hospitals across South Carolina, just like the emergency departments, will enforce masking on entry for all patients and those accompanying them until they have been evaluated to determine if they have an infectious disease.

In labor and delivery and other birthing areas, any patient or care partner who has a fever, rash, or respiratory symptoms will be asked to keep wearing their mask, the Prisma press release said.

Internal state health department records obtained by Healthbeat under South Carolina’s public records law list several public exposure incidents during December and January across Prisma Health facilities, from hospitals to urgent care centers and pediatrics practices. Similar measles exposure incidents have also occurred in facilities operated by the region’s other major health provider, the Spartanburg Regional Healthcare System, the records show.

The exposure at the labor and delivery unit at Prisma Health Greer Memorial Hospital, which is located between Spartanburg and Greenville, is of particular concern, experts say, because of the increased risks measles poses to unvaccinated mothers and their babies.

Prisma Health has not answered Healthbeat’s questions since last week about how and when the exposure occurred at the labor and delivery unit and whether anyone became infected. The Prisma Health representatives at Wednesday’s press conference again declined to answer these questions.

The risks of pregnant women being exposed to measles was among issues highlighted Wednesday by South Carolina state epidemiologist Dr. Linda Bell in her weekly call with reporters about the current state of the outbreak.

How the South Carolina measles outbreak grew from 5 to 876 cases

Bell said the South Carolina Department of Public Health has learned of 19 people, including children and adults, who have required hospitalization for complications of measles since the outbreak started last fall. These complications have included measles encephalitis in children – a dangerous swelling of the brain that can have long-term consequences.

“Additionally, several pregnant women were exposed to and required administration of immune globulin to protect against the high risk of complications for measles to pregnant women and their newborns that they could infect,” Bell said.

Immune globulin is a type of protective antibody treatment. Bell declined to provide additional details or say whether the exposures occurred in health care settings.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2. Search for providers that specifically work with uninsured patients

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

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

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

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

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

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

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

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

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

3. Call your local health department

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

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

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

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

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

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

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

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

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

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

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

5. Your diagnosis might lead you to specialized resources

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

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

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

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

“Everything is out there,” she said.

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

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

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

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

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

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In South Carolina’s surging measles outbreak, infectious people have exposed others to the virus in the labor and delivery unit of a hospital – where babies are at high risk of infection, as well as in the workplaces of some of the region’s major employers, including manufacturing plants for BMW and Michelin.

Internal records obtained by Healthbeat from the South Carolina Department of Public Health’s outbreak response reveal more about the scope of the outbreak’s impact within the state and across the country than has been previously made public.

The documents, obtained under South Carolina’s public records law, also show the state’s outbreak has resulted in measles exposure incidents in public locations in several other states. They include infectious people from South Carolina who attended a large youth conference in Kentucky, went to a hospital in Florida, and visited busy travel convenience stores in Georgia and Texas.

How the South Carolina measles outbreak grew from 5 to 847 cases

Within South Carolina, the department’s internal outbreak reports, as well as emails updating the state’s governor’s office, reveal numerous measles exposure events inside health care facilities. Many have involved urgent care clinics. Others have occurred when infectious people exposed others to the virus at hospitals and pediatrics practices.

The reports note the challenges state health department officials have faced trying to stop one of the largest measles outbreaks in decades, including making sure those in quarantine understand they need to stay at home and away from others, and dealing with some schools that have been slow to cooperate with outbreak investigations. The records reveal the department issued a final notice last month to a private Christian school, warning that it was about to face enforcement action for failing to fully share information about exposed students.

After initially growing slowly since the outbreak was identified on Oct. 2 with just five cases, the number of measles cases exploded in January, nearing 850 confirmed infections by the end of the month. For now, the outbreak is mostly in and near Spartanburg County, in the northwest part of South Carolina, where it’s being fueled by clusters of unvaccinated children and adults.

South Carolina travelers expose people in other states

While health officials in Washington state, North Carolina, and California have announced recent measles cases in their states that are linked to the South Carolina outbreak, the documents obtained by Healthbeat list additional states and locations where infectious people who are part of the outbreak have traveled.

According to the South Carolina DPH’s internal briefing reports for its director, there were exposure incidents during December and January involving contagious South Carolina residents who traveled to Kentucky, where exposures occurred at a “Large NYE Youth Conference” and also at a Hyatt Place hotel; in Georgia at a Love’s travel center; in Texas at a Buc-ee’s travel center; and in Florida at an Embassy Suites hotel.

In addition, there was a potential public exposure at a hospital in Florida, according to a Dec. 29 email from the South Carolina health department to the South Carolina’s governor’s office. The email did not include the hospital’s name or location.

The other reports released to Healthbeat provide little information about the circumstances of the public exposure sites or whether anyone became infected. In most cases, the reports only list the names of sites of public exposures that have occurred in the previous 21 days – which is the maximum period of time it can take for a person to develop symptoms after being exposed to measles.

The South Carolina DPH told Healthbeat its staff was not able to quickly provide more details about the locations listed in the records. Officials with Hyatt, Love’s, Buc-ee’s, and Embassy Suites’ operator Hilton did not answer Healthbeat’s questions about the exposure incidents listed in the reports.

A spokesperson for the Texas Department of State Health Services said it had not been notified of a measles exposure incident at a Buc-ee’s there during this time period. Officials at the Florida Department of Health did not respond to questions from Healthbeat seeking more information about the hospital and Embassy Suites exposures there.

It’s also unclear exactly where or when the “Large NYE Youth Conference” occurred in Kentucky. The South Carolina DPH said it doesn’t have specific details of the event. Officials at the Kentucky Department for Public Health did not answer Healthbeat’s questions about the conference or the separate exposure incident at a Hyatt Place hotel, which appears to have resulted in the infection of a Kentucky resident.

Last month, the local health department in Lexington-Fayette County, Kentucky, issued a measles alert saying an “unvaccinated, out-of-state traveler” stayed at the Hyatt Place in Hamburg, Kentucky, from Dec. 31 through Jan. 2, and also visited a Panera in Hamburg on Jan. 1. No mention was made of the South Carolina outbreak.

An unvaccinated Kentucky resident who was exposed to this “out-of-state traveler” later tested positive for the disease, the Kentucky DPH announced on Jan. 15. A department spokesperson did not answer Healthbeat’s questions about whether the Hamburg exposures and measles infection are linked to the South Carolina outbreak.

Exposures include hospitals, a maternity unit, urgent care centers

Within South Carolina, the state health department’s internal outbreak reports reveal more measles exposure locations than just the schools and stores, restaurants, businesses, and others that have been publicly shared in the information released to the public.

South Carolina state epidemiologist Dr. Linda Bell, in emailed comments to Healthbeat, said the state only notifies the public of the locations of measles exposure incidents when the department knows the specific date and time the exposure occurred, and when it cannot notify all those who have been directly exposed to the infectious person.

In recent weeks, Bell has spoken at media briefings about health care facilities – without naming names – as a place where measles exposures and infections have been occurring.

“We have seen transmission associated with exposures in health care settings,” Bell said during a Jan. 28 briefing. She said the department continues to encourage health care facilities to put masks on people who arrive with symptoms of respiratory illness, which can be early symptoms of measles, and isolate them from waiting areas where other people might be exposed.

Bell said health facilities also should make sure their workers – including administrative and intake staff – are vaccinated. “We are having to track a number of workers across disciplines and health care settings who have been exposed,” Bell said.

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

State health officials and members of the medical community have been urging that anyone who may have measles call before visiting health facilities, so that arrangements can be made to safely provide assessment and care – such as through a remote telemedicine appointment, an after-hours office visit, or admission to a special hospital isolation unit.

The newly released documents detail the names of hospitals, urgent care clinics, and some practice locations where infectious people have exposed others to measles.

Two of the major health systems serving the South Carolina Upstate region at the center of the outbreak – Spartanburg Regional Healthcare System and Prisma Health – have had multiple incidents where infectious people went into their facilities and exposed others to measles in the December through January period, the state health department’s records show.

One of the listed exposure incidents occurred in the labor and delivery unit at Prisma Health Greer Memorial Hospital, which is located between Spartanburg and Greenville. A spokesperson for Prisma would not answer questions about the incident or whether any infections were associated with it.

Measles is especially dangerous to babies, who are too young to be vaccinated, according to the Centers for Disease Control and Prevention. The virus spreads through the air and infectious particles can remain in a room for two hours after the infected person has left the area.

“Exposure to measles in a labor and delivery unit is highly concerning because measles is extremely contagious and poses serious risks to both pregnant people and those who may not be fully protected against measles,” said Dr. Michael Warren, chief medical and health officer for the March of Dimes, who previously served as the associate administrator of the federal Health Resources and Services Administration’s maternal and child health bureau.

While not commenting on the specific incident in South Carolina, Warren told Healthbeat that the ability of the measles virus to linger in the air for hours increases the likelihood of exposures occurring in that kind of a health care setting. The Birthplace at Greer Memorial Hospital has 10 labor, delivery, recovery and postpartum and recovery rooms, according to a promotional video on its website.

“Labor and delivery units care for multiple patients, with pregnant and postpartum women, newborns, and health care workers in close proximity, so even a single measles exposure can lead to rapid spread if not identified and managed quickly,” Warren said. He added that because newborns and pregnant people can’t receive the measles vaccine, those who are exposed may need special treatment with immunoglobulin, a substance that helps fight infections.

In addition to the exposure incident at Greer Memorial Hospital, other Prisma Health facilities that are listed in the records as sites of public measles exposures include: Greenville Memorial Hospital and its emergency department; Prisma Health Pediatrics in Greer; Prisma Health Urgent Care locations in Boiling Springs and Greenville; and Prisma Pediatrics - Spartanburg.

A South Carolina Department of Public Health nurse holds a box containing vaccine for a mobile clinic in Spartanburg County. Two doses of the vaccine is 97% effective at protecting against infection with measles, according to the Centers for Disease Control and Prevention.

Prisma Health did not answer questions about whether it is aware of any measles infections occurring in association with exposure incidents in its facilities. In a brief emailed statement, a spokesperson for the system noted that measles is highly contagious and that people can spread the virus before they are diagnosed.

“Prisma Health has taken extensive proactive measures during the measles outbreak to protect patients, visitors, and team members, including visitor restrictions, enhanced masking policies, additional precautions, and broad patient and community education,” the statement said.

Spartanburg Regional Healthcare System also wouldn’t answer questions about the specific exposure incidents inside its facilities and whether any have resulted in infections. Among the system’s facilities noted in the records for exposures: Spartanburg Regional Medical Center, Spartanburg Regional ER, and Pelham Medical Center.

In an emailed statement, the system said it has taken several actions to address the risks of measles exposure in its facilities. They include signs posted at Medical Group of the Carolinas practices to inform patients about the signs and symptoms of measles and instructing them to stay in their vehicles, call the practice’s phone number, and wear a mask. Masks are being required in all of the system’s emergency rooms and immediate care centers. “Associates and providers also are taking airborne precautions – such as wearing masks – when evaluating patients who might have measles,” the system said.

Measles enters BMW, Michelin manufacturing plants

Beyond health care facilities, the documents also show exposures at some major employers in the Spartanburg area that have not been included in the information the state health department has released publicly.

The most prominent of the employers listed in the records are BMW and Michelin.

BMW Manufacturing employs more than 12,000 people at BMW Group Plant Spartanburg, which assembles BMW sports activity vehicles and coupes on what the company describes as its 10 million-square-foot campus. Michelin has had a major tire manufacturing presence in the Spartanburg area for decades.

The state health department flagged the exposures at the BMW and Michelin plants to the state’s governor’s office in a Jan. 12 email with outbreak updates.

In a statement to Healthbeat, BMW said: “The Plant Spartanburg workforce has been informed about the measles cases at the plant. We are following guidance from the South Carolina Department of Public Health and are in regular communication with our teams regarding recommended health protocols.”

The BMW statement said it is providing measles vaccinations onsite and that the company is sharing updates and resources with employees. “We will continue to monitor the situation closely and encourage anyone who is unvaccinated or uncertain about their vaccination status to contact their health care provider promptly,” the company said.

A spokesperson for Michelin declined to answer questions about its exposure and what actions the company is taking in response.

Outbreak investigators face challenges at some schools

Since the South Carolina outbreak began in October, hundreds of students in the Spartanburg area have needed to quarantine at home – and stay out of classes – because they have been exposed to someone who was contagious with measles.

While many schools have helped the state health department’s outbreak investigators identify which students have been exposed and need to be quarantined because they are not fully vaccinated or lack immunity from prior infection, the records obtained by Healthbeat show that others have been slow to provide information.

As measles exploded, officials in Texas looked to CDC scientists. Under Trump, no one answered.

In one case, the health department got to the point of threatening enforcement action.

Last month, the South Carolina DPH issued a final warning to Westgate Christian School in Spartanburg that it was about to be served with a public health order and face possible penalties because of its failure to comply with an outbreak investigation, according to the records and additional information Bell provided in response to Healthbeat’s questions.

“Being able to identify and notify staff and students who may have been exposed and are at risk for measles is very important to our efforts to limit the spread of measles to the greatest degree possible,” Bell said. “In order to do so, we require lists from the school of those who may be at risk. Schools that don’t provide the full information needed to contact those at risk within 48 hours are considered noncompliant.”

According to Bell, on Dec. 29 the state health department provided a formal, written request to Westgate seeking contact information for students identified as close contacts of a person with measles. The list that the school provided on Dec. 31 was “insufficient,” Bell said.

Bell said the department issued a final notice to the school on Jan. 9, warning that if the requested information wasn’t received by 1 p.m. on Jan. 10, the department “would issue a Public Health Order pursuant to S.C. Code § 44-1-140 compelling compliance.” Under its authority to collect information to address threats to public health, she said the department can take enforcement actions including fines and other legal actions when organizations fail to comply.

Bell said the school provided the required information on Jan. 10, resolving the issue.

Pastor James Wooten, who is listed as the school’s president, told Healthbeat that the school drew the warning because of “some confusion.” The school is a ministry of Westgate Baptist Church. Wooten said that the final notice was unexpected and that the school thought it had provided the health department with the requested information.

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

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

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

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

Hello from Nairobi.

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

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

U.S. pulls out of the WHO

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

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

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

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

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

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

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

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

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

His takeaway?

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

A Nipah virus outbreak

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

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

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

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

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

Neither screw nor worm; still horrible

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

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

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

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

Why is it back?

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

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

A million missing midwives

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

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

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

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

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

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

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

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

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

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

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

I’ll see you next week.

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

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

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

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

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

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

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

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

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

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

Is Covid during pregnancy linked to autism? What a new study shows, and what it doesn’t

Although Covid has become less deadly, because of population immunization and mutations making the virus less severe, researchers say the politicization around the infection is obscuring what science is increasingly confirming: Covid’s potential to cause unexpected, possibly chronic health issues. That in turn, these scientists say, drives the need for more, rather than less, research, because over the long term, Covid could have significant economic and societal implications, such as higher health care costs and more demands on social programs and caregivers.

The annual average burden of the disease’s long-term health effects is estimated at $1 trillion globally and $9,000 per patient in the United States, according to a report published in November in the journal NPJ Primary Care Respiratory Medicine. In this country, the annual lost earnings are estimated to be about $170 billion.

One study estimates that the flu resulted in $16 billion in direct health costs and $13 billion in productivity losses in the 2023-24 season, according to a Dec. 30 report in medRxiv, an online platform that publishes work not yet certified by peer review.

Studies show Covid’s growing reach

Much has been learned about Covid since the virus emerged in 2019, unleashing a pandemic that the World Health Organization reports has killed more than 7 million people. By the spring of 2020, the term “long Covid” had been coined to describe chronic health problems that can persist post-infection.

More recent studies show that infection by the virus that causes Covid, SARS-CoV-2, can result in heightened health risks months to more than a year later.

For example, researchers following children born to mothers who contracted the virus while pregnant have discovered they may have an increased risk for autism, delayed speech and motor development, or other neurodevelopmental challenges.

Another study found babies exposed to Covid in utero experienced accelerated weight gain in their first year, a possible harbinger of metabolic issues that could later carry an increased risk for cardiovascular disease.

These studies suggest avoiding severe Covid in pregnancy may reduce risk not just during pregnancy but for future generations. That may be another good reason to get vaccinated when pregnant.

“There are other body symptoms apart from the developing fetal brain that also may be impacted,” said Andrea Edlow, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School who was involved in both studies. “We definitely need more research.”

Epidemiologists point to some specific, emerging challenges.

A U.K. study in the New England Journal of Medicine found people who fully recovered from mild Covid infections experienced a cognitive deficit equal to a three-point drop in IQ. Among the more than 100,000 participants, deficits were greater in people who had persistent symptoms and reached the equivalent of a nine-point IQ drop for individuals admitted to intensive care.

Ziyad Al-Aly, a clinical epidemiologist who has studied longer-term health effects from Covid, did the math. He estimated Covid may have increased the number of adults in the United States with an IQ of less than 70 from 4.7 million to 7.5 million — a jump of 2.8 million adults dealing with “a level of cognitive impairment that requires significant societal support,” he wrote.

“People get Covid-19, some people do fine and bounce back, but there are people who start experiencing problems with memory, cognition, and fuzzy brain,” he said. “Even people with mild symptoms. They might not even be aware.”

Diane Yormark, 67, of Boca Raton, Florida, can relate. She got Covid in 2022 and 2023. The second infection left her with brain fog and fatigue.

MRNA vaccines, once a Trump boast, now face attacks from some in GOP

“I felt like if you had a little bit too much wine the night before and you’re out of it,” said Yormark, a retired copywriter, who said the worst of her symptoms lasted for about three months after the infection. “Some of the fog has lifted. But do I feel like myself? Not like I was.”

Data from more than a dozen studies suggest Covid vaccines can help reduce risk of severe infection as well as longer-lasting health effects, although researchers say more study is needed.

But vaccination rates remain low in the United States, with only about 17% of the adult population reporting that they got the updated 2025-26 shot as of Jan. 16, based on CDC data.

Trump administration officials led by HHS Secretary Robert F. Kennedy Jr. have reduced access to Covid vaccines despite the lack of any new, substantiated evidence of harm. Though the shots were a hallmark achievement of the first Trump administration, which led the effort for their development, Kennedy has said without evidence that they are “the deadliest vaccine ever made.”

In May he said on X that the CDC would stop recommending Covid shots for healthy children and pregnant women, citing a lack of clinical data. The Food and Drug Administration has since issued new guidelines limiting the vaccine to people 65 or older and individuals 6 months or older with at least one risk factor, though many states continue to make them more widely available.

The Trump administration also halted almost $500 million in funding for mRNA-based vaccines. Administration officials and a number of Republicans question the safety of the Nobel Prize-winning technology — heralded for the potential to treat many diseases beyond Covid — even though clinical trials with tens of thousands of volunteers were performed before the Covid mRNA vaccines were made available to the public.

And numerous studies, including new research in 2025, show Covid vaccine benefits include a reduction in the severity of disease, although the protective effects wane over time.

How Covid may affect brain health

Researchers say more and broader support is important because much remains unknown about Covid and its impact on the body.

The growing awareness that, even in mild Covid cases, the possibility exists for longer-term, often undetected organ damage also warrants more examination, researchers say. A study published this month in eBioMedicine found people with neurocognitive issues such as changes in smell or headaches after infection had significant levels of a protein linked to Alzheimer’s in their blood plasma. EBioMedicine is a peer-reviewed, open-access journal published by The Lancet.

In the brain, the virus leads to an immune response that triggers inflammation, can damage brain cells, and can even shrink brain volume, according to research on imaging studies that was published in March 2022 in the journal Nature.

An Australian study of advanced brain images found significant alterations even among people who had already recovered from mild infections — a possible explanation for cognitive deficits that may persist for years. Lead study author Kiran Thapaliya said the research suggests the virus “may leave a silent, lasting effect on brain health.”

Al-Alay agreed.

“We don’t know what will happen to people 10 years down the road,” he said. “Inflammation of the brain is not a good thing. It’s absolutely not a good thing.”

That inflammatory response has also been linked to blood clots, arrhythmias, and higher risk of cardiovascular issues, even following a mild infection.

A University of Southern California study published in October 2024 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology found the risk for a major cardiac event remains elevated nearly three years after Covid infection. The findings held even for people who were not hospitalized.

“We were surprised to see the effects that far out” regardless of individual heart disease history, said James R. Hilser, the study’s lead author and a postdoctoral fellow at the UCLA David Geffen School of Medicine.

Covid can also reactivate cancer cells and trigger a relapse, according to research published in July in the journal Nature. Researchers found that the chance of dying from cancer among cancer survivors was higher among people who’d had Covid, especially in the year after being infected. There was nearly a twofold increase in cancer mortality in those who tested positive compared with those who tested negative.

The potential of the Covid virus to affect future generations is yielding new findings as well. Australian researchers looked at male mice and found that those who had been infected with and then recovered from Covid experienced changes to their sperm that altered their offspring’s behavior, causing them to exhibit more anxiety.

Meanwhile, many people are now living — and struggling — with the virus’ after-effects.

Dee Farrand, 57, of Marana, Arizona, could once run five miles and was excelling at her job in sales. She recovered from a Covid infection in May 2021.

Two months later, her heart began to beat irregularly. Farrand underwent a battery of tests at a hospital. Ultimately, the condition became so severe she had to go on supplemental oxygen for two years.

Her cognitive abilities declined so severely she couldn’t read, because she’d forget the first sentence after reading the second. She also had to leave herself reminders that she is allergic to shrimp or that she likes avocados. She said she lost her job and returned to her previous occupation as a social worker.

“I was the person who is like the Energizer bunny and all of a sudden I’d get so tired getting dressed that I had to go back to bed,” Farrand said.

While she is better, Covid has left a mark. She said she’s not yet able to run the five miles she used to do without any problems.

This story originally published at KFF Health News, Healthbeat’s national reporting partner.

What’s going well: Marburg virus winding down. A cheap malaria defense. The future of antibiotics.

2026-01-22T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week’s news has an unexpected but welcome throughline: optimism! From effective outbreak control to promising new research, we have a few stories that suggest key parts of the global health system are still functioning well, even under strain. (For the disappointed masochists out there, don’t worry. I’ll likely be back with some bummer news next week.)

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Marburg virus: Not too early to celebrate

We’ve been covering how Ethiopia is faring during its first-ever outbreak of Marburg virus, an Ebola-like hemorrhagic disease with no vaccine.

How this outbreak unfolds matters beyond this one country and one disease. For me, it’s the second real test after last year’s Ebola flare-up in the Democratic Republic of the Congo of whether the international order still has the muscle to contain deadly outbreaks in an era of austerity.

