Tag: public health

It’s been a tumultuous week for U.S. Health and Human Services Secretary Robert F. Kennedy Jr. He and the Trump Administration fired Susan Monarez, director of the U.S. Centers for Disease Control and Prevention (CDC), just a month after she was confirmed, which triggered a series of high-profile resignations within the agency. Days later, nine former CDC leaders called on Kennedy to resign. Underlying this tumult is Kennedy’s vaccine-skeptical agenda, and on Sept. 4, Kennedy defended his controversial actions at HHS during a Senate hearing—in which he also maintained his skepticism about vaccines.

“When were you lying, Sir: when you told this committee that you were not anti-vax, or when you told Americans that there’s no safe and effective vaccine?” Sen. Tina Smith, a Democrat from Minnesota, asked Kennedy, referring to a podcast appearance in which he questioned the safety of vaccines.

“Both are true,” he replied.

Kennedy’s time as HHS secretary has been marred with controversy. In June, he fired all of 17 members of the Advisory Committee for Immunization Practices (ACIP), which develops vaccine recommendations for the CDC to consider, and then replaced them with new members, some of whom have expressed skepticism about vaccines. In early August, he canceled $500 million in funding for mRNA vaccine development, even though that technology led to the development of the COVID-19 vaccine.

Under his watch, the U.S. Food and Drug Administration (FDA) decided to limit approval for COVID-19 shots