Oddly, there has been very little sustained reporting on how the outbreak is actually progressing. (And, mea culpa, my cynic’s heart usually assumes no news means bad news!) So as I promised last week, I’ve followed up. I reached out to International Medical Corps, one of the organizations leading the Marburg fight, and spoke with Lawrence Mutharia, its country director for Ethiopia. What’s the state of play?

An unambiguous success.

“We are now at day 36 with no confirmed new cases,” Mutharia told me on Monday. He reports that the focus has shifted from an active response to making sure systems are in place if the virus resurfaces, “while waiting for the outbreak to be officially declared as over.”

This outcome was not guaranteed. The virus hit the outskirts of Jinka, a remote, under-resourced area with no prior experience handling a disease this lethal. I’ve hesitated to describe that reality too vividly in past updates, partly to avoid sliding into lazy stereotypes or misleading ideas about what “rural Africa” looks like. But the truth is that the communities surrounding Jinka follow culturally and socially traditional ways of life, with Indigenous conceptions of medicine that are far removed from modern biomedical practice. Without putting too fine a point on it: I have attended only one meeting in my life where participants arrived in full body paint, scarification, and feathered headdresses. It was in Jinka.

You could imagine this could be a tough setting for an outbreak response built on community cooperation with foreign medical guidance.

Nevertheless, Mutharia says that early, effective outreach to local communities was actually one of the response’s key strengths. That, a rapid influx of funding, early deployment of medical teams, and clear leadership from Ethiopia’s federal Ministry of Health. “Timely and coordinated efforts are crucial” for stopping fast-moving outbreaks like Marburg, he noted, and in this case they were deployed close to a best-case scenario.

Perhaps more importantly, and beating another one of my nagging fears, Mutharia told me that donor support for the response was “quite adequate.” That support included, to their credit, rapid funding from the U.S. State Department. Given the tightening of purse strings globally and America’s pullback last year, this was all the more striking. As Mutharia put it, “we are currently in a situation of trying to do more with less.”

My takeaway?

First, you have to applaud the responders to this crisis. And taken together with last year’s Ebola response in the DRC, this outbreak offers clear proof that the international community has lost neither the will nor the ability to respond to serious global health risks. For viruses like Marburg and Ebola (truly nightmare diseases) each day of delay makes them exponentially harder and more expensive to contain. At least for now, that lesson has not been unlearned.

Who controls Europe’s medicines?

Two stories out this week focus on Europe’s drug supply problem. (No, not the Ibiza kind.)

First, the Financial Times is reporting that U.S. pharmaceutical companies are openly threatening to withhold new medicines from Europe if governments refuse to pay higher prices.

Speaking at the JPMorgan health care conference, Pfizer CEO Albert Bourla framed the choice starkly: “When [we] do the math, shall we reduce the U.S. price to France’s level or stop supplying France? We [will] stop supplying France.” Other executives said they were considering delaying or skipping European launches altogether as they try to offset revenue lost from Trump-era price cuts in the United States.

At the same time, on Tuesday the European Parliament moved to shore up Europe’s pharmaceutical defenses. Lawmakers adopted proposals to rebuild manufacturing capacity inside the European Union and coordinate national stockpiles. Ultimately, the EU is pushing a “Buy European” approach that prioritizes security of supply and production within the bloc.

The takeaway? Europe is caught in a squeeze. Drugmakers are signaling they are willing to use access as leverage to raise prices, just as European lawmakers are trying to reduce their dependence on those same companies.

How the economics and politics will play out next is unclear, so I’ll be following up on this story.

Antibiotic optimism (with caveats)

A lot of modern medicine rests on a very fragile assumption that our antibiotics will keep working … and, uh, we know they won’t.

Drug-resistant infections kill millions of people globally each year, and new antibiotics are not being developed fast enough to keep up with the spread of resistance. (A large part of the issue is that antibiotics rarely recoup their R&D costs. In fact, biotech companies that specialize in them have a bad track record of going bust.)

But in an essay in the Washington Post, biochemist and antibiotic researcher Andre Hudson argues that the future may be a hopeful one. His case for optimism rests on the idea that (putting aside our laggardly development of new drugs) other scientific advancements may catch up to the threat.

He makes four main points: First, faster and more precise diagnostics are increasingly reducing unnecessary antibiotic use. Second, antibiotics are no longer the only tool in town. Hudson outlines how researchers are developing alternatives, including genetically engineered viruses (!) that hunt bacteria and gene-targeting tools to “disable resistance genes” in bacteria.

Third and fourth, Hudson finds hope in a clearer understanding of how resistance moves through entire systems, and in policy solutions meant to fix the economics behind antibiotic development. (Being frank here: This is where I feel the optimism is less earned.)

On the systems side, Hudson argues that drug resistance is finally being understood as more than a hospital problem. Antibiotics move through farms, food, wastewater, and trade, and that matters. But understanding the problem is not the same as controlling it. On policy, he points to ideas meant to fix the broken economics of antibiotics, including draft U.S. legislation that would pay companies for having lifesaving drugs available rather than selling more of them. It is a sensible fix. It has also been stuck in Congress for three years.

Still, a hopeful take!

American dollars … revisited?

Two stories out this week clarify what last year’s U.S. pullback in global health funding really amounted to, and what may come next this year.

The damage? All told, in 2025 the United States (still the world’s largest funder of global health) slashed its spending by roughly 66%, according to new end-of-year estimates reported in Think Global Health. It took months for this picture to come into focus, and “the cuts are bigger than we expected, not less,” said Joseph Dieleman, who leads financing tracking at the Institute for Health Metrics and Evaluation, a research group that analyzes health spending worldwide.

We’ve reported extensively on earlier data of the pullback, but it’s worth reading this article, particularly for the data visualization on where the cuts landed.

Looking forward, things are murkier … which is better than bad.

Devex is reporting that a draft, bipartisan foreign assistance bill for 2026 would allocate $9.4 billion for global health. That is still well below recent highs (down a quarter from the $12.4 billion in 2024) but far more than many expected after last year’s upheaval. The bill preserves core funding for HIV, malaria, tuberculosis, and polio, and includes unexpected support for the vaccine funding organization GAVI, alongside family planning money, and dollars for several U.N. agencies the administration had tried to zero out.

One takeaway is that this is a signal that the U.S. government is not ready to walk away from global health. Another is that the bill exposes a sharp divide between the majority Republican Congress and the Trump administration on global health funding.

Mitchell Warren, executive director of the HIV nonprofit AVAC (and a friend of the Checkup!) raises the most trenchant questions in the article: “Will both houses of Congress approve the bill? Will the president sign it? And, perhaps more importantly, will the president actually spend congressional appropriations and accept at last that it is Congress, and not him, who has the power of the purse?” he said.

What do these two stories mean together? “Bottom line is that while most programs have been gutted, most of the budgets are being preserved. Where and how those funds get spent remains to be seen,” Dieleman told me.

A ‘dirt cheap’ malaria defense

We’re going all in on optimism today, so why not end on a high note?

A clever new study suggests malaria prevention may already be woven into daily life, The Guardian reports. Researchers found that treating baby-carrying cloth wraps with insecticide cut malaria cases in infants by roughly two-thirds in parts of western Uganda.

The idea is brilliant. In many communities, babies spend much of the day tied to their mothers’ backs in cloth wraps. (I can’t stress enough just how ubiquitous this is in East Africa.) Treating those wraps with permethrin, the same insecticide used in bed nets, adds protection during hours when nets are not in use.

Anecdotal, but as one mother told the researchers: “I’ve had five children. This is the first one that I’ve carried in a treated wrap, and it’s the first time I’ve had a child who has not had malaria.”

The best part? “It’s dirt cheap,” reports one of the researchers.

As mosquitoes increasingly bite outdoors and earlier in the evening, treated wraps could help close one of malaria prevention’s most stubborn gaps. They won’t replace bed nets or vaccines, but they add protection exactly where infants already are, in a way that fits seamlessly into daily life.

I’ll see you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

As U.S. is poised to lose measles-free status, RFK Jr.’s new CDC deputy downplays its significance

2026-01-22T01:38:12+00:00

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After a year of ongoing measles outbreaks that have sickened more than 2,400 people, the United States is poised to lose its status as a measles-free country. However, the newly appointed principal deputy director at the Centers for Disease Control and Prevention, Ralph Abraham, said he was unbothered by the prospect at a briefing for journalists this week.

“It’s just the cost of doing business with our borders being somewhat porous for global and international travel,” Abraham said. “We have these communities that choose to be unvaccinated. That’s their personal freedom.”

Infections from other countries, however, accounted for only about 10% of measles cases detected since Jan. 20, 2025, the official start of the deadly measles outbreak in West Texas, which spread to other states and Mexico. The rest were acquired domestically. This marks a change since the United States eliminated measles in 2000. Measles occasionally popped up in the United States from people infected abroad, but the cases rarely sparked outbreaks, because of extremely high rates of vaccination. Two doses of the measles, mumps, and rubella vaccine strongly prevent infection and halt the virus’ spread.

To maintain its measles elimination status, the United States must prove that the virus has not circulated continuously in the nation for a year, between Jan. 20, 2025, and Jan. 20, 2026. To answer the question, scientists are examining whether the major outbreaks in South Carolina, Utah, Arizona, and Texas were linked.

Health officials confirmed that the main measles virus strain in each of these outbreaks is D8-9171. But because this strain also occurs in Canada and Mexico, CDC scientists are now analyzing the entire genomes of measles viruses — about 16,000 genetic letters long — to see whether those in the United States are more closely related to one another than to those in different countries.

The CDC expects to complete its studies within a couple of months and make the data public. Then the Pan American Health Organization, which oversees the Americas in partnership with the World Health Organization, will decide whether the United States will lose its measles elimination status. And that would mean that costly, potentially deadly, and preventable measles outbreaks could become common again.

“When you hear somebody like Abraham say ‘the cost of doing business,’ how can you be more callous,” pediatrician and vaccine specialist Paul Offit said in an online discussion hosted by the health blog Inside Medicine on Tuesday. “Three people died of measles last year in this country,” Offit added. “We eliminated this virus in the year 2000 — eliminated it. Eliminated circulation of the most contagious human infection. That was something to be proud of.”

Abraham said vaccination remains the most effective way to prevent measles but that parents must have the freedom to decide whether to vaccinate their children. Several states have loosened school vaccine requirements since 2020, and vaccine rates have dropped. A record rate of kindergartners, representing about 138,000 children, obtained vaccine exemptions for the 2024-25 school year.

Information on vaccines has been muddied by Health and Human Services Secretary Robert F. Kennedy Jr., who previously founded an anti-vaccine organization. He has undermined vaccines throughout his tenure. On national television, he has repeated scientifically debunked rumors that vaccines may cause autism, brain swelling, and death.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, disparaged the Trump administration’s focus on finding genetic technicalities that may spare the country’s measles-free status. “This is the wrong thing to pay attention to. Our attention has to be on stopping the outbreaks,” she said.

While scientists race to study spread of measles in U.S., Kennedy unravels hard-won gains

“If we keep our status, it should be because we have stopped the spread of measles,” she said. “It’s like they’re trying to be graded on a curve.”

The Trump administration impeded the CDC’s ability to assist West Texas during the first critical weeks of its outbreak and slowed the release of federal emergency funds, according to KFF Health News investigations. However, the agency stepped up its activity last year, providing local health departments with measles vaccines, communication materials, and testing. Abraham said HHS would give South Carolina $1.5 million to respond to its outbreak, which began nearly four months ago and had reached 646 cases as of Tuesday.

If the CDC’s genomic analyses show that last year’s outbreaks resulted from separate introductions from abroad, political appointees will probably credit Kennedy for saving the country’s status, said Demetre Daskalakis, a former director of the CDC’s national immunization center, who resigned in protest of Kennedy’s actions in August.

And if studies suggest the outbreaks are linked, Daskalakis predicted, the administration will cast doubt on the findings and downplay the reversal of the country’s status: “They’ll say, who cares.”

Indeed, at the briefing, Abraham told a reporter from Stat that a reversal in the nation’s status would not be significant: “Losing elimination status does not mean that the measles would be widespread.”

Data show otherwise. Case counts last year were the highest since 1991, before the government enacted vaccine policies to ensure that all children could be protected with measles immunization.

Lauren Sausser contributed reporting. Amy Maxmen is a national reporter for Healthbeat through a partnership with KFF Health News.

Consolidation may be the answer to more austere global health funding

2026-01-15T13:43:48+00:00

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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.

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.

Vaccines are helping older people more than we knew

2026-01-14T14:09:28+00:00

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Let’s be clear: The primary reason to be vaccinated against shingles is that two shots provide at least 90% protection against a painful, blistering disease that a third of Americans will suffer in their lifetimes, one that can cause lingering nerve pain and other nasty long-term consequences.

The most important reason for older adults to be vaccinated against the respiratory infection RSV is that their risk of being hospitalized with it declines by almost 70% in the year they get the shot, and by nearly 60% over two years.

And the main reason to roll up a sleeve for an annual flu shot is that when people do get infected, it also reliably reduces the severity of illness, though its effectiveness varies by how well scientists have predicted which strain of influenza shows up.

But other reasons for older people to be vaccinated are emerging. They are known, in doctor-speak, as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert.

The list of off-target benefits is lengthening as “the research has accumulated and accelerated over the last 10 years,” said William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

Some of these protections have been established by years of data; others are the subjects of more recent research, and the payoff is not yet as clear. The first RSV vaccines, for example, became available only in 2023.

Still, the findings “are really very consistent,” said Stefania Maggi, a geriatrician and senior fellow at the Institute of Neuroscience at the National Research Council in Padua, Italy.

The CDC sidelined these childhood vaccines. Here’s what they prevent.

She is the lead author of a recent meta-analysis, published in the British journal Age and Ageing, that found reduced risks of dementia after vaccination for an array of diseases. Given those “downstream effects,” she said, vaccines “are key tools to promote healthy aging and prevent physical and cognitive decline.”

Yet too many older adults, whose weakening immune systems and high rates of chronic illness put them at higher risk of infectious diseases, have not taken advantage of vaccination.

The Centers for Disease Control and Prevention reported last week that about 31% of older adults had not yet received a flu shot. Only about 41% of adults 75 and older had ever been vaccinated against RSV, or respiratory syncytial virus, and about a third of seniors had received the most recent Covid-19 vaccine.

The CDC recommends the one-and-done pneumococcal vaccine for adults 50 and older. An analysis in the American Journal of Preventive Medicine, however, estimated that from 2022, when new guidelines were issued, through 2024, only about 12% of those 67 to 74 received it, and about 8% of those 75 and older.

What we’re learning about flu and RSV shots

The strongest evidence for off-target benefits, dating back 25 years, shows reduced cardiovascular risk following flu shots.

Healthy older adults vaccinated against flu have substantially lower risks of hospitalization for heart failure, as well as for pneumonia and other respiratory infections. Vaccination against influenza has also been associated with lower risks of heart attack and stroke.

Moreover, many of these studies predate the more potent flu vaccines now recommended for older adults.

Could the RSV vaccine, protective against another respiratory illness, have similar cardiovascular effects? A recent large Danish study of older adults found a nearly 10% decline in cardiorespiratory hospitalizations — involving the heart and lungs — among the vaccinated versus a control group, a significant decrease.

Why flu season will likely be worse this year and how to prepare

Lowered rates of cardiovascular hospitalizations and stroke did not reach statistical significance, however. That may reflect a short follow-up period or inadequate diagnostic testing, cautioned Helen Chu, an infectious disease specialist at the University of Washington and co-author of an accompanying editorial in JAMA.

“I don’t think RSV behaves differently from flu,” Chu said. “It’s just too early to have the information for RSV, but I think it will show the same effect, maybe even more so.”

Vaccination against still another dangerous respiratory disease, Covid, has been linked to a lower risk of developing long Covid, with its damaging effects on physical and mental health.

What studies show about shingles vaccine and dementia

Probably the most provocative findings concern vaccination against shingles, aka herpes zoster. Researchers made headlines last year when they documented an association between shingles vaccination and lower rates of dementia — even with the less effective vaccine that has since been replaced by Shingrix, approved in 2017.

Nearly all studies of off-target benefits are observational, because scientists cannot ethically withhold a safe, effective vaccine from a control group whose members could then become infected with the disease.

That means such studies are subject to “healthy volunteer bias,” because vaccinated patients may also practice other healthy habits, differentiating them from those not vaccinated.

Although researchers try to control for a variety of potentially confounding differences, from age and sex to health and education, “we can only say there’s a strong association, not a cause and effect,” Maggi said.

But Stanford researchers seized on a natural experiment in Wales in 2013, when the first shingles vaccine, Zostavax, became available to older people who had not yet turned 80. Anyone who had was ineligible.

Over seven years, dementia rates in participants who had been eligible for vaccination declined by 20% — even though only half had actually received the vaccine — compared with those who narrowly missed the cutoff.

“There are no reasons people born one week before were different from those born a few days later,” Maggi said. Studies in Australia and the United States have also found reductions in the odds of dementia following shingles shots.

In fact, in the meta-analysis Maggi and her team published, several other childhood and adult vaccinations appeared to have such effects. “We now know that many infections are associated with the onset of dementia, both Alzheimer’s and vascular,” she said.

In 21 studies involving more than 104 million participants in Europe, Asia, and North America, vaccination against shingles was associated with a 24% reduction in the risk of developing dementia. Flu vaccination was linked to a 13% reduction. Those vaccinated against pneumococcal disease had a 36% reduction in Alzheimer’s risk.

Inside the FDA’s vaccine uproar: It’s not just about Covid shots

The Tdap vaccine against tetanus, diphtheria, and pertussis (whooping cough) is recommended for adults every 10 years, with vaccination among older adults often prompted by the birth of a grandchild, who cannot be fully vaccinated for months. It was associated with a one-third decline in dementia.

Other researchers are investigating the effects of shingles vaccination on heart attacks and stroke and of Covid vaccination on cancer survival.

Inflammation may play a role

What causes such vaccine bonuses? Most hypotheses focus on the inflammation that arises when the immune system mobilizes to fight off an infection. “You have damage to the surrounding environment” in the body, “and that takes time to calm down,” Chu said.

The effects of inflammation can far outlast the initial illness. It may allow other infections to take hold, or cause heart attacks and strokes when clots form in narrowed blood vessels. “If you prevent the infection, you prevent this other damage,” Chu said.

Hospitalization itself, during which older patients can become deconditioned or develop delirium, is a risk factor for dementia, among other health problems. Vaccines that reduce hospitalization might therefore delay or ward off cognitive decline.

Health officials in the Trump administration have assailed childhood vaccines more than adult ones, but their vocal opposition may be contributing to inadequate vaccination among older Americans, too.

Many will not only miss out on the emerging off-target benefits but will remain vulnerable to the diseases the vaccines prevent or diminish.

“The current national policy on vaccination is at best uncertain, and in instances appears anti-vaccine,” said Schaffner, a former member of the CDC’s Advisory Committee on Immunization Practices. “All of us in public health are very, very distressed.”

“The New Old Age” is produced through a partnership with The New York Times. This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Millions of Americans are expected to drop their Affordable Care Act plans. They’re looking for a Plan B.

2026-01-12T16:30:50+00:00

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It’s feeding time for the animals on this property outside Nashville, Tennessee. An albino raccoon named Cricket reaches through the wires of its cage to grab an animal cracker, an appetizer treat right before the evening meal.

“Cricket is blind,” said Robert Sory, who is trying to open a nonprofit animal sanctuary along with his wife, Emily. “A lot of our animals come to us with issues.”

The menagerie in Thompson’s Station includes Russian foxes, African porcupines, emus, bobcats, and some well-fed goats.

The Sorys are passionate about their pets and seem to put the animals’ needs before their own.

Both Robert and Emily started 2026 without health insurance.

Robert had been covered through a marketplace plan subsidized through the Affordable Care Act. His share of the monthly premiums was $0. When he looked up the rates for 2026, he saw that a barebones “bronze”-level plan would cost him at least $70 a month. He decided to forgo coverage altogether.

“When you don’t have any income coming in, it doesn’t matter how cheap it is,” he said. “It’s not affordable.”

Couple lost jobs within days of each other

Marketplace plans from the Affordable Care Act no longer feel very affordable to many people, because Congress did not extend a package of enhanced subsidies that expired at the end of 2025. Last week, the House did pass legislation to extend the expired subsidies, and negotiations have moved to the Senate. Without a deal, an estimated 4.8 million will go without coverage this year.

But even without a health plan, people will still need medical care. Many, like the Sorys, have been thinking through their plan B to maintain their health.

Georgia ACA enrollment falls as federal changes push prices higher

The Sorys both lost jobs in November, within days of each other. Robert worked as a farmhand. Emily worked at a staffing firm and lost her insurance along with her position.

“It’s a horrible, horrible market right now. Really tough,” she said.

The first time she had to pay out-of-pocket for her three monthly prescriptions, the cost was $184.

“To equate that to kind of how we think about it, you’re talking about 350 pounds of food for these animals,” Robert said. He pointed to his bobcats, who eat only meat.

Newly uninsured look for workarounds

To keep kibble in the food bowls, the Sorys are prepping for an uninsured future. They see the same psychiatrist and met with him to make a plan. He was willing to work with them by charging $125 per visit. They’ll have to go every three months to keep their prescriptions current.

And if other medical problems emerge? They’re hoping for the best.

“I’m not somebody who gets sick super often, thank God,” Robert said. “And if I do, generally I go to an emergency room where they’re going to bill me later.” Robert said he would arrange a repayment plan for bills like that.

Emily has costly health conditions and has already taken on substantial medical debt. “It’s just sitting there, and I’ve racked up money,” she said. “But I’ve had to go to the doctor.”

Emily Sory feeds foxes at her home in Thompson’s Station, Tennessee.

Help for uninsured includes donated drugs and sliding scales

Hospitals and clinics are bracing for the influx of newly uninsured patients. They’re also concerned that people won’t know about alternative ways to get medical care.

“We don’t have marketing dollars, so you’re not going to see big billboards or radio ads,” said Katina Beard, CEO of Matthew Walker Comprehensive Health Center in Nashville. It’s one of the country’s 1,400 federally qualified health centers, also called FQHCs.

FQHCs are partially funded by the federal government. Although they do not usually offer free care, their fees tend to be lower or on a sliding scale.

Uninsured people who get care receive a bill, Beard said, “but the bill will be based on their ability to pay.”

FQHCs often have on-site pharmacies, and some offer prescription medications free of charge through a partnership with the Dispensary of Hope, a Nashville-based nonprofit.

Many hospital pharmacies also partner with the nonprofit, which has distributed medication donated by pharmaceutical companies to 277 sites in 38 states. Participating pharmacies must make the medicine available free of charge to people without insurance who have annual incomes below 300% of the federal poverty limit.

The organization primarily sources medications for chronic conditions such as high blood pressure, diabetes, and mental health. Demand is expected to outstrip supply in the new year, according to CEO Scott Cornwell.

“We’re projecting and engaging with our manufacturers and asking them, ‘Are you willing to help support, for this future status that we are anticipating?’” he said. “By and large,” he said, pharmaceutical companies have said they’re willing to step up.

“It’s a continuous conversation that we’re having,” Cornwell said.

10 states have a Medicaid ‘gap’

Hospitals will also have to find a way to care for more patients who cannot pay. Industry groups such as the Federation of American Hospitals have been vocal about the threat to hospitals’ financial health and have urged Congress to extend the enhanced subsidies, which take the form of tax credits.

The impact might be most acute in states like Tennessee that have not expanded Medicaid to cover people who work but do not have job-based insurance and cannot afford it on their own.

Ten states have chosen not to expand Medicaid to uninsured, low-income adults — an optional provision of the ACA that is mainly paid for by federal funds.

This Medicaid “gap” is expected to cause uninsured rates to jump, at the high end of the spectrum, by as much as 65% in Mississippi and by 50% in South Carolina, according to the Urban Institute.

As Emily Sory pets a Russian fox, she acknowledges she is keenly aware that she will soon become part of this growing population. After all, her last job involved health care staffing. Her mother is a nurse.

“I understand the system. And I get it’s people like me that don’t pay their bill are why it suffers. And I feel bad,” she said. “But at the same time, I don’t have the money to pay it.”

This article is from a partnership that includes Nashville Public Radio, NPR, and KFF Health News, Healthbeat’s national reporting partner.

ByHeart baby formula outbreak prompts global safety study as U.S. struggles to find botulism source

2026-01-08T16:06:51+00:00

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An international food standards committee of the United Nations and World Health Organization has called for a scientific risk assessment of botulism spores in powdered infant formulas as a result of the U.S. outbreak linked to ByHeart products.

The action by the Codex Committee on Food Hygiene, supported by attendees from 50 member countries, noted the “global implications” of contaminated baby formula. It was taken as U.S. health agencies have struggled since early November to determine how ByHeart’s formula became contaminated.

Investigations have been ongoing since early November.

At least 51 U.S. babies have been sickened with infant botulism in the outbreak, with no new cases identified in recent weeks; all required hospitalization. The U.S. Food and Drug Administration has said it was first alerted on Nov. 6 to an initial cluster of illnesses linked to ByHeart formula and that its investigation has been underway since then.

ByHeart has recalled all of its formula products. Federal officials have said they cannot rule out the possibility the company’s formula – which was marketed as a premium, organic formula “closest to breast milk” – has been contaminated with botulism bacteria since it was first put on the market in March 2022.

Food safety advocates said they supported the international risk assessment, but noted it will likely take years to result in any reforms to protect against future outbreaks.

A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe.”
Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest

“It’s a really bad sign for Americans when a slow-moving international scientific agency has now initiated public plans, and yet our own regulators responsible for preventing this outbreak haven’t taken any public action,” said Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest, a consumer advocacy group in Washington, D.C., that focuses on food issues.

“A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe,” Sorscher told Healthbeat. “Instead, we have utter silence. It’s a complete failure of leadership.”

Officials with the FDA, Centers for Disease Control and Prevention, and U.S. Department of Health and Human Services said their investigations are ongoing but they did not answer Healthbeat’s questions this week about what challenges may be contributing to delays in finding the cause.

They also didn’t respond to questions about whether it’s surprising that a source of ByHeart’s botulism bacteria contamination hasn’t yet been identified.

Federal regulators haven’t decided whether a U.S. risk assessment is needed

Infant botulism is caused by babies ingesting spores of Clostridium botulinum bacteria, which can take 30 days to start growing in their immature guts and produce a toxin that can cause symptoms ranging from constipation, loss of head control, difficulty swallowing and breathing, and respiratory arrest.

Recent tests by government investigators and ByHeart have detected botulism bacteria in some containers of the company’s formula. The company received a formal warning letter from the FDA in August 2023 about contamination issues with a different type of bacteria and its plants have been cited by FDA inspectors for manufacturing and sanitation issues.

A HHS spokesperson, in an email to Healthbeat, said the FDA advocated for the Codex committee’s request for the international risk assessment. Staff from the FDA and U.S. Department of Agriculture participated in the Codex meeting, the meeting’s report shows.

ByHeart baby formula recall exposes dangerous gaps in food safety

“We welcome any and all scientific evidence that can inform recommendations on this important public health matter,” HHS said.

When asked whether the FDA or CDC would be doing their own U.S. assessment of risks for infant formula contamination with Clostridium botulinum bacteria, which cause infant botulism, HHS said that has not yet been determined. The FDA will decide the need for any additional risk assessment after more information is gathered about the current outbreak, HHS said.

“Additional testing by ByHeart, FDA, CDC, and state partners is currently underway, and more results are expected in the coming weeks,” HHS said. No details were provided about the types of testing being done.

ByHeart said the ongoing investigation “includes a rigorous audit of every step of our supply chain” and that the company is working closely with regulators to identify the source of the contamination.

HHS Secretary Robert F. Kennedy Jr., in launching Operation Stork Speed last spring, said that “safe, reliable, and nutritious” infant formula is a priority of the administration.

During the Codex Committee on Food Hygiene, which held its multi-national meeting Dec. 15-19 in Nashville, Tenn., members discussed the need for scientific input to inform a potential revision in the international code of hygienic practice for powdered infant formula. The code has sections that need updating, including sections on cleaning and environmental monitoring when producing formula, participants said.

Global review seeks to identify safety gaps in powdered formula manufacturing

“While Members acknowledged that historical data had not always categorized Clostridium botulinum as a major risk in these products, the importance of investigating whether current gaps in [the powdered infant formula code] contributed to the risk was underlined,” according to the report of the meeting.

The committee’s request seeks a risk assessment of spore-forming pathogens in powdered infant formula, and specifically cites Clostridium botulinum, which causes infant botulism, and Bacillus cereus, which can produce a toxin that causes nausea, vomiting and diarrhea.

Nestle is undertaking a global recall of certain infant formulas because of possible contamination with the toxin produced by Bacillus cereus. The company said a potentially contaminated ingredient is the culprit. While the recall involves formula sold in dozens of countries, the company’s recall advisory as of Thursday morning did not list the United States.

The Codex committee also has asked for an update to the existing risk assessment and scientific advice on environmental pathogens, such as Cronobacter and Salmonella, and to provide additional scientific advice to inform recommendations for strengthened pathogen control measures in all stages of the formula manufacturing process.

During last month’s meeting, a representative of the Food and Agriculture Organization of the United Nations, also referred to as the FAO, said that the scientific advice requested by the committee would be provided by an international scientific expert group called JEMRA – the Joint FAO/WHO Expert Meetings on Microbial Risk Assessment. The FAO did not respond to questions from Healthbeat about how long the risk assessment process will take or what it will involve.

Elisabeth Sterken, a nutritionist with the International Baby Food Action Network Global Council, said actions to address infant botulism and other microbial risks in powdered infant formula need to be taken sooner than will occur through this process. IBFAN is an international coalition that advocates for public policies that favor breastfeeding and investigates the marketing of infant formula.

“From JEMRA, which will likely take years, its recommendation will then go back to the Codex Committee on Food Hygiene, and any changes in the Code of Hygienic Practice will take at least another two years,” Sterken told Healthbeat.

Moms say ByHeart recall has shaken their trust in baby formula safety

“From there the final recommendations go to national regulatory bodies,” she said. “In the meantime, infants will continue to be at risk from the serious health consequences of potentially contaminated powdered infant formula.”

HHS, the FDA, and CDC have not responded to a Dec. 8 letter from the Safe Food Coalition, a group of major food safety organizations, that has called for actions to address “dangerous deficiencies” in the nation’s food inspection and regulatory systems that they say have been highlighted by the ByHeart recall and infant botulism outbreak.

Sorscher, whose organization – the Center for Science in the Public Interest – is a member of the coalition, called the lack of any response to the five-page letter “unacceptable.”

“These agencies owe answers to the public, and the silence at this point speaks volumes about their current ability to protect our food,” she said.

The letter, among many recommendations, has called for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

Other coalition members that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

The HHS last month told Healthbeat it has received the letter and will be responding to it.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

The CDC sidelined these childhood vaccines. Here’s what they prevent.

2026-01-06T23:46:20+00:00

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The federal government has drastically scaled back the number of recommended childhood immunizations, sidelining six routine vaccines that have safeguarded millions from serious diseases, long-term disability, and death.

Just three of the six immunizations the Centers for Disease Control and Prevention says it will no longer routinely recommend — against hepatitis A, hepatitis B, and rotavirus — have prevented nearly 2 million hospitalizations and more than 90,000 deaths in the past 30 years, according to the CDC’s own publications.

Vaccines against the three diseases, as well as those against respiratory syncytial virus, meningococcal disease, flu, and Covid, are now recommended only for children at high risk of serious illness or after “shared clinical decision-making,” or consultation between doctors and parents.

The CDC maintained its recommendations for 11 childhood vaccines: measles, mumps, and rubella; whooping cough, tetanus, and diphtheria; the bacterial disease known as Hib; pneumonia; polio; chickenpox; and human papillomavirus, or HPV.

Federal and private insurance will still cover vaccines for the diseases the CDC no longer recommends universally, according to a Department of Health and Human Services fact sheet; parents who want to vaccinate their children against those diseases will not have to pay out-of-pocket.

Experts on childhood disease were baffled by the change in guidance. HHS said the changes followed “a scientific review of the underlying science” and were in line with vaccination programs in other developed nations.

HHS Secretary Robert F. Kennedy Jr., an anti-vaccine activist, pointed to Denmark as a model. But the schedules of most European countries are closer to the U.S. standard upended by the new guidance.

For example, Denmark, which does not vaccinate against rotavirus, registers around 1,200 infant and toddler rotavirus hospitalizations a year. That rate, in a country of 6 million, is about the same as it was in the United States before vaccination.

“They’re OK with having 1,200 or 1,300 hospitalized kids, which is the tip of the iceberg in terms of childhood suffering,” said Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a co-inventor of a licensed rotavirus vaccine. “We weren’t. They should be trying to emulate us, not the other way around.”

Public health officials say the new guidance puts the onus on parents to research and understand each childhood vaccine and why it is important.

Here’s a rundown of the diseases the sidelined vaccines prevent:

RSV. Respiratory syncytial virus is the most common cause of hospitalization for infants in the United States.

The respiratory virus usually spreads in fall and winter and produces cold-like symptoms, though it can be deadly for young children, causing tens of thousands of hospitalizations and hundreds of deaths a year. According to the National Foundation for Infectious Diseases, roughly 80% of children younger than 2 who are hospitalized with RSV have no identifiable risk factors. Long-awaited vaccines against the disease were introduced in 2023.

Hepatitis A. Hepatitis A vaccination, which was phased in beginning in the late 1990s and recommended for all toddlers starting in 2006, has led to a more than 90% drop in the disease since 1996. The foodborne virus, which causes a wretched illness, continues to plague adults, particularly people who are homeless or who abuse drugs or alcohol, with a total of 1,648 cases and 85 deaths reported in 2023.

Hepatitis B. The disease causes liver cancer, cirrhosis, and other serious illnesses and is particularly dangerous when contracted by babies and young children. The hepatitis B virus is transmitted through blood and other bodily fluids, even in microscopic amounts, and can survive on surfaces for a week. From 1990 to 2019, vaccination resulted in a 99% decline in reported cases of acute hepatitis B among children and teens. Liver cancer among American children has also plummeted as a result of universal childhood vaccination. But the hepatitis B virus is still around, with 2,000-3,000 acute cases reported annually among unvaccinated adults. More than 17,000 chronic hepatitis B diagnoses were reported in 2023. The CDC estimates about half of people infected don’t know they have it.

Rotavirus. Before routine administration of the current rotavirus vaccines began in 2006, about 70,000 young children were hospitalized and 50 died every year from the virus. It was known as “winter vomiting syndrome,” said Sean O’Leary, a pediatrician at the University of Colorado. “It was a miserable disease that we hardly see anymore.”

The virus is still common on surfaces that babies touch, however, and “if you lower immunization rates it will once again hospitalize children,” Offit said.

Meningococcal vaccines. These have been required mainly for teenagers and college students, who are notably vulnerable to critical illness caused by the bacteria. About 600 to 1,000 cases of meningococcal disease are reported in the United States each year, but it kills more than 10% of those it sickens, and 1 in 5 survivors have permanent disabilities.

Flu and Covid. The two respiratory viruses have each killed hundreds of children in recent years — though both tend to be much more severe in older adults. Flu is on the upswing in the United States, and last flu season the virus killed 289 children.

What is shared clinical decision-making?

Under the changes, decisions about vaccinating children against influenza, Covid, rotavirus, meningococcal disease, and hepatitis A and B will now rely on what officials call “shared clinical decision-making,” meaning families will have to consult with a health care provider to determine whether a vaccine is appropriate.

“It means a provider should have a conversation with the patient to lay out the risks and the benefits and make a decision for that individual person,” said Lori Handy, a pediatric infectious disease specialist at the Children’s Hospital of Philadelphia.

In the past, the CDC used that term only in reference to narrow circumstances, like whether a person in a monogamous relationship needed the HPV vaccine, which prevents a sexually transmitted infection and certain cancers.

The CDC’s new approach doesn’t line up with the science because of the proven protective benefit the vaccines have for the vast majority of the population, Handy said.

In their report justifying the changes, HHS officials Tracy Beth Høeg and Martin Kulldorff said the U.S. vaccination system requires more safety research and more parental choice. Eroding trust in public health caused in part by an overly large vaccine schedule had led more parents to shun vaccination against major threats like measles, they said.

Georgia parents show strong confidence in childhood vaccines as federal guidance shifts

The vaccines on the schedule that the CDC has altered were backed up by extensive safety research when they were evaluated and approved by the FDA.

“They’re held to a safety standard higher than any other medical intervention that we have,” Handy said. “The value of routine recommendations is that it really helps the public understand that this has been vetted upside down and backwards in every which way.”

Eric Ball, a pediatrician in Orange County, California, said the change in guidance will cause more confusion among parents who think it means a vaccine’s safety is in question.

“It is critical for public health that recommendations for vaccines are very clear and concise,” Ball said. “Anything to muddy the water is just going to lead to more children getting sick.”

Ball said that instead of focusing on a child’s individual health needs, he often has to spend limited clinic time reassuring parents that vaccines are safe. A “shared clinical decision-making” status for a vaccine has no relationship to safety concerns, but parents may think it does.

HHS’s changes do not affect state vaccination laws and therefore should allow prudent medical practitioners to carry on as before, said Richard Hughes IV, an attorney and a George Washington University lecturer who is leading litigation against Kennedy over vaccine changes.

“You could expect that any pediatrician is going to follow sound evidence and recommend that their patients be vaccinated,” he said. The law protects providers who follow professional care guidelines, he said, and “RSV, meningococcal, and hepatitis remain serious health threats for children in this country.”

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

South Carolina measles outbreak grows in wake of holiday season

2026-01-06T21:39:20+00:00

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The ongoing measles outbreak in South Carolina – one of the nation’s largest in recent months – continues to grow in the wake of the holiday season, with 26 new infections reported Tuesday.

This surge in new cases raises to 211 the total number of people infected in the outbreak, which began last fall and is centered in Spartanburg County, along the state’s northwestern border.

Nearly all of those infected have been children and teens, and nearly all have been unvaccinated, according to the South Carolina Department of Public Health. Four people, including children and adults, have been hospitalized for complications of the disease.

“The sharp increase in cases and the number of people currently in quarantine does not indicate the outbreak is waning,” said Dr. Linda Bell, the state epidemiologist who is leading the department’s measles response.

“The primary challenge to controlling measles spread is the lower than needed vaccination coverage to achieve herd immunity in the community,” she said.

Statewide, the percentage of students who are fully vaccinated with two doses of measles vaccine has fallen below the 95% needed to protect against outbreaks. At some individual schools, vaccination rates can be significantly lower.

South Carolina’s outbreak is among 49 U.S. outbreaks reported during 2025, according to the Centers for Disease Control and Prevention. Nationwide, these outbreaks were responsible for most of the 2,065 confirmed measles cases nationwide last year, according to CDC data that was most recently updated on Dec. 31.

While scientists race to study spread of measles in U.S., Kennedy unravels hard-won gains

It’s the first time in more than 30 years that the number of measles cases in the United States has exceeded 2,000. There were three deaths.

Arizona, which also is experiencing a recent outbreak of measles along the Arizona-Utah border, had identified 214 infections as of its update on Tuesday. In Utah, 156 people had been diagnosed with measles in that outbreak as of Dec. 30.

Texas, which announced the end to its significant measles outbreak in August, confirmed more than 760 cases, with 99 people hospitalized and two deaths of school-age children.

The United States was deemed to have eliminated measles in 2000. But the ongoing outbreaks that began last year have put the country at risk of losing its measles elimination status.

In South Carolina, state health officials on Tuesday said 144 people are in quarantine and seven more are in isolation. For those in quarantine, the latest end date is Jan. 28.

The outbreak shows no signs of being brought under control. The state health department said the newly identified cases potentially exposed others to measles in multiple public settings, including schools and churches.

It typically takes 7 to 12 days – but sometimes up to 21 days – after exposure for people to start showing initial symptoms, such as cough, runny nose, red eyes, and a fever, which are later followed by a rash. That means those who were exposed and became infected in late December will start showing symptoms now and in the coming days.

“This disease finds pockets of unvaccinated folks and just runs through those pockets like wildfire,” said Dr. Robert Oliverio, chief medical officer for ambulatory care and population health for Roper St. Francis Healthcare in Charleston. “It tends to hit hard. These couple of school systems in the Upstate now are really getting decimated.”

While the outbreak has so far been centered around Spartanburg County on the northern edge of the state, he said he wouldn’t be surprised to see cases in other parts of the state. “I can’t imagine that we’ll get through this season, particularly with schools getting back in and kids traveling around.”

A person who has measles is contagious starting four days before the disease’s hallmark rash appears and continues to be able to spread the virus through four days after symptoms appear. South Carolina health officials have emphasized that this means people can spread the disease before they know they are infected.

“It is very important for those with mild illness or who are in quarantine to stay home to protect others,” the state health department said Tuesday. “We encourage employers to support workers in following DPH recommendations to stay out of work while ill or in quarantine. which also protects businesses, other workers, and clients.”

Among the places where new public exposures to measles have occurred: Sugar Ridge Elementary and Boiling Springs Elementary on Dec. 18 and 19, prior to the schools’ winter break. Nine students of these schools are in quarantine, state health officials said.

Between Dec. 19 and Dec. 25, exposures occurred at four churches: Tabernacle of Salvation Church, Slavic Pentecostal Church of Spartanburg, Unitarian Universalist Church of Spartanburg, and Ark of Salvation Church.

Over the weekend, South Carolina health officials issued another public alert that a person infected with measles – who was unaware they were infectious – had made Christmas Eve visits in Greenville, S.C., to a Best Buy store and a downtown gastropub called the Nose Dive. Then on Dec. 27, the person attended a planetarium show at the Spartanburg Library.

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

Screwworm threat returns to U.S.: Why it matters

2026-01-05T14:29:14+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In 2025, the United States faced a series of reminders that the security of our food supply depends on public health systems that are largely invisible to the general population. Poultry and dairy production were disrupted by H5N1 avian influenza and infant formula by botulism contamination. Less visible was a parasite that once terrified American ranchers: the New World screwworm.

The resurgence of screwworm highlights the fragility of infectious disease control and the importance of sustained government cooperation across different sectors and across international borders.

What screwworm is and why it matters

The New World screwworm is caused by the larvae of a blowfly called Cochliomyia hominivorax. The adult fly targets warm-blooded animals, most often cattle, and lays its eggs in open wounds. These wounds can be large, such as those caused by branding or dehorning, or barely visible, such as a tick bite or an abrasion.

Within hours, the eggs hatch, and the larvae burrow into the flesh and feed aggressively on living tissue. (This is what distinguishes screwworm from other maggots, which eat decaying or dead tissue.) As the larvae grow, the wound expands, attracting more flies, which deposit even more eggs. The larvae cause severe pain, tissue destruction, secondary infections, and often death of the animal.

After several days, mature larvae drop to the ground, pupate in the soil, and emerge as adult flies ready to repeat the cycle on another cow. Under warm conditions, the entire process can take only a few weeks. In a herd setting, infestations can spread rapidly, devastating entire herds of cattle.

Before eradication, screwworm caused hundreds of millions of dollars in financial losses each year in the United States. Ranchers spent enormous time and money on treatment and prevention. The parasite also occasionally infected wildlife, pets, and some humans.

How screwworm was controlled in the 20th century

Beginning in the mid 20th century, U.S. scientists developed a special technique to stop screwworm reproduction. The “sterile insect technique” involved breeding millions of male screwworm flies in specialized facilities, sterilizing them with radiation, and releasing them into the wild. Because female screwworm flies mate only once, they produce no offspring after they mate with a sterile male fly. Over time, the screwworm population dies off.

Using this approach, screwworm was eliminated from the United States by the mid 1960s. The program then moved south, in collaboration with Mexico and Central American countries. By the early 2000s, screwworm had been pushed as far south of the United States as Panama. Every week, sterile flies were released to prevent northward spread from endemic regions in South America, creating a biological barrier to screwworm making its way into the United States.

This screwworm control program remains one of the most successful examples of international disease control in the Americas. To maintain it, however, requires constant effort to produce sterile flies and conduct surveillance for breakthrough infections.

Why the screwworm threat has returned

For decades, screwworm was largely absent from the United States and Mexico. That changed in 2023, when outbreaks began spreading northward through Central America and into southern Mexico. The reasons are still being investigated, but likely include interruptions in sterile fly production during the Covid pandemic, increased movement of cattle and people, and the sheer difficulty of maintaining surveillance across remote terrain.

In August, the United States confirmed its first human screwworm case in decades. The patient, a Maryland resident, had recently traveled to El Salvador and returned with larvae embedded in living tissue. The infection was treated successfully, and there was no evidence that infection was either acquired locally or transmitted onward.

While the risk to Americans of this case was low, it was considered an important warning sign. Because they are so rare, even one human screwworm infection suggests widespread prevalence in animals.

The economic stakes are particularly worrisome. Cattle herd sizes in the United States are near historic lows due to drought and rising costs. In response to the screwworm threat, the United States halted cattle imports from Mexico in 2025. Prolonged disruption could drive prices higher, an important problem because the average American consumes 60 pounds of beef each year.

What is being done to stop the New World Screwworm outbreak?

The United States and Mexico have begun to rebuild the capacity that previously stopped screwworm transmission in both countries. Sterile insect production in Panama has been expanded to release roughly 100 million flies per week. Facilities in southern Mexico are being renovated to produce tens of millions more, and the U.S. Department of Agriculture is working on additional dispersal capacity in Texas.

These efforts are expensive and slow. Experts estimate that several hundred million sterile flies per week may be needed to re-establish the barrier that once existed. At the same time, workforce reductions and loss of institutional memory are making it harder for the U.S. government to respond quickly.

New tools are also emerging. Last month, the Food and Drug Administration conditionally approved a topical antiparasitic drug for cattle that can help prevent or treat screwworm infestations. While this drug gives cattle farmers another option, there are challenges with using it; it is prescription only, has withdrawal periods, and cannot be used in all cattle.

Why this matters beyond screwworm

The return of screwworm illustrates broader lessons about public health and food security. When they work, public health protections are invisible, and, when they fail, the consequences are difficult and expensive.

Particularly with food security, these protections must embrace a One Health model, in which human, animal, and environmental sectors work in partnership. And, finally, at a time when the United States has dramatically cut its global health workforce, screwworm offers an important example about why such work remains essential.

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.

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

ByHeart baby formula recall: What to know about 4 new developments

2025-12-19T23:30:03+00:00

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It’s been six weeks since ByHeart Inc. began recalling its popular organic baby formula amid a nationwide outbreak of infant botulism – and nearly two years since children started becoming infected across the country.

Here are four things to know about the latest developments in the outbreak investigation and formula recall.

Some good news: No new cases of sick infants discovered in the past week

The U.S. Food and Drug Administration announced this week that the identification of new infant botulism cases linked to ByHeart infant formula has slowed, with none identified during the past week.

The number of infants known to have been sickened in the outbreak remains at 51 – and all of them required hospitalization. The infants live in 19 states. There have been no deaths.

The most recent date a child started showing signs of illness was Dec. 1, according to the FDA.

The lack of new cases is an encouraging sign. ByHeart did an initial, limited recall of its formula products on Nov. 8, followed by a recall of all of its products on Nov. 11.

But it can take up to 30 days after an infant ingests botulism spores for the bacteria to start growing in the child’s immature gut and produce a toxin that causes symptoms, such as constipation, poor eating, loss of head control, difficulty swallowing and breathing, and potentially respiratory arrest. And ByHeart formula remained on the shelves of some stores for weeks after the recall. (More on this below.)

Some bad news: The discovery that babies started being sickened two years ago

Until recently, federal health officials had said the earliest outbreak illnesses began in August. But they’ve now identified children who were fed ByHeart formula who were hospitalized with infant botulism as far back as December 2023.

The Centers for Disease Control and Prevention has expanded its outbreak case definition to include any infant with botulism who was exposed to ByHeart baby formula at any time since the product first went on the market in March 2022.

Initially, investigators were focused only on infants sickened since Aug. 1, 2025. When they looked at earlier infant botulism cases, they identified 10 additional children who consumed ByHeart products and fell ill from December 2023 through July 2025. Those cases are included in the 51 total outbreak cases.

While no cases have been identified before December 2023, the investigation is ongoing, and the FDA said it “cannot rule out the possibility that contamination might have affected all ByHeart formula products.”

Federal officials and ByHeart say they are still investigating how botulism bacteria spores got into ByHeart formula.

FDA issues warning letters to retailers that kept selling recalled ByHeart formula

Retailers across the country continued to sell ByHeart infant formula for weeks after the recall began on Nov. 8 and was expanded to include all products on Nov. 11.

State and local food safety officials along with FDA inspectors performed more than 4,000 spot-checks of retail stores across the country to ensure recalled ByHeart’s formula was no longer being sold. Yet they continued to find ByHeart products on store shelves at more than 175 locations in 36 states, the FDA said.

However, those checks of retail stores, Healthbeat reported last month, were slowed by FDA delays in sharing ByHeart product distribution lists with state and local officials.

The FDA says it hasn’t received any reports of recalled ByHeart formula still being on store shelves since Nov. 26.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered ByHeart single-serve “anywhere pack” sticks on a shelf with a promotional “Sale!” sign offering a $2 discount more than a week after all of the company’s products were recalled because of botulism risks.

This week the FDA called on food industry officials across the country to improve their compliance with protecting the public from recalled products.

The FDA also announced it sent formal warning letters on Dec. 12 to corporate officials at Target, Walmart, Kroger, and Albertsons Companies for failing to remove ByHeart products from their store shelves.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered a promotional “Sale!” sign offering a $2 discount off recalled ByHeart single-serve “anywhere pack” sticks from Nov. 16 to Nov. 22, according to the FDA’s warning letter to the company.

Investigators found recalled ByHeart formula on Target store shelves across 20 states from Nov. 12 to Nov. 20, the FDA’s letter said.

Workers at Target stores – as well as those at Walmart stores in 21 states, Kroger stores in 10 states, Albertsons Companies’ stores operated under various names in 11 states – gave state and local inspectors a variety of explanations for the presence of ByHeart formula in stores after the recalls were launched, the letters say.

Explanations included that store associates weren’t aware of the recall and that there was confusion over which specific lots were recalled. Workers also told investigators that there were failures to remove all of the recalled products from shelves and that stocking of shelves occurred when recalled products arrived after the recall notification, the warning letters say.

The four companies have 15 days to respond to the FDA warning letters with steps they are taking to address violations or provide information supporting why they believe they haven’t violated the law.

In a statement to Healthbeat, Walmart said: “We take all reports of inaction seriously and will respond to the letter.” The company said it “moved swiftly” to issue a sales restriction and remove the product from its stores and online platform.

Albertsons Companies said they have procedures to address product recalls and that ByHeart products have been removed from their stores. Target and Kroger did not immediately respond to Healthbeat’s requests for comment on their warning letters.

Food safety groups call for botulism testing, investigation of recall delays

The ByHeart formula recall and outbreak has “exposed dangerous deficiencies” in the nation’s food inspection and regulatory systems, according to a letter sent to the heads of the FDA, CDC and Department of Health and Human Services by the Safe Food Coalition, whose members are national food safety advocacy groups.

The five-page letter calls for a range of reforms to strengthen food safety inspections and regulations and improve the speed of recalls. It also urges fully funding food safety work and illness surveillance systems at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.

Citing Healthbeat’s reporting, the coalition is calling for the FDA to investigate bureaucratic delays in releasing to state food safety regulators the names of retailers that received ByHeart’s recalled products. It’s a lengthy process “that can and must be streamlined not just with respect to recall communication, but for all communication with state regulators,” the Dec. 8 letter said.

The Safe Food Coalition letter, among its many recommendations, also calls for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

“I think it’s critically important that the agency go out there in the field and do a survey of all the infant formula out there to reassure consumers and to understand whether this is a broader problem,” Sarah Sorscher, director of regulatory affairs at the Center for Science in the Public Interest, told Healthbeat.

Other groups in the Safe Food Coalition that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

Federal officials have not yet replied to the coalition’s letter. “HHS is in receipt of the letter and will respond directly to the requestors,” HHS said Friday in an email to Healthbeat.

“FDA acted quickly to protect the public, issuing multiple warnings alongside the firm’s initial and expanded recall,” HHS said in its email.

The FDA has previously not responded to Healthbeat’s questions about delays in sharing ByHeart’s product distribution lists with local and state food safety regulators.

HHS said Friday that the FDA began conducting its own recall effectiveness checks “at the corporate level of large retailers” on Nov. 10 – two days after ByHeart announced its initial recall of two batches of formula.

The FDA didn’t receive ByHeart’s product distribution lists from the company until Nov. 12, the day after the company expanded the recall to all products, HHS said. The list was shared the same day with a subset of state food safety regulators who had information-sharing agreements on file with the FDA, the HHS said.

HHS acknowledged that the FDA had to go through a process to obtain exceptions for local and state regulators that lacked information agreements and “where such sharing of commercial confidential information would be otherwise prohibited under the Trade Secrets Act.”

Healthbeat reported last month that according to the Association of Food and Drug Officials – whose members are state and local regulators – the FDA didn’t start fully sharing ByHeart’s product distribution lists with all state and local officials until a teleconference held at 6 p.m. on Nov. 14 – nearly a week after the formula was linked to the outbreak and the company had launched its initial recall on Nov. 8.

HHS did not say how many states had information sharing agreements with FDA that allowed them to receive the distribution lists on Nov. 12. The department only said a “majority” of the 50 states and the District of Columbia have the agreements.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Inside the FDA’s vaccine uproar: It’s not just about Covid shots

2025-12-19T16:02:40+00:00

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Six days after a senior Food and Drug Administration official sent a sweeping internal email claiming that Covid vaccines had caused the deaths of “at least 10 children,” 12 former FDA commissioners released an extraordinary warning in the Dec. 3 issue of the New England Journal of Medicine.

They wrote that the claims and policy changes in the memo from Vinay Prasad, the head of the FDA’s Center for Biologics Evaluation and Research, pose “a threat to evidence-based vaccine policy and public health security” and break sharply from longstanding scientific norms.

What is unfolding inside the FDA is not a narrow dispute over Covid vaccines. It is an attempt, according to critics and vaccine scientists, to rewrite the rules governing the entire U.S. vaccine system — how risks are weighed, how benefits are proved, and how quickly lifesaving shots reach the public. Former agency leaders warn that if these changes take hold, the consequences could be lasting: fewer vaccines, slower updates, weakened public trust, and more preventable outbreaks.

Prasad made clear he sees the moment as corrective. “Never again will the U.S. FDA commissioner have to himself find deaths in children for staff to identify it,” he wrote, telling employees the agency’s mission, and its “worldview,” would change.

Prasad’s email reopened old arguments about Covid vaccines, using what is generally considered weak and misleading science in the peer-reviewed research community. He claimed that FDA staff had found “at least 10” deaths in children that happened “after and because of” Covid vaccination, using reports from the Vaccine Adverse Event Reporting System.

The VAERS system is notoriously crowdsourced, meaning anyone can contribute, and scientists say it serves only as a clearinghouse for reports. For example, a person could file a report saying that after getting a flu shot, their hair turned purple. Though that report would remain in the database until it was reviewed, it cannot prove the cause of medical events. But Prasad argued that the true number of deaths was likely higher because many cases go unreported.

On Substack, Inside Medicine reported Dec. 11 that Prasad used incomplete information and that a Dec. 5 internal FDA memo set the pediatric death toll from Covid shots somewhere between zero and seven. Department of Health and Human Services spokesperson Emily Hilliard wrote, “The FDA’s investigation into deaths caused by Covid vaccines is still ongoing and there’s no final count yet of those deaths.”

Prasad also accused the FDA and the Centers for Disease Control and Prevention of downplaying the risk of heart inflammation, called myocarditis, in young men; criticized the agency for approving shots for teenagers; and suggested that school and workplace vaccine mandates may have “harmed more children than we saved,” adding that “we do not know if we saved lives on balance.”

By comparison, more than 2,100 American children died of Covid itself since the pandemic began, the CDC reported.

Based on his erroneous and misleading claims about Covid vaccines, Prasad proposed a major overhaul of how vaccines are approved. He said the FDA should stop relying on immune markers to establish the efficacy of shots, such as antibody levels, and instead require large placebo-controlled randomized trials that track hospitalizations and deaths before approving most new vaccines.

Many immunologists and vaccine experts say it’s unethical to test vaccines known to be effective against disease with a control group that would receive a placebo, exposing them to infection.

“There is a rock-solid principle in bioethics that it is unethical to test any drug or vaccine against a placebo if it is known to be safe and effective. The reason is that such placebo-controlled trials would effectively deny patients access to a vaccine that could prevent a dangerous infectious disease,” said Lawrence Gostin, a professor of global health law at Georgetown University.

Prasad called the current flu vaccine system an “evidence-based catastrophe,” questioned the approval of vaccines for pregnant women based on immune response alone, and raised concerns about giving multiple vaccines at once. He told staff to rewrite FDA guidelines to match his new “worldview” and said anyone who disagreed with his “core principles” should resign.

The former FDA leaders expressed alarm in the NEJM article. They said Prasad is exploiting public frustration over the federal response to Covid to spark doubt about the entire childhood vaccine system, which could undo decades of success in protecting children from deadly diseases.

“This is really different. And it’s really dangerous. And people will be hurt, particularly by the vaccine decisions,” former FDA Commissioner Robert Califf said in an interview. He also warned that Prasad’s proposed policies — which he noted echo positions on vaccines held by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist — could shake the entire vaccine market.

“The goal of RFK seems to be to make it impossible for vaccines to be available in the U.S.,” he said. If the proposals advance, he added, “it won’t be a viable business.”

Hilliard pushed back sharply on those concerns, writing: “The American people deserve evidence-based science. Prasad’s email lays out a philosophical framework that points us toward that higher standard. We will soon release documents laying out that framework and data confirming how the Covid vaccine resulted in children’s deaths that previous leadership failed to properly investigate.”

For generations, the childhood vaccine program has depended on clear rules, strong safety systems, and public trust. Experts say Prasad’s ideas, based on claims they argue are not supported by real evidence, could make it much harder to test, approve, and deliver vaccines to families.

Prasad’s framework could fuel parental doubt

Prasad’s memo indicates he considers VAERS reports as proof that vaccines caused children’s deaths. The system, though, is designed to be only an “early warning system” for potential safety issues with vaccines that can be investigated further.

“VAERS signals should never be taken as proof of true vaccine risks without careful, confirmatory studies,” said Katherine Yih, an epidemiologist and longtime investigator with the Vaccine Safety Datalink, a CDC program.

Doing so, scientists say, directly feeds public fear at a time when many parents are already unsure whom to trust.

“Causation requires converging evidence, not just one report or coincidence,” said Robert Hopkins, medical director of the National Foundation for Infectious Diseases.

Prasad’s framework, however, treats uncertainty as a reason to halt development entirely.

Experts fear this doubt won’t stay limited to Covid vaccines. Once parents start to question the FDA’s honesty, they may begin doubting longstanding vaccines for measles, polio, or whooping cough — shots that have protected children for decades.

“Science must be transparent,” Gostin said. If families believe the FDA is misusing data or silencing experts, confidence in the entire vaccine system can collapse, he said. “There’s a public narrative that people have lost trust in science, but that’s not true. The vast majority want the FDA to make decisions based on the best scientific evidence. Once they believe that the agency is marginalizing scientists and cherry-picking evidence, their trust will plummet.”

Vaccine pipeline is delicate

Prasad’s new framework will likely make it far harder for companies to produce or update vaccines. The 12 former FDA commissioners warned that requiring clinical trials for all new or updated shots would slow vaccine improvements and leave people unprotected. His plan, they wrote, “would impede the ability to update vaccines in a timely fashion, especially for respiratory viruses.”

For fast-changing viruses like flu and Covid, this could be disastrous. There’s simply not enough time to run full clinical trials every time a virus mutates.

There are also major business effects. Vaccine development is costly, and companies may decide the United States is no longer worth the risk. If companies slow down or leave the market, families could face shortages, fewer innovations, and fewer protections for their kids.

Science depends on ‘checks and balances’

Science depends on open and public debate. Prasad’s memo warned his employees against it. In addition to demanding that FDA staff members who disagree with him resign, he said their disputes should stay private and called leaks “unethical” and “illegal.”

Susan Ellenberg, a former director of the FDA’s Office of Biostatistics and Epidemiology, warned that Prasad risks destroying the process that makes science credible. “If disagreement is treated as disloyalty, you lose the only mechanism that keeps science honest,” she said.

Without strong internal debate, safety reviews become weaker. “You lose the checks and balances that make vaccine safety science credible,” said Kathryn Edwards, a pediatric infectious disease specialist at Vanderbilt University Medical Center who served on the Clinical Immunization Safety Assessment Network during the Covid pandemic.

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

There’s more to the measles comeback than misinformation

2025-12-18T12:00:00+00:00

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Hello from Sydney, Australia.

I arrived on Sunday to spend the holidays with my in-laws. It has been an odd and heavy start. We landed just hours after the attack at Bondi Beach, a short distance from where we are staying. At the same time, this is Australia at Christmas, with its familiar rituals. Shrimp, shorts, and sunburns.

This week, I am finally catching up on a disease I have largely avoided covering: measles. I have tended to see its resurgence in the West as a misinformation problem with American roots. But as we’ll see, that framing falls short.

My name is William Herkewitz, and I’m a journalist (usually) 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.

Blaming misinformation isn’t enough to explain measles’ return

Follow measles across the West and you find an uncomfortable trail of resurgence. For example: Europe is seeing record cases, and Canada just officially lost its measles elimination status. For developed countries, this rise is most often blamed on vaccine misinformation. Basically, that widespread distrust and conspiracy-minded thinking (supercharged by a Covid-era backlash) is increasingly hollowing out vulnerable, unvaccinated pockets of people for the virus to spread between.

Disease breakdown: Measles is one of the most contagious viruses on Earth. It spreads through the air when an infected person coughs or breathes. It causes fever, cough, a distinctive rash, and can lead to death, especially in young children. Two doses of the 50-year-old measles vaccine is 97% effective and remains the only viable way to stop the spread of the disease.

In the United States, it is especially easy to believe this explanation right now. As Healthbeat reports, America’s chief public health official and renowned anti-vaxxer Robert F. Kennedy Jr. is actively undermining “the ability of public health officials to prevent and contain outbreaks” of the virus. But is that the full story?

Australia is the strongest test of this explanation (and, conveniently, I’m here). That’s because it’s a country with one of the world’s most robust public health and vaccination systems, free childhood vaccines, and historically high coverage. And measles cases are rising here, as well, Medscape reports.

I reached out to Julie Leask, a professor of public health at the University of Sydney and one of Australia’s leading experts on what people think, feel, and do about vaccination. I asked if vaccine misinformation is simply eroding confidence in the same way here, too.

Leask surprised me. In Australia, she said, while “the clickbaity idea that [measles resurgence] is all about vaccine refusal” absolutely dominates local headlines, the data do not fully support that explanation. She pointed to Australia’s National Vaccination Insights Project, a vaccination surveillance system that tracks the real-world reasons children miss doses. “Vaccine refusal is absolutely a problem,” she told me, “but it’s not the only problem.”

Leask notes that two other forces are doing at least as much work to recirculate the disease in Australia. One is rising measles cases in developing countries like Vietnam, Thailand, and Indonesia, where people may travel and return with an infection. The other is a mix of everyday practical barriers that Leask calls “social determinants of vaccination.” These range from hard-to-reach clinics and staff shortages to families who missed routine shots during the pandemic and never fully caught up, which have left pockets of children without vaccines or only partially vaccinated. Together, she said, those factors can pose as much risk as anti-vaccine sentiment alone.

The larger lesson, she argued, is that across the developed world, measles control depends as much on keeping vaccination easy, accessible, and routine as it does on countering misinformation.

Is misinformation rising, and should we be wary of it? Without question. But focusing on it alone misses where other real gaps are opening.

Kenya court pauses ‘America First’ health deal

Over the weekend, Kenya’s High Court halted the new U.S.-Kenya health aid deal that we discussed last week, Kenya’s The Standard reports. The agreement was meant to lock in $1.6 billion in American funding, and was the first test case of Washington’s new “America First” health aid model.

The issue? Data.

Tucked into the agreement was a provision committing Kenya to share population-wide health data with the United States and U.S. companies for up to 25 years, a scope and timeline that critics say were never clearly explained to the public or debated in parliament.

Last week I wrote that I “initially didn’t read this as a nefarious data grab,” but rather as a clumsy fix for the surveillance gap the United States created by exiting the World Health Organization. (But, as The Standard notes, the agreement “requires Kenya to share extensive medical data, including HIV/AIDS, tuberculosis, malaria, maternal and child health,” in addition to data purely on “disease surveillance,” which frankly makes my more charitable interpretation harder to sustain.)

Certainly, this ruling is an early embarrassment for the Trump administration’s flagship health agreement, though its practical impact on the deal will remain unclear for quite a while. The case isn’t even due in court until Feb. 12.

What’s the takeaway?

Well, it’s worth revisiting my conversation with John Kuehnle, who ran America’s health programs for the U.S. Agency for International Development in Kenya from 2020 to 2024. We discussed the data clause last week, well before the court intervened, and Kuehnle walked through potential rationales for why U.S. negotiators wanted the data in the deal at all.

A generous interpretation is that the information could “be mutually beneficial if it’s used to develop medicines and medical devices that are tailored to the needs for Kenyans and other Africans,” he said. But Kuehnle noted that this business case is thin at best. “What’s the point of making a drug tailored to a population that can only afford it if a donor buys it, when the donor funding runs out in five years?”

Even if the courts allow the data sharing to go through, Kuehnle cautioned that political consent is unlikely to outlast the money. “If no material gains come from Kenyans giving their data to the U.S. in the first five years, I would not be surprised if this fizzles after five years and the funding runs out,” he said. “I don’t see Kenyans continuing to share data for 20 years after the funding runs out simply because a politician in 2025 agreed to do so.”

An HIV surge in Papua New Guinea

Papua New Guinea is facing one of the fastest-growing HIV epidemics in the world*, The Guardian reports. New infections have roughly doubled since 2010, with nearly half occurring among children and young people. This has prompted the government to declare HIV a national crisis, as overstretched health services buckle after the loss of international funding.

Over a third of people living with HIV in Papua New Guinea don’t know they are infected, and mother-to-child transmission of the virus remains “one of the highest globally.” At the same time, prevention and outreach have weakened as international funding has fallen away. The Guardian story notes that hundreds of clinics run by the government and churches have cut back services or shut down entirely.

Luckily, Australia has moved to plug part of the funding gap, increasing its annual HIV funding to about $6.6 million. UNAIDS says this will keep its Papua New Guinea office operating for another two years. But this intervention only buys time. One source in the article says what when U.S. funding stopped this year, there was “no second plan given to us, and we were told to close down the clinic,” said a social worker in the capital, Port Moresby.

The takeaway: Even senior Papua New Guinean officials concede that there is no clear plan for the HIV outbreak if foreign funding doesn’t return. Foreign minister Justin Tkatchenko warned the country needs a “fallback position,” adding: “The long-term strategy is doing it ourselves. We can’t continually rely on other donor partners to help us.”

(*Worth noting: Papua New Guinea’s doubling of HIV cases is still dwarfed by the wild surges currently seen in the Philippines, Fiji, or Madagascar.)

Your lungs on airplane mode

Air travel has a dirty little secret … what passengers are breathing.

A new study in the journal Environmental International finds that airline passengers can be exposed to extremely high levels of ultrafine air pollution while flying, Oman’s The Arabian Stories reports. This is especially true during boarding, taxiing, and landing.

The findings are new here, but so too was the research approach. The researchers basically brought air-quality monitors onto real flights and measured what was in the cabin air at each stage of the trip, instead of relying on estimates or airport data.

The key point is that jet engine pollution can seep into cabin air before the plane reaches cruising altitude, when filtration systems work best. The particles the researchers measured are small enough to reach deep into the lungs and even enter the bloodstream, raising concerns for flight crews and airport workers who face this exposure repeatedly.

So the takeaway … is never fly again?

No, not exactly. While the pollution spikes were striking, the researchers also found that when you average exposure across an entire flight, overall ultrafine particle levels inside planes are actually lower than what people experience in many everyday settings, like sitting in heavy road traffic. The researchers say the risk is less about any single flight than about repeated exposure, and the findings point to specific moments on the ground where pollution is entering the cabin and could, in theory, be reduced.

Yes, we’re ending on poop

Let’s end this week’s edition with some optimistic news somewhere unexpected: the sewer.

Public health officials in the UK are expanding wastewater testing to spot outbreaks by analyzing what people flush away, the Financial Times reports. When people are infected, they shed viruses and bacteria in their waste, often days before symptoms appear. Sewers gather this, uh, trove of data, turning treatment plants into incidental health monitors for entire cities.

What I found striking in the Financial Times reporting isn’t the UK’s plan itself, but how fast wastewater surveillance is proliferating and diversifying worldwide.

The EU launched a Global Consortium for Wastewater and Environmental Surveillance for Public Health last year, while local projects are popping up elsewhere. In Houston, researchers detected measles virus in sewage 10 days before any cases were officially reported, a result that Anthony Maresso of Baylor College said “underscores the high sensitivity of the method.” In Nevada, scientists are using artificial intelligence to scan wastewater for flu, RSV, mpox, measles, gonorrhea, and drug-resistant fungi.

Gross? Absolutely. But incredibly cool? Oh yeah.

It’s a reminder that even as traditional disease surveillance faces challenges, new tools are emerging in unlikely places. And sure, wastewater is messy and unglamorous … but after the flush, the data are hard to spin!

Healthbeat will be on a holiday break for the next two weeks. I’ll see you next year.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Hospitals mum on how they’ll handle new guidance on hepatitis B shots for newborns

2025-12-18T00:11:17+00:00

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Maternity hospitals across the country will now play a significant role in whether babies will universally be vaccinated against hepatitis B at birth as the federal government drops its long-held recommendation for the shot.

But many of the nation’s largest maternity hospitals wouldn’t answer questions over the past week about their current policies and how they will handle the changing guidance.

The guidance now only recommends a birth dose of the vaccine for a subset of babies whose mothers test positive for the hepatitis B virus or whose status is unknown. They further suggest that mothers who test negative for the virus but still want to vaccinate their babies delay the shots for at least two months after birth – a dramatic change that major medical societies say will cause a resurgence of liver disease.

Late Tuesday, the Centers for Disease Control and Prevention announced that its acting director, Jim O’Neill, had approved the vaccine recommendations made early this month by an advisory panel that had been reconstituted to only include members selected by Health and Human Services Secretary Robert F. Kennedy Jr., a vaccine critic.

Healthbeat asked 10 of the nation’s largest maternity hospitals and systems that deliver the most babies about their existing policies for hepatitis B birth doses and whether they are changing as a result of the new CDC Advisory Committee on Immunization Practices guidance. These 10 hospitals and systems delivered more than 227,000 babies in 2024, according to the American Hospital Association’s annual survey data.

All but two of these large maternity hospitals wouldn’t answer specific questions – in writing or in an interview – about their hepatitis B birth-dose policies, existing standing orders for newborns, or any impact of the new federal guidance.

“Unfortunately we will not be able to provide anyone to speak on this matter at this time,” said a spokesperson for Northside Hospital in Atlanta. The spokesperson didn’t respond to questions about why.

Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

At Orlando Health Orlando Regional Medical Center in Florida, a spokesperson responded similarly and without explanation: “We are unable to assist with this request.” Healthbeat received similar responses from several of the other large maternity hospitals.

HCA Healthcare, one of the nation’s largest hospital chains, equivocated without answering questions about individual hospital policies or how they may change. HCA helps operate St. David’s North Austin Medical Center in Texas, which is listed among the American Hospital Association’s largest maternity hospitals.

“As a health system, it is our practice to support our physicians by providing information and best practices, including the latest guidance from CDC as well as professional societies, so they can use their extensive training and experience to exercise their independent medical judgment to assess patients’ needs and determine appropriate care,” HCA said in a statement to Healthbeat.

Other hospitals and systems that didn’t answer Healthbeat’s questions included: NYU Langone Hospitals in New York City, Parkland Health in Dallas, AdventHealth Orlando in Florida, and Northwestern Memorial Hospital in Chicago.

A spokesperson for the American Hospital Association said the group had no comment on why so many of the nation’s largest maternity hospitals seemed reluctant to discuss how they are responding to the change in federal guidance.

Two large maternity hospitals told Healthbeat they plan to continue to offer and recommend universal hepatitis B vaccination for babies born at their facilities regardless of whether their mothers have tested positive, a practice that continues to be endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, and numerous other major medical societies.

At Memorial Hermann Greater Heights Hospital in Houston, the birth dose of hepatitis B vaccine will continue to be offered to all newborns, said Dr. Luis Ostrosky, chief epidemiology officer for the Memorial Hermann Health System.

“Following best evidence and guidance from major medical societies, Memorial Hermann will continue to offer and recommend neonatal hepatitis B vaccination, in line with the American Academy of Pediatrics immunization schedule,” Ostrosky said. “Parents will continue to have the choice – as has always been the case – to accept or decline the recommended guidance, in consultation with their health care provider.”

Babies born on the Inova Fairfax Medical Campus, located in Falls Church, Virginia, near the nation’s capital, also will continue to be universally offered a birth dose of the vaccine, which a spokesperson for the system said remains a part of its standard newborn nursery order to be given within 24 hours of birth with parental consent.

“Inova follows the American Academy of Pediatrics recommendation for universal Hepatitis B vaccination at birth due to the decades of clinical and scientific evidence demonstrating its safety and efficacy in preventing serious illness,” the health system said in an email to Healthbeat. “Decisions regarding vaccination are always made collaboratively between Inova patients and their care providers.”

It appears that New York-Presbyterian Hospitals in New York City also are continuing to provide universal birth doses. This system gave an obscure, one-sentence response to Healthbeat without providing details of its birth dose policies or standing orders. It said: “All our hospitals follow NYSDOH guidance and established best practices,” referring to the New York State Department of Health. The department’s website says it continues to recommend the universal birth dose.

The CDC had recommended universal vaccination of newborns since 1991. Since that time the annual number of reported cases among U.S. infants and children has dropped by 99%, from 16,000 to less than 20, according to the American Academy of Pediatrics.

The birth dose of the vaccine prevents the virus from being transmitted to babies during childbirth and protects them during childhood against infections that can be spread by family members and other caregivers who often are unaware they are infected.

The virus is highly contagious and spreads through contact with blood and body fluids. It can spread through sharing personal items such as razors, toothbrushes, and nail clippers, as well as through sexual contact and the use of unsterile needles.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

“This is a vaccine that we have several decades of experience with. We know it’s safe, we know it’s effective, and we know that it’s important,” said Dr. Michael Warren, chief medical and health officer for the March of Dimes, who previously served as the associate administrator of the federal Health Resources and Services Administration’s maternal and child health bureau.

Warren said it’s unclear whether the changing federal guidance will create any barriers to families accessing birth doses for their infants when they deliver at hospitals across the country.

“Hospital policy absolutely does matter,” Warren said. “Almost all babies in this country are born in hospital settings, and so the hospital is really this important front door to a life of good health, and that starts with that routine newborn care, including that birth dose of hepatitis B vaccine.”

If hospital policies were to create barriers, it would contribute to a decrease in vaccination rates and an increase in cases of hepatitis B infections, which can cause cirrhosis, liver failure, and liver cancer, he said.

Warren said he can’t speculate why hospitals seemed reluctant to answer Healthbeat’s questions about their policies and response to the federal guidance. He said he’s heard anecdotally that some hospitals are planning to continue offering universal birth doses.

In Michigan, several health systems – Corewell Health, Henry Ford Health, McLaren Health Care, Munson Healthcare and the University of Michigan Health – have said they will continue to provide universal hepatitis B immunization of newborns, according to the Detroit Free Press.

Warren noted that several state health departments have issued recommendations encouraging parents to continue to have their babies universally vaccinated at birth. A few have issued standing orders or executive directives that authorize providers to administer the doses.

“I hope that their hospitals and those states will follow those recommendations,” Warren said.

Parents who want their babies to receive the birth dose or who have questions about the vaccine can talk with their obstetricians and pediatricians, he said.

“We hope that families are always asking questions about routine newborn care and why it’s important to have these recommended pieces of care done,” Warren said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

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.

What a Supreme Court decision on inclusive curriculum could mean for vaccine laws

2025-12-12T15:04:39+00:00

What does the book “Pride Puppy!” have in common with a measles vaccine?

Some religious parents don’t want their children exposed to either one.

But is that position enough to overturn New York law and force the state to offer a religious exemption to Old Order Amish parents and others who say their faith does not allow them to vaccinate their children? That’s a question the U.S. Supreme Court recently told a lower court to consider.

In its Mahmoud v. Taylor ruling last summer, the Supreme Court’s conservative majority found that Montgomery County Public Schools’ interest in having all children learn from an LGBTQ-inclusive curriculum was not greater than parents’ rights to direct their children’s religious upbringing. Parents must have the ability to opt out, the court said.

On Monday, the Supreme Court vacated a decision by the U.S. Court of Appeals for the 2nd Circuit upholding New York’s vaccine mandate, which does not allow for religious exemptions, and told the lower court to reconsider it in light of the Mahmoud decision.

Legal experts told Chalkbeat that doesn’t mean the Supreme Court is poised to require religious exemptions. It’s not unusual for the Supreme Court to ask lower courts to re-examine rulings in light of new decisions that have even a tangential connection, they said. Often, the outcome remains the same.

But if the Supreme Court were confident Mahmoud had no bearing on vaccine law, the justices could have simply declined to take the case and let New York’s law stand, said Dorit Reiss, a law professor at the University of California San Francisco who has studied religious exemptions. Vaccine supporters should be concerned by the court’s decision not to take that course, she said.

“At the very least, they think there might be something there,” Reiss said. “But how much they believe it is up in the air.”

The case is playing out during a tenuous time for public health and as the Supreme Court steadily expands the bounds of religious freedom. An investigation by NBC News and Stanford University found vaccination rates falling and the use of exemptions rising in many communities. A measles outbreak killed two unvaccinated children in Texas, and the United States is at risk of losing its measles elimination status.

Many public health experts fear that under Health and Human Services Secretary Robert F. Kennedy Jr., the federal government is dismantling a vaccine infrastructure that saved countless lives and is actively undermining public trust in vaccines.

In a Dear Colleague letter earlier this year, Kennedy warned states they risk their federal funding if they don’t allow religious exemptions.

Most states already have religious or personal belief exemptions. Any change in the legal status quo would have limited effect. But it would take away a tool — narrowing or reducing exemptions — that has been shown to increase vaccination rates. Four of the five states without religious exemptions — California, New York, Connecticut, and Maine — tightened their requirements in recent years in response to disease outbreaks.

“It adds worry at a time when we have a lot to worry about with vaccines,” Reiss said.

Religious exemptions raise questions about sincerity

School vaccine mandates go back to the 19th century, and the courts have repeatedly upheld their validity, even without religious exemptions.

A 1970 measles outbreak in Texarkana underscored the role mandates could play in increasing vaccination rates — nearly all the cases occurred on the Texas side of the city, where there was no school mandate. Arkansas, in contrast, had a school mandate and had conducted mass vaccination campaigns. Along with federal incentives, the Texarkana example contributed to more widespread adoption of school vaccine requirements.

Many states adopted religious exemptions, Reiss said, with the assumption that only very small religious minorities would use them. Most major faith traditions allow or even encourage vaccination. But over time, these exemptions became widely abused and hard to police, she said. The government could not make religious exemptions conditional on membership in a particular faith, nor could the government require, say, that a Catholic follow the Pope’s teachings, or that a Jewish person listen to their rabbi.

But more significantly, Reiss said, people lie. Anti-vaccine Facebook groups coach non-religious parents on what to say to obtain a religious exemption, and studies find that parents claiming religious exemptions often cite safety concerns when questioned.

That dynamic contributed to states like California and New York removing religious exemptions. They now allow only medical exemptions.

The Texas-based First Liberty Institute, which is representing the Amish parents, argued in its petition to the Supreme Court that because New York allows medical exemptions, the lack of a religious exemption amounts to discrimination.

“Today in New York, if a vaccine would harm your lungs, you may be exempted; but if it would harm you soul, you may not,” attorneys wrote.

While not all Amish families reject vaccines, no one doubts the religious sincerity of the families suing the state, Reiss said. That makes the case one to watch.

“Yes our Almighty God wants us to fully put our faith + trust in Him,” Joseph Miller, one of the Amish parents suing New York, said in written testimony. “Which is in conflict to put our trust in vaccines. We are also commanded to not be conformed to this world.”

West Virginia’s vaccine mandate, with no religious exemption, has been in place since 1905, and the state enjoys very high vaccination rates. Gov. Patrick Morissey, a Republican, issued an executive order allowing religious exemptions shortly after taking office in January, but the state Supreme Court blocked the order from going into effect. The mandate remains in place for now.

That shift highlights how views of vaccines are increasingly partisan, with support declining among Republicans. In a related development, vaccine legislation became nearly as partisan as abortion even before the pandemic, according to research by Kevin Estep, a sociologist and associate professor of health administration and policy at Creighton University.

“The most dangerous thing right now, in my mind, is putting fuel on the fire of the idea that the government is infringing on parental rights,” Estep said. “That might create new vaccine hesitancy where there wasn’t before.”

It’s unclear how expanding religious freedom affects vaccines

Richard Katskee, an assistant clinical law professor at Duke University, authored an amicus brief in support of the school district in Mahmoud, and he believes the case sets a dangerous precedent. But the justices were careful to stick to curriculum, which could limit how widely it applies.

“I still think there will be real wariness from the court to hurt public health,” Katskee said. “There has been a history of deference.”

Douglas Laycock, a professor emeritus at the University of Texas and the University of Virginia, wrote a brief in support of the parents in Mahmoud. But he agrees that applying Mahmoud to vaccine exemptions could be a stretch.

“One [case] is about asking kids to listen to these stories that are about topics that are pretty religiously sensitive,” Laycock said. “The other is about a medical requirement that protects every kid in the school from diseases that are at best a problem and at worst disabling or fatal.”

Mahmoud isn’t the only Supreme Court decision potentially weighing on vaccine law.

In Tandon v. Newsom, the Supreme Court overturned a California restriction on in-home gatherings during the depths of the pandemic that was challenged by a couple that held Bible study in their home. A federal judge in 2023 cited that case in ruling that Mississippi must allow religious exemptions to its school vaccine mandate.

The reason Mississippi had no religious exemption at the time was because the state Supreme Court had struck it down in 1979. In that ruling, the justices could not believe that the First Amendment requires that “innocent children, too young to decide for themselves … be denied the protection against crippling and death that immunization provides because of a religious belief adhered to by a parent or parents.”

Mississippi regularly boasted the highest vaccination rates in the nation. Now that religious exemptions are allowed, Mississippi still has high overall vaccination rates, but it’s no longer No. 1. Rates for children under 2 years old are now below the national average.

Erica Meltzer is Chalkbeat’s national editor based in Colorado. Contact Erica at emeltzer@chalkbeat.org.

Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

2025-12-12T14:36:10+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

When Su Wang was in medical school, she donated blood. That’s when she learned she was infected with hepatitis B, a virus that attacks the liver and can lead to cancer and death decades later.

“I was 18, healthy, in college,” she said. “And suddenly I had a chronic illness I didn’t even know about.”

Born in Florida in 1975, Wang grew up before the hepatitis B vaccine was routinely given to newborns. For years, she assumed she had been infected by her mother, only to discover later that both her parents were negative. “It turns out my grandparents, who cared for me after birth, probably passed it to me,” she said. “That’s how easy this virus spreads — not from some exotic risk factor, just family.”

Today, Wang is the medical director for viral hepatitis programs at RWJBarnabas Health in New Jersey. Her story now sits at the center of a historic turning point in public health.

On Dec. 5, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to end the universal U.S. recommendation for the newborn dose of the hepatitis B vaccine, instead adopting a policy urging individual-based decision-making.

Under the new approach, only infants born to mothers who test positive for hepatitis B will automatically receive a dose of the vaccine and hepatitis B antibodies shortly after birth. For everyone else, if the parents choose to vaccinate, the birth dose can be delayed until 2 months of age.

All the committee members were appointed by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist. In an 8-to-3 vote, the panel decided that since most pregnant women now receive hepatitis B testing, administering the vaccine at birth should be reserved for infants whose mothers test positive. They framed the shift as a way to reduce interventions deemed unnecessary, align vaccination with test results, and give parents more control over timing. Supporters of the decision described it as a move toward parental choice rather than a reflection of changing epidemiology.

Vaccine panel drops recommendation that all newborns get hepatitis B shot

But to many clinicians and epidemiologists, the change represents a dangerous rollback that could reverse three decades of progress toward eliminating a disease that still infects as many as 2.4 million Americans and kills tens of thousands each year. They see echoes of the 1980s, when risk-based vaccination left entire generations unprotected, and worry the country is about to repeat that mistake.

Moreover, the panel’s move on hepatitis B — in the face of overwhelming data that show the birth dose is effective and safe — portends further upheaval for the nation’s childhood vaccine schedule, a cornerstone of public health.

“They’re not just trying to change one vaccine,” said Angela Rasmussen, a virologist and an editor of the scientific journal Vaccine. “They’re trying to dismantle how vaccine policy is made.”

Department of Health and Human Services spokesperson Emily Hilliard responded: “ACIP reviews all evidence presented and issues recommendations based on evidence and sound judgment to best protect America’s children.”

The authors of a new independent review by the Vaccine Integrity Project, which evaluated more than 400 studies and reports, warned in a public comment that delaying the birth dose “would reduce protection for infants and increase the risk of avoidable HBV infections, undermining decades of progress” toward eliminating the hepatitis B virus. The review was led by researchers at the University of Minnesota’s Center for Infectious Disease Research and Policy, which created the Vaccine Integrity Project in response to what it regards as Trump administration actions that “put the federal vaccine landscape at risk,” and it was vetted by outside experts.

“We fought hard for that universal birth dose because targeted approaches missed too many babies,” Wang said. “We know what happens when you wait.”

What’s unfolding now is not just a technical policy update but a fundamental test of the systems meant to protect the most vulnerable. The debate turns on a few critical questions — whether testing is reliable enough to replace universal safeguards, how infectious hepatitis B truly is, why past strategies failed, and what the CDC’s internal shake-ups mean for vaccine policy writ large.

Why universal vaccination was created

Hepatitis B testing sits at the center of the new ACIP recommendation, but even the CDC acknowledges that testing alone can’t guarantee protection. Pregnant women may test negative if the virus was acquired late in pregnancy or during the “window period,” before hepatitis B surface antigens become detectable. False negatives happen. No testing system, no matter how well designed, can catch every infection. That’s why universal vaccination was created in the first place.

If a mother’s status is unknown at delivery, hospitals are supposed to give the newborn a hepatitis B vaccine within 12 hours, adding hepatitis B antibodies for premature infants or if the mother later tests positive. But in real clinical settings, these safeguards routinely break down. Results take time. Nurses miss or misread labs. Pharmacies delay deliveries. Documentation gets lost.

“Every step you add increases the chance that something falls through the cracks,” Wang said. “Delaying the vaccine just adds another.”

ACIP’s vote shows how that logic is being challenged.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

Some committee members suggested dropping the third hepatitis B shot if antibody levels look high after the second.

But Brian McMahon, a liver disease specialist who has spent decades treating hepatitis B, told the panelists that the data doesn’t support that idea. “Only maybe 20% to 30%” of infants have an adequate antibody level after the first dose, he said.

“You need two doses to really reach a high level of protection,” he said, with the third shot giving a stronger, longer-lasting response.

He said the overall message coming from the committee seemed designed to “discourage the birth dose.”

“They’re making it more and more difficult,” McMahon said.

In a second vote, ACIP also encouraged parents and clinicians to order post-vaccine serology tests — blood tests that measure protective antibody levels — after the second or third dose. The tests, ACIP said, should be covered by insurance.

Hepatitis B is more infectious than HIV or hepatitis C

Hepatitis B can survive on toothbrushes, razors, and household surfaces for a week. It spreads not just from mother to child but also through ordinary family contact: shared items, open sores, small blood exposures. In the 1980s, researchers found that about half of infections in American children came not from mothers but from other household members.

That’s why state health departments continue to insist that every newborn be vaccinated within 24 hours of delivery, regardless of maternal status. “Delaying vaccination misses a crucial period of potential exposure,” a New York advisory warned this year. The vaccine, it noted, is 80% to 100% effective when given on time.

The Vaccine Integrity Project report underscores the stakes. Since the universal birth dose was introduced in 1991, pediatric hepatitis B infections in the United States have dropped by more than 99%. A 2024 CDC analysis estimated that the current schedule has prevented more than 6 million hepatitis B infections and nearly 1 million hospitalizations.

The benefits are lifelong. Infants vaccinated at birth are shielded not just from hepatitis B but also from the liver failure and cancer it can cause decades later. Yet because the disease unfolds slowly, the consequences of policy shifts may not surface for 20 or 30 years.

Trieu Pham, a California physician, doesn’t need to imagine those consequences. Born in Vietnam in 1976, he probably contracted the virus at birth. “If the vaccine had existed then, I wouldn’t have gone through what I did,” he said. Diagnosed in his 20s, he developed cirrhosis by 40. At 47, he was coughing blood from ruptured esophageal veins. Eventually, he required a liver transplant to survive.

“You live with this constant fatigue and fear,” he said. “And the saddest part is it was preventable.”

His three children, all vaccinated within hours of birth, are free of hepatitis B. “That’s the difference a day can make,” Pham said.

Data show the universal strategy is most effective

In 1982, ACIP recommended the new hepatitis B vaccine only for adults at high risk: health care workers, injection drug users, and men who have sex with men. But by the late 1980s, it was clear that risk-based vaccination couldn’t contain transmission. Many newly infected adults didn’t fit any defined risk group. Identifying high-risk people proved imperfect, stigmatizing, and ultimately ineffective.

Meanwhile, infants infected during or shortly after birth had a 90% chance of developing chronic infection, compared with less than 5% in adults. Yet public health officials repeated the same targeted strategy, this time with newborns. In 1988, the CDC recommended universal prenatal screening and linked an infant’s vaccination to the mother’s test result, again basing protection on a risk marker instead of vaccinating all infants.

As before, it failed. Many infected mothers weren’t correctly identified. Some were never tested, some were tested too early, and others had results that were misread or never communicated. Too many infants slipped through the cracks, proof that another targeted approach couldn’t reliably protect them.

In 1991, the CDC issued its landmark guidance recommending that all infants, regardless of their mother’s infection status, receive a hepatitis B vaccine at birth, followed by two additional doses in infancy. By 2005, the policy was fully embedded in the routine immunization schedule, then reaffirmed in 2018. This evolution was based on data showing that a universal strategy, rather than a targeted one, was the most effective in preventing infections.

U.S. stands alone in abandoning birth dose

The CDC’s new hepatitis B policy rests on the premise that moving the decision to parents will strengthen trust in the vaccine system. Supporters frame it as an empowerment shift — a way to give families more control.

In 1999, when it was last recommended to postpone the first dose of hepatitis B vaccine for infants born to uninfected mothers, vaccination rates also dropped among infants born to those who were infected.

“Opt-in policies sound patient-centered,” Wang said, “but in practice they’re inequitable. They leave behind the very families who need protection most” — the ones most likely to miss prenatal care and testing, have infections that go undetected or arise after testing, or slip through gaps in hospital care, as well as infants who can be exposed and infected by other caregivers and household members.

Those are often immigrant families, including from Asian and Pacific Islander communities in which hepatitis B remains endemic. “We already underdiagnose and undertreat these populations,” Wang said. “This change would deepen that gap.”

The United States is now the only country to abandon a universal hepatitis B birth dose recommendation. Though it will take decades to gather outcomes data, some researchers predict that delaying the first dose of hepatitis B vaccine to 2 months of age could result in over 1,400 preventable infections and about 300 cases of liver cancer per year.

“We don’t get to choose what we inherit,” Wang said. “But we do get to choose what we pass on.”

This story originally published at KFF Health News, Healthbeat’s national reporting partner.

How states and cities can defend public health in 2026

2025-12-11T13:19:07+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In 2025, the federal government pursued a deliberate strategy to reduce its role in protecting public health. As a result of changes to the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and other operating divisions, public health experts agree that the country is now less well protected against infectious diseases, environmental hazards, unsafe food, and chronic conditions.

In 2026, the question facing governors, mayors, and local health officials is glaring: What can be done now to protect public health if the federal government will not? The answer is that state and local governments need to act to support the supplies, staff, systems, and statutes needed to enable and enforce public health.

Supplies: Build stockpiles for public health emergencies and reproductive health

Every public health emergency requires supplies, such as diagnostics, vaccines, therapeutics, and personal protective equipment. For most routine events, states and local governments can rely on their own reserves and commercial supply chains for these so-called “countermeasures.”

For larger or unusual events, they have historically relied on the federal government, such as test kits produced and shipped by the CDC or through supplies released from the Strategic National Stockpile (initially established in 1999). That assumption is no longer safe.

In 2025, staffing to maintain and support this stockpile was cut, along with funding for vaccine research, procurement, and delivery. Similarly, the White House blocked the release of federal emergency funding for response and recovery from environmental disasters in North Carolina and Illinois because they have Democratic governors.

Outside of acute events, there is an additional risk that the federal government could restrict medications for reproductive health given the administration’s strong position opposing abortion.

In 2026, state and local governments could start planning for supply instability by building or expanding countermeasure stockpiles to infectious diseases, reproductive health, and other health emergencies. At a minimum, these stockpiles would need to cover the first weeks of an emergency and ensure continuity of routine services if federal systems falter.

To prepare for the possibility that the federal government’s role could be permanently reduced, states could also consider investing, potentially through a multi-state consortium, in capacity to manufacture or complete the final preparation and distribution of countermeasures. Consider, for example, how California is working to produce and distribute insulin to improve costs and access for its residents. A multi-state network could stabilize supply, support research and development, and reduce dependency on the federal systems.

Staffing: Mitigate the loss of public health workforce

The United States entered the pandemic with a public health workforce that had already been thinned out. In 2025, that situation worsened considerably. Federal grants support a large percentage of staffing at state and large municipal health departments. The administration has cut this funding by canceling grants, rescinding funds already awarded, impounding funds appropriated by Congress, and passing cuts through legislation. Many health agencies have had to eliminate staff and have no funding to replace those functions.

Rebuilding the workforce requires money. In 2026, states will need to find additional funding to restore personnel working on surveillance, community outreach, environmental health, laboratory testing, maternal and child health, and emergency preparedness. It will also fall to them to recruit and retain the next generation of workers with programs that used to be supported by the federal government, such as loan repayment and training programs for public health advisers, field epidemiologists, microbiologists, and related fields.

Even with more funding, no jurisdiction will be able to replace all of the staff lost through federal cuts. This is where artificial intelligence could play an important role. A large percentage of public health practice is cognitive labor: People gather data, clean it, interpret it, and translate it into protocols, policy, and public communications. AI systems purpose-built for public health can automate much of this work, freeing time for humans to conduct field investigations, engage with the community, and work with stakeholders on policy.

Systems: Ensure continuity of disease surveillance systems

Public health relies on systems to monitor health conditions that are largely invisible to the public. These surveillance systems link together data collection in the community, at health care facilities, and from the environment with laboratories and information management systems. These systems require long-term investment to ensure public health agencies can monitor the trends in important health conditions and the impact of interventions.

Some systems have been dismantled, and others are being starved of resources. If this continues, states will lose the ability to detect emerging threats, monitor ongoing ones, and issue credible guidance both within their borders and to understand what is happening in neighboring localities.

In 2026, states will need to begin constructing their own analytic infrastructure and supporting existing academic initiatives, such as Beacon. This can take several forms. It could be in the form of multi-state coalitions that synthesize data across multiple jurisdictions, share resources for laboratory testing, information management, and data analysis.

Statutes: Bolster public health legal authority before it is challenged

According to the U.S. Constitution, public health authority is vested in states and localities. During the pandemic, those laws became targets. In many states, new statutes have been passed to weaken isolation and quarantine powers, vaccine requirements, and emergency authority. The federal government is also asserting greater control over immigration, law enforcement, and regulatory powers in ways that may undermine local action during health emergencies.

In 2026, states and cities will need to publicly clarify and codify their health authorities. This begins with rapid legal reviews of existing statutes governing disease reporting, isolation and quarantine, environmental enforcement, reproductive health, and emergency powers. Those authorities could then be updated and enacted into law.

Even in situations in which existing authorities have not changed, there may be value in conducting these reviews publicly and issuing public statements or passing new laws that signal to courts, the media, and the public that these powers are legitimate, expected, and necessary.

In 2026, states may also need to prepare for conflict with the current administration if there are infectious disease emergencies where they need to restrict people’s movement or mandate vaccines. Multi-state legal defense coalitions may need to be formed now to coordinate litigation, share expertise, and act quickly to defend state authority for public health emergency powers.

The need for states to act now to protect public health

The dismantling of federal public health is likely to proceed further in 2026 as the safety net for health insurance (Medicaid) becomes weaker and the impact of declining vaccination rates grows. While states cannot replace the enormous role that the federal government has played and needs to play, communities will be more reliant than ever on their local health agencies than at any point in recent memory. While each of the actions described above requires a different tactic, they all share the same principle: Do not underestimate the risk. The time to act is now.

Kenya signs first U.S. aid deal – but can it afford to pay its share?

2025-12-11T12:00:00+00:00

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Hello from Nairobi.

Last weekend I went to an ugly-sweater holiday party at the start of the dry season and learned something important about hubris. There is hot, there is very hot, and then there is “woolen knitwear in equatorial sun.” I will choose differently next time.

What’s new this week? Some big moves on American foreign aid, plus we’ve hit the point in the year when the consequences of the past 12 months are starting to show up in the data. Some of what follows is tough reading, but I promise we will end on something light.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Kenya signs the first ‘America First’ health deal

Allow me start this week’s opening story with a short rewind on what happened this year to America’s aid bureaucracy. (Bear with me, the background really does matter.)

Earlier this year, the Trump administration shut down America’s foreign aid agency, the United States Agency for International Development. While most American aid programs ended with it, about 17% of USAID’s former contracts survived. These included some (though not all) lifesaving global health programs. By July, those programs were all transferred to the State Department, which has been quietly rehiring former USAID staff as temporary contractors to keep them running. Still, for months the ultimate fate of that remaining health aid was anybody’s guess.

Finally, in September, the State Department announced a new plan for American health aid moving forward, which was presented under the banner of “America First.” The heart of the new approach would be country-by-country deals. But the announcement left huge questions about actual funding and long-term commitments unanswered.

Still with me? This brings us to the latest news.

The United States finally signed the first of those global deals here in Kenya last week, Health Policy Watch reports. The agreement promises “$1.6 billion over the next five years,” for priorities like malaria control and disease surveillance, and hinges on Kenya committing to raise its own health spending by $850 million. Moving forward, American officials say as many as 49 more agreements could follow in Africa alone.

There has been some hubbub in Kenya about one clause in the deal, which requires the Kenyan government to share health surveillance data with the United States for 25 years, including providing U.S. businesses with genetic data. (I initially didn’t read this as a nefarious data grab, but instead as Washington trying to patch the disease reporting gap it opened when it pulled out of the World Health Organization.)

Meanwhile, Secretary of State Marco Rubio praised the agreement’s new approach by saying, “We are not going to spend billions of dollars funding the NGO industrial complex while close and important partners like Kenya either have no role to play or have very little influence over how health care money is being spent.” It’s worth noting: That framing is flat-out inaccurate, since USAID historically co-designed Kenya’s health programs with the Kenyan government, and routed much of its funding through local Kenyan organizations.

This all gets to my bigger question: How much is actually different in practice, once you sift past the rhetoric? I reached out to John Kuehnle, my old colleague who actually ran America’s health programs for USAID in Kenya from 2020 to 2024, to ask. (Today Kuehnle is the CEO of the American NGO Partners for World Health).

Kuehnle welcomes the effort to persuade Kenya to invest more of its own money, which he says mirrors what USAID and the Centers for Disease Control and Prevention had pushed for years. But he warns that “the challenge that we always had was that we knew that even if we got the Kenyan government to agree to increase spending over time, fiscally that would be very difficult for them to actually do. I don’t think that has changed,” he said. (It’s worth noting that the agreement is, uh, non-binding.)

“I think that the Kenyan government signed this agreement out of desperation to guarantee funding for the next five years, and buy time in the hopes that their financial situation improves, or that there is a regime change in the U.S. that is open to renegotiating [the agreement] when it ends,” Kuehnle said.

As the agreement rolls out, Kuehnle points to a few key signals to watch.

For one, “the U.S. government currently does not have enough staff in Kenya to manage an [agreement] like this. Keep an eye on ... the amount of funding that actually moves.” And perhaps most importantly, Kuehnle raised the specter of the c-word that had constrained many of USAID’s earlier attempts to route money more directly through governments like Kenya’s: corruption. “I think many Kenyans outside of the Kenyan government do not believe that their government can be trusted to manage funds directly,” he said.

Preventable childhood deaths are increasing

For the first time in 25 years, childhood deaths from preventable diseases are rising globally, TIME magazine reports. (This is according to University of Washington researchers in the Gates Foundation’s annual report on global health.) All told, an additional 200,000 children under 5 are expected to die in 2025, bringing the total to about 4.8 million. (Disclosure: The Gates Foundation is a funder of Healthbeat).

To be clear, these are deaths that could have been entirely avoided “with vaccines or other [existing] treatments.” In the report (which can be downloaded here) Bill Gates himself puts this compound tragedy fairly succinctly: “There’s something especially devastating about a child dying of a disease we know how to prevent.”

Regular readers of the Global Health Checkup probably won’t be surprised by what is being fingered as the primary driver of this reversal: “significant cuts to spending in global health from the world’s largest donors.”

What’s the takeaway?

For one, it’s worth noting that the report largely presents this year’s rise in deaths as a short-term bump rather than a lasting reversal. Even without reversing the global cuts, the projections show child deaths falling again in most future scenarios, even as soon as next year. At the same time, the report warns that child survival is now more fragile than before, and that progress against preventable diseases can be increasingly pushed off course by shocks like conflict, climate disruption… or a further drop in funding.

Malaria is on an ominous path

The World Health Organization just published its yearly report on the global state of malaria, Euronews reports. (One note up front: Like the tuberculosis data we covered three weeks ago, WHO’s reporting speed is glacial, so the “2025” report only describes 2024.)

How was last year? Ominous.

Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

Even before this year’s aid cuts, malaria cases ticked up in 2024 over 3%, reaching an estimated 282 million total cases. Deaths also rose upward to 610,000 in 2024, with the majority being young children in “11 African countries.”

Malaria is one of the rare tropical diseases with a well-funded advocacy community and decades of scientific focus, so it’s worth asking, why we were losing ground last year?

There are really two answers, according to the WHO. One is rising resistance to malaria drugs and insecticides, and the other is a familiar foe, climate change, which is giving various mosquito species more places to survive and more months each year to spread the parasite.

My takeaway: Looking “forward” to this past year, malaria is the disease I’m most worried about on the continent I call home. That’s because malaria moves fast (the incubation period is tiny), and once you let off the brakes, or conditions shift, cases can explode. As we covered in early October, in places like Cameroon, aid agencies are already saying the clock has rolled back 20 years due to the aid pullback. If we were already losing ground, the worst may still be ahead.

Exit ebola, enter cholera

It’s been a week of whiplash in the Democratic Republic of the Congo. As we reported last week, the country announced the end of the Ebola outbreak on Dec. 1. But UNICEF, the U.N. Children’s agency, just confirmed that DRC is now contending with its worst cholera outbreak in 25 years, Reuters reports.

Just by the numbers, there’s been more than 64,000 cases and roughly 1,888 deaths since the start of the year. But one, smaller line hit me particularly hard: “In one case, a quarter of the children in a Kinshasa orphanage … died days after the disease swept through.”

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The conditions driving this disaster are painfully familiar: “Only 43% of people in Congo have access to at least basic water services [like basic plumbing or just treated water], the lowest rate in Africa, and just 15% use basic sanitation,” like toilets or sanitized latrines. Combine that with ongoing conflict, displacement, overcrowding, and crumbling infrastructure, and cholera is spreading through many communities with ease. Unsurprisingly, UNICEF is calling for “more funding” to help contain the crisis, which is unlikely to come unless it is diverted from elsewhere.

The takeaway: It is encouraging to see what the world can do when it focuses on a threat like Ebola. But if that focus is built on rerouting and draining support from other crises, and if the plan for this cholera outbreak also just moves money from one emergency to the next … it’s hard to celebrate a system that’s only moving the danger around.

Expert advice from Scandinavians on winter darkness

Admittedly some tough news in today’s report, so let’s end with something light. With the solstice around the corner, the Associated Press published a story that sums up advice from Nordic health professionals on coping with winter darkness.

As far as I could tell, the advice seemed sound: You should get morning light, keep your routines, stay social, and lean into winter. That said, there’s a famous adage in journalism on the importance of verifying whatever anyone tells you, even from trusted sources: It’s “if your mother says she loves you, check it out.”

So I passed on the article to three close Scandinavian friends of mine for, uh, let’s call it fact checking. I asked them to be unvarnished, and boy were they!

Generally, my Nords concurred with the AP. Ragnar, a Norwegian-Swede, stressed just how central the cultural value of coziness (“hygge”) really is for managing the enduring dark, along with a steady drumbeat of holiday festivals and “small cozy moments and traditions,” he said. Although … he noted that a certain triumvirate of important and traditional Scandinavian winter staples was entirely missing in the AP story. That’s alcohol, caffeine, and salty Christmas food. But “I’m not sure if these are the best tips to put into a global health newsletter,” he acknowledged.

Miriam, a Swede, challenged the central premise of the article. “I’m not sure we, as a population, know how to deal with the winter darkness,” she said. “Yeah, we do a lot of things, but also a lot of people just go depressed.”

But my favorite takeaways came from Théo (also Swedish) who wrote to me from Kuala Lumpur, Malaysia. “My best remedy for managing Nordic winters is not living there,” he said.

He also took umbrage with one particular line in the AP story. “The saying ‘there’s no such thing as bad weather — only bad clothing’ is a scam invented to force preschool kids to play outside even in the rain and freezing cold,” he said, channeling what sounded like a long-held grievance. “Ice on the sidewalk and horizontal rain mixed with snow 100 % qualifies as bad weather.”

I’ll see you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

This HIV expert quit the CDC: ‘Erasing people from the story harms actual people’

2025-12-10T12:00:00+00:00

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John Weiser, a doctor and researcher, has treated people with HIV since the beginning of the AIDS epidemic in the 1980s. He joined the CDC’s HIV prevention team in 2011 to help lead its Medical Monitoring Project, the only in-depth survey of HIV across the United States. The project has shaped the country’s response to the epidemic over two decades, but the Trump administration censored last year’s findings and stopped funding it.

Weiser spoke with KFF Health News on the evening before World AIDS Day, which the U.S. government didn’t acknowledge for the first time since 1988. That was only the latest blow to efforts to combat HIV. The Trump administration has cut funds to provide lifesaving HIV care abroad, withheld money to prevent and treat HIV in the United States, and fired HIV experts at the Centers for Disease Control and Prevention.

Weiser was fired from the CDC during mass layoffs in April, rehired in June, and then resigned. He continues to treat patients at Grady Memorial Hospital in Atlanta. In November, he published an article that warns against complying with presidential orders to censor data about transgender people.

The following conversation has been condensed and edited for clarity.

In the first weeks of his presidency, Donald Trump issued several executive orders with implications for HIV programs. One directed federal employees to exclude gender identities that didn’t correspond to a person’s biological sex assigned at birth.

On how this played out at the CDC:

We were told to scrub any mention of gender or transgender people from dozens of research papers and surveillance reports that had already been published or were going to be published, and to stop collecting information from participants about their gender identity. For example, we had to recalculate our numbers on HIV among men who have sex with men, or MSM, a category that the CDC changed to “males who have sex with males.”

The CDC had no director at the time. The order came from on high. And there was no discussion about whether we wanted to comply with the directive.

On how this directive has affected his research:

Using data from the Medical Monitoring Project, we found that people with HIV who misused opioids were more likely to engage in behaviors that could pass on HIV to another person — through unprotected sex or shared injection. And we found that very few people who misused opioids were receiving treatments for substance misuse. This information could have been useful to change clinical practice and boost funding to treat people with HIV who misuse opioids.

We were getting ready to publish this study, but when I put the paper through CDC’s clearance process, I was told to remove data about the prevalence of opioid misuse among transgender people.

I thought carefully about that, and I decided not to do that because it’s bad science to suppress data for ideologic reasons, and because erasing people from the story harms actual people. I thought about my transgender patients and how I would face them, and what I would say to them while I’m sitting with them in the exam room, knowing that I had erased their existence from CDC.

I withdrew the paper. It remains unpublished.

On how removing data harms people:

Purging data about transgender people has the effect of erasing them from the real world, pretending that they don’t exist. This group of people is heavily affected by HIV, and this type of information informs improvements in treatment. My transgender patients struggle with poverty, with unstable housing, with food insecurity, with mental health disorders, with substance misuse, and face a huge amount of stigma and discrimination in their daily lives.

My transgender patients are trying to get by, day by day. They’re trying to survive. I think it’s important to realize that somebody who is transgender needs to feel comfortable in their own body to be healthy — and denying them recognition compounds their challenges.

After the executive order came down, one of my patients said she felt even more afraid of being in public and not passing, and so she was considering having additional surgical treatment to feel safer. Her concern was not about politics. It was about survival.

On why the CDC went along with orders to remove transgender data:

I think the hope was that by complying with the directive, other work at the CDC would be spared. And unfortunately, that hasn’t proved to be the case. Funding for the Medical Monitoring Project was terminated after 20 years, and the concern within CDC is that the president will eliminate all HIV prevention and surveillance funding.

One of my concerns while there was that if it’s OK to comply with a directive to remove information about gender, what if the next demand is that we don’t report about people who emigrated from other countries, or on people who are experiencing homelessness? What if there’s a directive to suppress data about a particular racial or ethnic group that’s unpopular? How far would we go?

Some HIV clinics and organizations have considered curtailing their work with transgender people and undocumented immigrants, or on equity initiatives, because they fear the loss of federal funds.

His advice on these decisions:

People making these decisions are in a really tough spot. They want to do what’s best for their programs. They want to do what’s best for their employees. They want to do what’s best for the people they’re charged with taking care of. Those are careful decisions that need to be made weighing all of the considerations. What I want these leaders to do is also consider how a decision to essentially throw one group of people under the bus undermines scientific integrity, and harms everyone.

And I think that it’s also necessary for the rise of autocracy to go along, to compromise, to acquiesce. While all of this was going on, I heard an interview with Masha Gessen, who is a Russian American journalist who writes about the rise of autocracy. Gessen explained that decisions to go along are not made because people are unethical or heartless. They’re rational choices. They’re made in order to protect something that’s important — institutions, families, jobs — even if it means sacrificing principles. Gessen’s point is that this gradual process of compromising ultimately is what solidifies an autocrat’s power.

On why he resigned from the CDC:

As a physician working at the CDC, numbers have always described individual people, people whose suffering I witness. When you know somebody, they’re no longer just a concept that you make a judgment about.

I realized that I could do more good by spending more time with my patients than I could working for the CDC under this administration.

Amy Maxmen is a Healthbeat national reporter through a partnership with KFF Health News.

Vaccine panel drops recommendation that all newborns get hepatitis B shot

2025-12-05T20:33:43+00:00

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A longstanding recommendation that all babies be vaccinated at birth against hepatitis B was abandoned in a divided vote Friday by a federal advisory panel at the Centers for Disease Control and Prevention.

Members of the committee who voted in favor of the change hailed it as supporting informed vaccine choice by parents, who they say have been abandoned and marginalized by pediatricians when refusing or delaying immunizations.

“True choice has not been existing in practice,” said committee member Hillary Blackburn, a doctor of pharmacy. “No child should lose their medical home because their parents are engaging in the very individually based decision making we’re encouraging.”

Those who voted against the change said parents always have the final say in what vaccines their children receive, and that the new recommendations lacked scientific evidence and will result in children suffering needless infections and serious liver damage.

“We know that three doses given according to the existing schedule are safe and effective in preventing hepatitis B,” said Dr. Cody Meissner, a professor of pediatrics at Dartmouth’s Geisel School of Medicine. “We are doing harm by changing this wording, and I vote no.”

All of the committee’s members were chosen by Health and Human Services Secretary Robert F. Kennedy Jr., who has long been critical of vaccine safety. Kennedy dismissed the panel’s previous members during the summer, then fired Trump administration CDC Director Susan Monarez for what she told Congress was her refusal to rubber stamp future recommendations of the committee.

The CDC Advisory Committee for Immunization Practices voted 8-3 that women who test negative for the hepatitis B virus should consult with health care providers to “decide when or if“ their child should be vaccinated against the virus, with any initial dose “suggested” to be administered “no earlier than 2 months of age.”

The committee did not change the current recommendation that a birth-dose of the vaccine be given to infants born to women who test positive for the hepatitis B virus.

U.S. Sen. Bill Cassidy, the Republican chairman of the Senate Health Education, Labor, and Pensions Committee urged acting CDC Director Jim O’Neill to not sign the recommendations and maintain the current standards.

“As a liver doctor who has treated patients with hepatitis B for decades, this change to the vaccine schedule is a mistake,” Cassidy, whose vote was instrumental in Kennedy’s confirmation as HHS secretary, said on the social media platform X.

“The hepatitis B vaccine is safe and effective. The birth dose is a recommendation, NOT a mandate,” Cassidy said, noting that before the birth dose was recommended, 20,000 newborns a year were infected with hepatitis B. “Now, it’s fewer than 20. Ending the recommendation for newborns makes it more likely the number of cases will begin to increase again. This makes America sicker.”

The committee makes recommendations to the CDC director, who can accept or reject them. O’Neill is a deputy secretary at HHS in addition to serving as acting CDC director. CDC and HHS did not immediately respond to questions from Healthbeat about O’Neill’s timeframe for making a decision on the recommendations.

Major medical and public health associations – including the American Academy of Pediatrics, the American Medical Association, the Infectious Diseases Society of America and the National Association of City and County Health Officials – had urged the committee not to change the recommendation that all babies receive the birth dose.

The American Academy of Pediatrics has said it is not going to change its recommendation to pediatricians that all babies should receive a first dose of hepatitis B vaccine shortly after they are born.

The associations noted that babies born to mothers who test negative for hepatitis B virus remain at risk of infection early in life from families, caregivers, and other close contacts who may be infected but often do not know it.

The hepatitis B virus is highly contagious and spreads through contact with blood and body fluids. It can cause severe liver damage and cancer. The virus can spread from person to person through sharing of personal items such as razors, toothbrushes, and nail clippers, as well as through sexual contact and use of unsterile needles.

Universal infant and childhood vaccination against hepatitis B, recommended since 1991, has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults.

“Recommendations are not mandates,” Dr. Flor Muñoz, representing the Infectious Disease Society of America at Friday’s meeting, told the committee as it prepared to vote. “The issue of consent is not being solved with these changes … 30 years of information regarding the safety and efficacy of these vaccines are very strong to continue to support the existing recommendation.”

Committee members Meissner and Dr. Joseph Hibbeln, a psychiatrist and neuroscientist, objected throughout the meeting to what they said was a lack of evidence supporting the new recommendations. No data were presented to the committee to support recommending a two-month delay before babies born to hepatitis B negative moms get their first vaccine, they said.

“We have no basis for saying that. That’s been kind of pulled out of the air,” Meissner said.

“I am hopeful that pediatricians will continue to administer the birth dose within the first 24 hours of delivery and before discharge from the hospital. I think to follow any other course is not in the interest of the infant,” Meissner said.

Added Hibbeln: “This specific point is the reason why we tabled this issue for three months to more fully discuss it. However, we have still not had any information or science presented or discussed with regards to this issue of [giving the first dose of hepatitis B vaccine ] before or after 2 months of age. This is unconscionable.”

The committee also voted to recommend parents consider antibody testing to evaluate the hepatitis B vaccine’s effectiveness before getting subsequent doses. The vote passed with six members in favor, four opposed, and one abstaining.

This blood testing, the recommendation says, should be used to determine whether adequate protection against hepatitis B has been achieved. The recommendation says the cost of the testing should be covered by insurance.

Hibbeln objected to this testing recommendation being added to what had been a changing series of proposed recommendations shared with the committee with little time for advance consideration. “This fourth iteration of votes in 96 hours is still incredibly problematic,” he said.

“There is an absolutely novel concept being put forth here to vote, that a serology test should be offered” after the first dose, he said. “There has been no data presented that this plan would actually work.”

Dr. Raymond Pollak, a transplant immunobiologist, expressed similar concerns. “We have no data whether monitoring serology actually implies immunity,” he said.

Dr. Kirk Milhoan, a pediatric cardiologist who recently was appointed the committee’s chairman, said the tests could help parents decide how many vaccines their child needs.

“I would be very happy if we were to vote to simply recommend that this needs to be studied. That would also serve the purpose,” said Milhoan, noting “there is a paucity of data.”

But none of the committee’s members made a motion to do this.

This story has been updated with more details from Friday’s meeting.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

While scientists race to study spread of measles in U.S., Kennedy unravels hard-won gains

2025-12-05T15:09:32+00:00

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The United States is poised to lose its measles-free status next year. If that happens, the country will enter an era in which outbreaks are common again.

More children would be hospitalized because of this preventable disease. Some would lose their hearing. Some would die. Measles is also expensive. A new study — not yet published in a scientific journal — estimates that the public health response to outbreaks with only a couple of cases costs about $244,000. When a patient requires hospital care, costs average $58,600 per case. The study’s estimates suggest that an outbreak the size of the one in West Texas earlier this year, with 762 cases and 99 hospitalizations, costs about $12.6 million.

America’s status hinges on whether the country’s main outbreaks this year stemmed from the big one in West Texas that officially began Jan. 20. If these outbreaks are linked, and go on through Jan. 20 of next year, the United States will no longer be among nations that have banished the disease.

“A lot of people worked very hard for a very long time to achieve elimination — years of figuring out how to make vaccines available, get good vaccine coverage, and have a rapid response to outbreaks to limit their spread,” said Paul Rota, a microbiologist who recently retired from a nearly 40-year career at the Centers for Disease Control and Prevention.

Instead of acting fast to prevent a measles comeback, Robert F. Kennedy Jr., a lawyer who founded an anti-vaccine organization before taking the helm at the Department of Health and Human Services, has undermined the ability of public health officials to prevent and contain outbreaks by eroding trust in vaccines. The measles vaccine is safe and effective: Only 4% of nearly 1,800 confirmed U.S. cases of measles this year have been in people who had received two doses.

Kennedy has fired experts on the vaccine advisory committee to the CDC and has said, without evidence, that vaccines may cause autism, brain swelling, and death. On Nov. 19, scientific information on a CDC webpage about vaccines and autism was replaced with false claims. Kennedy told The New York Times that he ordered the change.

“Do we want to go back into a pre-vaccine era where 500 kids die of measles each year?” asked Demetre Daskalakis, a former director of the CDC’s national immunization center, who resigned in protest of Kennedy’s actions in August. He and other scientists said the Trump administration appears to be occupied more with downplaying the resurgence of measles than with curbing the disease.

HHS spokesperson Andrew Nixon said in a statement that vaccination remains the most effective tool for preventing measles and that the “CDC and state and local health agencies continue to work together to assess transmission patterns and ensure an effective public health response.”

Scientists look for links between outbreaks

CDC scientists are indeed tracking measles, alongside researchers at health departments and universities. To learn whether outbreaks are linked, they’re looking at the genomes of measles viruses, which contain all their genetic information. Genomic analyses could help reveal the origin of outbreaks and their true size, and alert officials to undetected spread.

Scientists have conducted genomic analyses of HIV, the flu, and Covid for years, but it’s new for measles because the virus hasn’t been much of a problem in the United States for decades, said Samuel Scarpino, a public health specialist at Northeastern University in Boston. “It’s important to get a surveillance network into place so that we could scale up rapidly if and when we need it,” he said.

Fulton health team logs 200 extra hours tracing measles exposures tied to GSU student

“We are working with the CDC and other states to determine whether what we’re seeing is one large outbreak with continued spread from state to state,” said Kelly Oakeson, a genomics researcher at the Utah Department of Health and Human Services.

At first glance, the ongoing outbreak in Utah and Arizona, with 258 cases as of Monday, seems linked to the one in Texas because they’re caused by the same strain of measles, D8-9171. But this strain is also spreading throughout Canada and Mexico, which means the outbreaks could have been sparked separately from people infected abroad. If that happened, this technicality could spare the United States from losing its status, Rota said. Being measles-free means the virus isn’t circulating in a country continuously year-round.

Canada lost its measles-elimination status in November because authorities couldn’t prove that various outbreaks from the D8-9171 strain were unrelated, said Daniel Salas, executive manager of the comprehensive immunization program at the Pan American Health Organization. The group, which works with the World Health Organization, includes health officials from countries in North, South, and Central America, and the Caribbean. It makes a call on measles elimination based on reports from scientists in the countries it represents.

Early next year, PAHO will hear from U.S. scientists. If their analyses suggest that measles has spread continuously for a year within the United States, the organization’s director may revoke the country’s status as measles-free.

“We expect countries to be transparent about the information they have,” Salas said. “We will ask questions, like, ‘How did you determine your findings, and did you consider other angles?’”

In anticipation of PAHO’s assessment, Oakeson and other researchers are studying how closely the D8-9171 strains in Utah match others. Instead of looking at only a short snippet of genes that mark the strain, they’re analyzing the entire genome of the measles virus, about 16,000 genetic letters long. Genetic mutations occur naturally over time, and the accumulation of small changes can act like a clock, revealing how much time has ticked by between outbreaks. “This tells us the evolutionary history of samples,” Oakeson said.

For example, if one child directly infects another, the kids will have matching measles viruses. But measles viruses infecting people at the start of a large outbreak would be slightly different than those infecting people months later.

Although the Texas and Utah outbreaks are caused by the same strain, Oakeson said, “more fine-grained details are leading us to believe they aren’t super closely related.” To learn just how different they are from each other, scientists are comparing them with measles virus genomes from other states and countries.

Ideally scientists could pair genetic studies with shoe-leather investigations into how each outbreak started. However, many investigations have come up dry because the first people infected haven’t sought care or contacted health departments. As in West Texas, the outbreak in Utah and Arizona is concentrated in close-knit, undervaccinated communities that are leery of government authorities and mainstream medicine.

Researchers are also trying to learn how many measles cases have gone undetected. “Confirmed cases require testing, and in some communities, there’s a cost to going to the hospital to get tested: a tank of gas, finding a babysitter, missing work,” Andrew Pavia, an infectious disease doctor at the University of Utah, said. “If your kid has a measles rash but isn’t very sick, why would you bother?”

Subtle Surveillance: Researchers analyzing genomes

Pavia is part of a nationwide outbreak surveillance network led by the CDC. A straightforward way to figure out how large an outbreak is would be through surveys, but that’s complicated when communities don’t trust public health workers.

“In a collaborative setting, we could administer questionnaires asking if anyone in a household had a rash and other measles symptoms,” Pavia said, “but the same issues that make it difficult to get people to quarantine and vaccinate make this hard.”

Instead, Pavia and other researchers are analyzing genomes. A lot of variation suggests an outbreak spread for weeks or months before it was detected, infecting many more people than known.

As measles exploded, officials in Texas looked to CDC scientists. Under Trump, no one answered.

A less intrusive mode of surveillance is through wastewater. This year, the CDC and state health departments have launched efforts to test sewage from households and buildings for measles viruses that infected people shed. A study in Texas found that this could function as an early warning system, alerting public health authorities to an outbreak before people show up in hospitals.

The quiet research of CDC scientists stands in stark contrast to its dearth of public-facing actions. The CDC hasn’t held a single press briefing on measles since President Donald Trump took office, and its last publication on measles in the agency’s Morbidity and Mortality Weekly Report was in April.

Rather than act fast to limit the size of the Texas outbreak, the Trump administration impeded the CDC’s ability to communicate quickly with Texas officials and slowed the release of federal emergency funds, according to investigations by KFF Health News. Meanwhile Kennedy broadcast mixed messages on vaccines and touted unproven treatments.

Daskalakis said that as the outbreak in Texas worsened, his CDC team was met by silence when they asked to brief Kennedy and other HHS officials.

“Objectively they weren’t helping with the Texas outbreak, so if we lose elimination, maybe they’ll say, ‘Who cares,’” Daskalakis said.

Nixon, the HHS spokesperson, said Kennedy responded strongly to the Texas outbreak by directing the CDC to help provide measles vaccines and medications to communities, expediting measles testing, and advising doctors and health officials. The U.S. retains its elimination status because there’s no evidence of continuous transmission for 12 months, he added.

“Preliminary genomic analysis suggests the Utah and Arizona cases are not directly linked to Texas,” the CDC’s acting director, Deputy HHS Secretary Jim O’Neill, wrote on the social platform X.

Given Kennedy’s distortions of data on vitamin A, Tylenol, and autism, Daskalakis said the Trump administration may insist that outbreaks aren’t linked or that PAHO is wrong.

“It will be quite a stain on the Kennedy regime if he is the health secretary in the year we lose elimination status,” he said. “I think they will do everything they can to cast doubt on the scientific findings, even if it means throwing scientists under the bus.”

Amy Maxmen is a national reporter for Healthbeat through a partnership with KFF Health News.

Vaccine panel delays votes on hepatitis B shot for newborns

2025-12-05T01:20:58+00:00

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A federal vaccine advisory committee delayed votes Thursday on changes to hepatitis B immunization recommendations for infants as a top Republican senator called the group “totally discredited.”

U.S. Sen. Bill Cassidy, chairman of the Senate Health, Education, Labor, and Pensions Committee, expressed outrage over a scheduled briefing to the Advisory Committee on Immunization Practices on Friday by lawyer and vaccine critic Aaron Siri.

“Aaron Siri is a trial attorney who makes his living suing vaccine manufacturers. He is presenting as if an expert on childhood vaccines. The ACIP is totally discredited. They are not protecting children,” Cassidy, a Louisiana Republican and a physician, said on the social media platform X.

It’s unclear whether Cassidy plans to take any further action. His spokespeople did not immediately respond to questions from Healthbeat.

The committee, based at the Centers for Disease Control and Prevention, has become a flashpoint for controversy since this summer when Health and Human Services Secretary Robert F. Kennedy Jr. dismissed all its members and appointed replacements.

At Thursday’s ACIP meeting, CDC vaccine subject matter experts were largely sequestered in a “SME room” away or remote offices, away from where the committee members meet and providing expert input through video connections only when asked.

Siri, a Kennedy ally, is scheduled to brief the committee Friday morning on the childhood and adolescent immunization schedule, the evolution of the schedule, and a comparison of the U.S. schedule to those in other countries. The meeting’s agenda, as of Thursday, did not disclose any details about his presentation.

Siri, who compared himself to consumer advocates like Ralph Nader, fired back at Cassidy on X, saying vaccine manufacturers regularly speak before the committee. “Yet, I have never heard you take issue with those presenters,” he wrote.

On Thursday, the committee’s focus was on a push by some of its members to reduce the number of infants who are vaccinated at birth against hepatitis B, a serious infection that can cause chronic liver disease and cancer. The committee’s work group was led by ACIP committee member Vicky Pebsworth, research director of the National Vaccine Information Center, a group that warns against vaccine risks.

“It’s been 35 years since the universal birth dose policy was implemented,” she said. The work group was asked to assess whether the universal birth dose should continue to be given to children of mothers who test negative for the virus.

Since the universal birth dose started being given in 1991, there has been a 99% decline in cases of hepatitis B among children, adolescents and young adults.

Pebsworth said the review was prompted to address parent and stakeholder concerns about administering the hepatitis B vaccine at birth.

The committee voted 6-3 to postpone until Friday votes on any changes to the current recommendation that all infants be vaccinated against hepatitis soon after birth.

The decision to delay came after some committee members objected that they had no way to know what they were voting on. While the proposals were verbally read to the committee by vice chairman Robert Malone, they weren’t provided copies of the proposals’ text so they could assess and discuss the language.

The proposals, among other things, would recommend a birth dose of hepatitis B vaccine for babies born to women who test positive for the virus – a significant change from the current recommendation that all babies receive the vaccine. The proposals also contain language that would recommend delaying an initial dose of the vaccine until a child is 2 months old.

Text of the three proposals briefly read during Thursday’s meeting was not posted on the committee’s website.

Edward Tate, a spokesperson for the Hepatitis B Foundation, said Thursday’s meeting was concerning for many reasons.

“The meeting lacked transparency, with many of the presentations showing one-sided data, and several points made by committee members clearly showed that they have a very specific agenda,” he said.

“The committee members dismissed the extensive body of scientific data and real-life experience that prove the necessity, safety and value of the universal birth dose vaccination for hepatitis B,” Tate said.

The committee will resume its meeting at 8 a.m. Eastern on Friday. The meeting will be livestreamed at this link.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

What to watch for at this week’s CDC vaccine advisory committee meeting

2025-12-04T14:57:58+00:00

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The front line in the escalating political, cultural and scientific war over vaccination in the United States will return to a meeting room at the Centers for Disease Control and Prevention in Atlanta on Thursday and Friday.

That’s where an important CDC vaccine advisory committee – whose members were replaced with appointees of Health and Human Services Secretary Robert F. Kennedy Jr. – is scheduled to take another series of votes that could reshape longstanding recommendations to protect babies against the cancer-causing hepatitis B virus.

The two-day meeting of the CDC Advisory Committee on Immunization Practices is happening in the wake of Kennedy personally ordering changes to language on the CDC’s website that diminishes the agency’s longstanding statement that “vaccines do not cause autism” as not being an evidence-based claim – despite decades of research that has not found a link between vaccines and autism.

And it comes less than a week after a top U.S. Food and Drug Administration vaccine official asserted in a memo to agency staff – without providing data – that at least 10 children’s deaths are related to Covid-19 vaccination. The FDA has not released any information about the cases or how any links were made to vaccines.

With the advisory committee scheduled to start meeting at 8 a.m. Eastern Thursday, the CDC had not posted a final meeting agenda by Wednesday evening. The posted draft agenda – listed only broad topics of discussion, without details about the specific issues of concern, the data that will be presented, or the names of individuals who will be making presentations. Sometime overnight, a final agenda was posted that added a few lines of additional information but still few details.

Here’s what public health practitioners say they are watching for at this week’s ACIP meeting, which will be livestreamed on Thursday and Friday.

Votes that may delay or limit babies’ protection against hepatitis B

At issue: The meeting’s agenda shows that Thursday’s session will be focused on discussions and votes related to this vaccine. Overnight the committee posted draft language for two proposed recommendations.

The first vote is on language that would change current recommendations for universal vaccination of babies soon after birth. The proposed new ACIP recommendation would be for “individual-based decision-making, in consultation with a health care provider” on whether to give the hepatitis B vaccine to infants born to women who test negative for the virus or whose status is unknown.

This proposed recommendation also would leave it up to parents, in consultation with their health providers, to “decide when or if their child will begin the HBV series.”

The second vote involves draft language that would recommend that parents consult with health care providers about giving their children blood tests to check levels of immunity before receiving follow-up hepatitis B shots. The cost of these tests should be covered by insurance, the draft language says.

At the committee’s last meeting in September, the group postponed a vote on recommending a delay for when babies receive a first dose of hepatitis B vaccine.

Currently all babies are recommended to be vaccinated against this virus soon after birth. This is done to help prevent infection during the birth process if the mom’s infection hasn’t been detected during prenatal screenings, and also to protect them from exposure to caregivers and other contacts who may not know they are infected.

ACIP members have previously discussed the need for better hepatitis B screening of mothers during pregnancy. Other concerns have been raised about whether only babies deemed to be at high risk of virus infection should receive the shots.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

Why it matters: Universal infant and childhood vaccination against hepatitis B has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults. The vaccine plays a significant role in preventing liver cancer caused by the virus.

“We have tried all of these methods that we’re now talking about potentially going back to and they did not work. So that is why universal vaccination is so important,” Michaela Jackson, the Hepatitis B Foundation’s program director for prevention policy, told Healthbeat before the final agenda was released.

“Prior to universal vaccination, only 50% of children who were being infected before the age of 10 were getting that from mother-to-child transmission,” she said. “The other 50% were getting it from places like day cares, from contact sports, from caregivers who didn’t know that they had hepatitis B. We’re talking about innocent interactions that you don’t really think about every day.”

The virus is highly infectious. It is transmitted through contact with blood and bodily fluids of infected people, who often have no symptoms or awareness they are living with the virus. While the virus can be spread through childbirth, sexual contact, and sharing contaminated needles, it also can be spread through contact with sharp items commonly shared in families: nail clippers, a toothbrush, even some kinds of jewelry.

Interest in changing the childhood and adolescent immunization schedule

At issue: It’s unclear what aspects of the schedule will be discussed. The posted draft agenda, which listed this as a discussion topic for Friday, didn’t say. The final agenda shows the presentation to the committee on this topic will be made by Aaron Siri, a lawyer and close adviser to Kennedy.

Critics of the current recommendations for when vaccines are given, including Kennedy, have questioned the number, timing, and spacing of shots.

The final agenda lists two sub-topics for Siri’s presentation: the evolution of the vaccination schedule and a comparison of the U.S. schedule to those in other countries.

Why it matters: “The childhood immunization schedule is an important framework that we use to protect children from harmful and potentially deadly childhood diseases,” Dr. Sean O’Leary, chair of the American Academy of Pediatrics committee on infectious diseases, said before the final agenda was posted.

“Every vaccine on that schedule and the recommended timing of it exists for a reason,” he said. “The timing of each dose of a vaccine for a child is critical, and it’s based on the age at which a child’s immune system can provide optimal protection after vaccination, and the earliest possible time for protection … There is no reason to delay or space out vaccines. Doing so just puts children at risk.”

Discussion of ‘adjuvants and contaminants’ in vaccines

At issue: The meeting’s draft agenda said there will be a discussion of adjuvants and contaminants on Friday afternoon. The final agenda describes the presentation as involving aluminum exposure from vaccines before the age of 24 months and persistent asthma at age 24 to 59 months.

Why it matters: “Just like the childhood vaccine schedule itself, every vaccine ingredient plays an important role in making sure the vaccine is safe and effective,” O’Leary said.

“I won’t be surprised if some on this committee refer to these ingredients as contaminants. This is simply false,” he said. “As with any medicine, the ingredients in vaccines are there for a reason. Aluminum, for example, they’ll talk a lot about aluminum. It’s one of the ingredients that vaccine skeptics like to go after.”

Aluminum salts, which are used in some vaccines – including diphtheria, tetanus and acellular pertussis, hepatitis A, and hepatitis B vaccines – boost the body’s immune response to the vaccine, O’Leary said.

“They’ve been safely used in vaccines for about 100 years and have been received by billions of people,” said Dr. Jesse Goodman, professor of medicine and infectious diseases at Georgetown University. “They strengthen our immune response and keep the antigens of the vaccine from disappearing too quickly.”

Wildcard issues, including alleged children’s deaths from Covid-19 shots

At issue: It’s been difficult for the public and public health stakeholders to provide focused input to the committee because information has not been shared in advance about the substance of the issues that will be discussed.

Why it matters: “There’s like zero transparency in this draft agenda,” said Rekha Lakshmanan, executive director of The Immunization Partnership, a Houston-based advocacy group. “We don’t know who’s going to be speaking. You know, it’s sort of like this rough outline that you put together in high school.”

With the ACIP meeting coming soon after last week’s internal FDA memo alleging 10 children’s deaths have been linked to Covid-19 vaccination, Lakshmanan, O’Leary and others said it’s possible the committee will raise the issue.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

How the Global Fund might cover a $6.7B shortfall in donations

2025-12-04T12:00:00+00:00

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Hello from Nairobi.

This week’s edition has an unexpected through-line. Several stories reveal how the global health system is preparing for a long season of austerity: from staff cuts at the World Health Organization, to a disappointing funding cycle for AIDS, tuberculosis and malaria control, to functioning drugs being abandoned over limited profit prospects. I’m trying to follow where bold pivots are being made, or where tough decisions are just being avoided.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The big fundraiser with small donor energy

Since we’ve last checked in, the Global Fund wrapped up its odd, tri-yearly fundraising conference. (I’ve previously described it as “the part telethon, part diplomatic speed-date,” which decides how much money the fund will actually have to work with.)

So how did it go?

Not great. Health Policy Watch reports that the conference ended with $11.3 billion, a full third short of its $18 billion goal. That’s also more than a quarter less money than the fund received in the previous cycle. While not exactly a worst-case scenario, the shortfall is a shocking drop for one of the central institutions in global health.

A bit of context: The Global Fund is a massive, 23-year-old organization that collects donations from wealthy governments and funnels them into programs that fight AIDS, tuberculosis, and malaria in more than 100 countries. It sits at the center of the global push against all three diseases. For example, about 60% of all international financing for malaria control still moves through this one institution.

There’s plenty of blame to spread around, but the drop is largely a reflection of a pullback from the fund’s largest historical donors. The UK cut its contribution by 15%, Germany by 23%, Canada by 16%, and Japan by more than half. But by far the largest hit comes from the United States, which went from $6 billion last cycle to $4.6 billion this time, a 23% drop. (France and the European Union are TBD; they didn’t pledge in the conference.)

There’s a lot to be said about the impact this shortfall will have on real lives and real illnesses, which we’ve covered before. But for now I’m left wondering: Is there any path forward that isn’t just … doing less with less money?

I reached out to Janeen Madan Keller, the global health policy deputy director at the Center for Global Development (which is a leading global development think tank) about this shortfall and what the fund should do now.

Keller and her colleagues have written a policy paper about just this, where they “propose a new funding model that protects grants for the poorest countries and provides loans to wealthier countries,” she says.

One advantage of their proposal is that it “helps shield the poorest countries from funding cuts, and the reflows from these loans provide a financial cushion for the Global Fund, making it less reliant on donors as the sole source of funding,” Keller says. It’s a bold path forward that could help the Global Fund survive a long winter of donor austerity.

In a blog accompanying the paper, Keller and her colleagues note that “a combined grant and loan model at the Global Fund could generate up to $1 billion each year in new financing by 2033 without reducing grants to the poorest countries.” That would be roughly enough to reset the organization’s finances back to its last funding cycle.

Still, the approach would leave some tough questions to be answered. “Would middle-income countries … borrow for health?” Keller and her colleagues ask.

Rising toll in Ethiopia’s first Marburg virus outbreak

Since we last checked, the death toll from the Marburg outbreak in southern Ethiopia has climbed to eight confirmed fatalities, with a total of 12 lab-confirmed infections (including the dead), the African Press Agency reports. Ethiopian authorities say that while only four patients remain under treatment, almost 400 contacts have been traced and monitored.

It is a grim but unsurprising escalation for the Ebola-like virus, which has no vaccine and kills over 90% of untreated patients. What’s the takeaway?

Honestly, it’s not really possible to distill from these numbers whether we are seeing an unrivaled success, a fumbling failure, or something in between. Even a sharp dip in reported cases in coming weeks might signal control … or just a widening blind spot. Still, officials insist field teams are moving quickly. But it’s just too early to assess how well the contact tracing and containment efforts are working.

Hope lies in the fact that Monday marked the official end of the Ebola outbreak (!) in the Democratic Republic of the Congo, a victory I’m choosing to read as evidence that the international community can muster the resources and urgency needed to respond effectively in Ethiopia.

Bird flu’s pandemic potential

The medical director of one of Europe’s top labs for studying flu and other airborne viruses — France’s Institut Pasteur respiratory infections center — has just raised a public warning about bird flu, Reuters reports.

Marie-Anne Rameix-Welti says the ongoing bird flu epidemic, which is tearing through bird populations globally, carries the very real risk of evolving human-to-human transmission. That shift could spark a global outbreak “potentially even more severe than the [Covid-19] pandemic we experienced,” she warns.

Right now, the virus remains largely confined to birds with only rare spillovers into humans. For example, while Washington state reported a case last month, it was the first in the United States since February.

The danger in bird flu lies in the fact that humans have no immunity to either of the major strains, which are H5N1 and H5N5. (The H and N numbers refer to the shape of two important proteins on the outside of the virus.) “People have antibodies against common H1 and H3 seasonal flu, but none against the H5 bird flu affecting birds and mammals, like they had none against Covid-19,” Rameix-Welti says.

The good news? Researchers say the odds of that evolutionary leap, as best we can estimate, are small. And the last pandemic dramatically improved our preparedness. Compared to Covid-19, “we have specific preventative measures in place. We have vaccine candidates ready and know how to manufacture them quickly ... we also have stocks of targeted antivirals that, in principle, would be effective against this avian influenza virus,” she says.

WHO to cut a quarter of its workforce

I’ve worked in international development long enough to hear plenty of moaning about the slow, recursive bureaucracies of the United Nations and the WHO (and yes, about the U.S. Agency for International Development, as well). And after a decade inside a government machine, my inner libertarian has learned to trust most complaints about inefficient or downright dysfunctional systems.

That said, I have to offer a small mea culpa.

Since starting the Global Health Checkup, I’ve gained a profound appreciation for just how much the WHO quietly holds together. From the big stuff, like detecting and containing disease outbreaks or moving supplies for global health crises, all the way down to the quotidian work of publishing the data and guidelines everyone else relies on.

But that brings us to The Guardian’s reporting that the WHO is preparing to cut roughly a quarter of its global workforce.

Is there any silver lining here? In theory, any contraction can sharpen priorities and make an institution more efficient. Sometimes a budget squeeze is the only thing that forces real reform.

But it’s impossible to read this report and come away thinking the outcome will be a net positive — or that it’s being managed in a thoughtful, strategic manner. The cuts fall heaviest on global and Africa-based staff: the very people who run surveillance systems, support ministries of health, and coordinate emergency responses when things go sideways.

As one expert told The Guardian: “Now, more than ever, WHO needs a clear, strategic vision to navigate its new fiscal reality. Instead, these cuts are aimed at global and Africa-based staff, at a time when WHO should be doubling down on its global work ... The loss of expertise will leave the world less healthy and less safe.”

A cure in search of a company

This week Science magazine reports a bizarre twist in the hunt for a new dengue drug.

The story starts two years ago, when a new antiviral called “mosnodenvir” was pushed into several rounds of clinical testing by its maker, Johnson & Johnson. Last week, the results from those trials were published in The New England Journal of Medicine. They showed astonishing results in preventing infection in two groups: purposefully exposed volunteers and close contacts of confirmed dengue cases.

Disease breakdown: Dengue is a millennia-old mosquito-borne virus that’s sometimes called “break-bone fever” for the intense joint and muscle pain it causes. Although it has a very low fatality rate (less than 1%), it spreads quickly through mosquitoes that thrive in cities. Three vaccines exist for the disease, but no treatments.

Lest you think I’m setting up a neat, hopeful ending for this week’s report … think again.

Johnson & Johnson walked away from the drug last year, shutting down its entire infectious-disease division just as the data turned promising. Part of the reason: “The profit potential for dengue treatments is limited.”

What makes this move especially frustrating is that while dengue already has three vaccines, all are constrained in different ways. One has been discontinued, another can’t meet global demand, and the third is limited to Brazil and only recently approved.

And the new trial data indicated that mosnodenvir could work as a very early treatment, a therapy that dengue has never had.

Still, there may be hope that another pharma company could buy up the drug and continue testing. As Anna Durbin, the infectious disease specialist at Johns Hopkins University who led one of the studies, put it: “There is a market, and I think there will be a company that picks it up.”

I’ll see you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Moms say ByHeart recall has shaken their trust in baby formula safety

2025-12-03T19:45:03+00:00

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For moms like Elisabeth Bates and Ashlee Johnson, the decision to feed their babies ByHeart infant formula was driven by necessity and influenced heavily by words like these on the products’ labels:

“Closest to Breast Milk”

“Made with Organic Grass-Fed Whole Milk”

“Certified Clean Ingredients”

“Purity Award”

Bates, a pediatric nurse practitioner in New York City, said she wanted something better for her son than your average baby formula.

Instead – like parents across the country – Bates has been on “high alert” scrutinizing 7-month-old Beau for signs of infant botulism and counting down the 30 days until he is safely beyond the period when any botulism bacteria spores he may have consumed before ByHeart’s recall could still germinate inside his body.

“Seeing that label, you as a parent, you just kind of automatically trust that some higher body gave them this kind of certification,” said Bates, who regrets stopping breastfeeding and giving her trust to the product. “There is a big feeling of guilt.”

So far, Beau remains healthy.

ByHeart’s recall of all of its formula products last month amid a growing nationwide outbreak of infant botulism has shaken the trust of moms and caregivers – not just in ByHeart’s formula, but also in formula made by other brands, moms from across the country told Healthbeat.

Nearly a month has passed since regulators and state health officials issued the first public warnings on Nov. 8 that ByHeart’s baby formula was suspected of fueling an increase in infant botulism hospitalizations across the country. Yet as the weeks have gone by, they’ve released little information about how botulism spores could have gotten into ByHeart’s formula – such as whether the source is likely inside a ByHeart manufacturing facility or in an ingredient used to make the companies’ formula.

This lack of information, the moms said, is not reassuring for families already on edge after making a hasty switch to different companies’ formulas in the wake of the ByHeart recall.

Johnson, who lives in Bremerton, Wash., said she worries about the potential for botulism contamination in the new formula she’s feeding her 5-month-old son, Elio.

“Even with the formula we’re using now, if he has an off day, I’m like: Is there something wrong with this one?” Johnson said. “It’s supposed to be top of the line, good stuff from a reputable company. And you are still worried about it. What if there’s another recall for this one?”

Bates said even her friends who never fed ByHeart formula are worried: “If this can happen to one formula, they’re also wondering: Could my formula be next?”

Few details released about how ByHeart formula became contaminated

At least 39 infants who were fed ByHeart formula have been hospitalized in 18 states with suspected or confirmed infant botulism, according to the Food and Drug Administration’s outbreak update on Wednesday. The dates these infants first started showing signs of illness ranged from Aug. 9 to Nov. 19.

ByHeart announced a small, initial recall of two batches of its formula on Nov. 8, then recalled all of its products on Nov. 11 after more babies were hospitalized.

ByHeart has all of its infant formula products amid a botulism outbreak affecting babies across the country.

Infant botulism is caused by babies ingesting spores of the bacterium Clostridium botulinum, which can colonize their large intestine. Once inside the body, it can take up to 30 days for the spores to activate and produce a paralyzing toxin in the child’s intestine, then start causing symptoms, such as constipation, difficulty feeding, and signs of muscle weakness, such as a floppy head.

The FDA and the Centers for Disease Control and Prevention have said little about their investigation into how botulism bacteria got into unopened containers of ByHeart infant formula. They have previously said they have not identified any other infant formula brands that pose a risk.

While ByHeart officials initially had emphasized “there is no historical precedent of infant formula causing infant botulism,” the company has since said that its own recent testing has detected botulism bacteria in five of 36 samples of unopened formula packages.

“Based on these results, we cannot rule out the risk that all ByHeart formula across all product lots may have been contaminated,” the company said late last month. “We continue to be focused on finding the root cause, through a rigorous audit of every step of our product development chain, from suppliers and raw ingredients, through to packaging and transportation.”

ByHeart did not answer questions from Healthbeat about what has been done to investigate each of those manufacturing steps and examine the component ingredients that were used to make the contaminated products.

Officials at the FDA and the CDC also did not answer questions from Healthbeat about what their investigation has found in the search for where and how botulism spores got into the product.

“FDA’s investigation, including onsite inspections, is ongoing to determine the point of contamination,” the agency said in an outbreak update last week that provided no details about what those recent inspections have found at ByHeart’s manufacturing plants or at any other companies that supplied the individual ingredients used to make ByHeart’s formula.

The FDA released redacted copies of inspection reports for three ByHeart manufacturing facilities from February and March 2025, and January 2024. The reports show manufacturing and contamination problems, some of which have been previously reported by Healthbeat and other news organizations.

But the FDA has released nothing about what its inspectors and investigators have found during the past month – in the wake of the infant botulism outbreak – as they have examined ByHeart’s manufacturing facilities, and potentially also the facilities of other companies supplying ingredients to ByHeart.

ByHeart told Healthbeat this week that “no observable links” have been found between the FDA’s facility inspection findings and the botulism bacteria that tests have detected in the company’s formula.

‘No signals’ other brands of infant formula are at risk, California officials say

The outbreak was initially identified by the California Department of Public Health, which noticed an increase in requests for a drug it makes to treat infant botulism. The drug, called BabyBIG, is the only FDA-approved treatment for infant botulism. California’s health department also serves as the nation’s infant botulism program.

The FDA has said it was alerted on Nov. 6 that California officials had identified a cluster of infant botulism cases linked to ByHeart’s formula.

CDPH told Healthbeat Tuesday evening that among the 118 infants nationwide treated for infant botulism with BabyBIG between Aug. 1 and Nov. 30, the only cases with a common source of exposure are those that have been linked to ByHeart’s formula.

FDA delays left recalled baby formula on store shelves, food safety expert says

“To date, there have been no signals that other infant formulas have been affected,” the department said in an email.

“It is usually difficult to pinpoint a root cause of any infant botulism case,” the department said. “Infant botulism is a very rare disease, and cases typically occur sporadically.”

CDPH noted that investigations and testing over many years indicate that most infant botulism patients become infected by simply swallowing microscopic dust particles containing spores. Honey is also a known and avoidable source of botulism bacteria spores.

The FDA and CDC did not respond to questions from Healthbeat about the potential for other products to be contributing to the recent rise in infant botulism cases.

Could contaminated milk or another ingredient be the source of botulism spores?

While ByHeart has said botulism bacteria has not been among the pathogens routinely tested for across the formula industry, formula maker Mead Johnson – whose brands include Enfamil – told Healthbeat it has tested its products for botulism contamination for years.

“Every lot of ingredients containing dairy undergoes testing for possible infant botulism contamination during the raw material phase because these bacteria can occur naturally in soil and farm environments, and we aim to mitigate risk right from the start,” Mead Johnson said in an email on Tuesday. “We also conduct routine clostridium and spore testing to ensure the quality and safety of our finished powdered products.”

The testing has not showed any evidence of infant botulism contamination, according to the company’s review of readily available testing records.

“To the best of our knowledge, there had never before been a confirmed case of botulism linked to infant formula. We are closely monitoring the recent competitor recall and look forward to understanding the circumstances behind it,” Mead Johnson said in its statement.

Formula maker Bobbie, which like ByHeart markets itself as a premium organic, whole milk formula, recently announced it is increasing testing of its facilities and products.

Recalled baby formula went to groups serving homeless and at-risk families

As of November, in the wake of ByHeart’s recall, Bobbie has added to its existing testing protocols a type of test that can identify potential spore-forming bacteria, including botulism bacteria. This kind of sulfite-reducing clostridia testing is a screening tool that can serve as an “early-warning system” that further testing is necessary if a positive result comes back, the company said.

It’s unclear what actions other formula makers are taking as a result of the ongoing ByHeart investigation.

Officials with the Infant Nutrition Council of America, an association of infant formula and toddler milk manufacturers, did not respond to repeated requests for comment since Nov. 20 about the potential implications of ByHeart’s botulism contamination for the wider formula industry. The council’s members include Abbott Nutrition, which makes Similac brand formula, and Perrigo Nutrition, which makes store-brand formulas and owns the rights to Nestlé’s Good Start brand.

Bill Marler, an attorney who has specialized in representing victims of foodborne illnesses for more than 30 years and who has filed four lawsuits against ByHeart on behalf of the families of sickened infants, told Healthbeat that manufacturing sanitation and ingredients are the primary suspects.

Marler said that ByHeart’s use of whole milk, not used by many formula makers, is a potential suspect ingredient. But the sanitation issues described in the FDA’s past inspections of ByHeart’s manufacturing plants are also concerning, he said.

“Hopefully they’re going to be able to figure out the number of kids that are sick and what likely lot they consumed from, and then start working their way back upstream,” said Marler, whose firm is based in Washington state.

David Clark, a dairy product industry consultant who specializes in infant formulas, said contaminated milking equipment is one of many potential sources of the contamination in ByHeart’s products.

Botulism bacteria can be found in the environment, stalls, and bedding on dairy farms, he said. The spores, he notes, are not killed by pasteurization. That’s why there are strict requirements for cleaning the cows’ udders and milking equipment, said Clark, whose firm Bovina Mountain Consulting is based in Englewood, Fla.

Officials with the U.S. Department of Agriculture, the federal agency responsible for animal health, did not respond to questions from Healthbeat about whether there have been any botulism outbreaks on dairy farms in the past year, whether there are any requirements for such outbreaks to be reported, and whether there are any regulations that require milk from infected cattle to be withheld from the food supply.

“Please direct these questions to the U.S. Food & Drug Administration,” the USDA press office replied in an email. The FDA also did not respond to the questions.

ByHeart formula carried ‘Purity Award’ certification from Clean Label Project

In addition to ByHeart’s manufacturing plants undergoing FDA inspections, the company’s cans and pouches were emblazoned with a certification that the formula had received a Clean Label Project “Purity Award.”

But the certification never involved any testing for pathogens like those that cause infant botulism, said Kate Stuard, a spokesperson for the Clean Label Project, a nonprofit group based in Colorado.

The project’s voluntary certification program, which manufacturers can apply to, tests a wide range of consumer products for industrial and environmental contaminants such as heavy metals, pesticides, and phthalates, Stuard said. The certification’s rules also require products be produced in facilities that maintain compliance with Good Manufacturing Practices.

The Clean Label Project recently removed ByHeart’s formulas from its list of certified products, a review of archived images of its website shows. The organization did not answer Healthbeat’s questions about when and why ByHeart’s listing was removed recently. The group also didn’t answer whether it took any actions against ByHeart’s purity certification in the wake of a previous recall in December 2022 for a different kind of bacterial contamination that prompted the FDA to issue a formal warning letter to ByHeart in August 2023.

The organization issued a general statement that “if a brand is subject to a recall, we suspend their certification pending the outcome of the investigation.” But it’s unclear what is done to alert consumers to any suspension.

ByHeart, which acknowledged the project’s practice of suspension during a recall investigation, told Healthbeat that the Clean Label Project “did not take action against ByHeart’s certification after a regulatory inspection or report. FDA inspections are a routine regulatory practice, and a core part of ByHeart’s continuous improvement program.”

Baby formula maker linked to botulism outbreak was warned previously about contamination issues

The Clean Label Project last month announced it has been selected to assist with Amazon’s Compliance Fast Track Program that will allow certified brands to have automatic compliance verification with the online retailer.

Health and Human Services Secretary Robert F. Kennedy Jr. last spring announced an initiative to improve the safety and nutrition of infant formulas. But so far the program, called Operation Stork Speed, has indicated a focus on nutrition reviews and testing for heavy metals and other contaminants.

Lack of answers about source of ByHeart contamination fuels concerns among moms

For now, the biggest question for many parents and caregivers remains: How did ByHeart’s botulism contamination happen – especially in a premium product that emphasized its purity to consumers.

“What if it happens at another facility?” asked Dezirae Davies, a medical assistant and mom in Canton, Ohio. “These are our prides and joys that we’re talking about. And some people don’t have the option of breastfeeding babies. So, it’s a really important thing to find out: How did this happen and why did this occur?”

Dezirae Davies holds her son, Koa, in June 2025. “I just wanted the best for my baby,” she said of her decision to feed him ByHeart formula, was recalled in November.

Davies said she chose ByHeart after a lot of research because she wasn’t producing enough milk after six months of breastfeeding her son, Koa. “We wanted something that was organic and more naturally made,” she said. “We wanted something that was comparable to my own breast milk.”

Koa did well on ByHeart’s formula for months until Davies got an alert on her phone last month about the recall. She remembers the horrible wave of panic as she realized that the recalled cans included one that Koa – who was by then 11 months old – had just finished.

“We talked to poison control for like an hour,” Davies said. As the family watched for infant botulism symptoms, Koa developed diarrhea from switching formulas. So they switched him to whole milk, based on his age and his doctor’s advice, and he’s now doing well, she said.

But dozens of families across the country have not been so fortunate.

Hanna Everett of Richmond, Kentucky, said her 4-month-old daughter, Piper, is among the dozens of infants who have been sickened with infant botulism after being fed ByHeart formula.

Piper, who Everett said had recently started drooling her formula out the sides of her mouth, became constipated the same weekend ByHeart announced its first recall. What hadn’t seemed anything serious, became terrifying warning signs in the wake of the recall announcement, prompting the family to rush Piper to the emergency room.

“They had to start numerous IVs, and they had to put a feeding tube in because of the muscle paralysis. They were worried she was going to aspirate,” Everett said.

“Watching them do the feeding tube and the IVs was just awful,” Everett said. “It’s hurting her. She’s screaming and crying.”

Once she started receiving the BabyBIG botulism treatment, which had to be shipped to the hospital, Piper clearly started feeling better, and she was able to return home within a few days, her mother said.

Doctors expect Piper to recover, Everett said, though she will need to receive feeding therapy to help improve her sucking and eating. “We caught hers very early,” Everett said. “We’re very thankful for that.”

Everett said picking out a new formula to feed Piper after ByHeart’s recall was incredibly stressful, but necessary because she has had difficulty producing enough breast milk.

“That was already a big decision the first time around, and I thought I made the right choice. Then it came back to hurt my daughter,” she said.

Everett’s message for the FDA and ByHeart: “They need to do better.”

“They were in trouble multiple times. I feel like the government agencies really let the ball slip on this,” said Everett, who has sued ByHeart in federal court. “It’s not something you should ever have to worry about when feeding your children.”

This article has been updated to include an update Wednesday from the FDA on the number of cases.

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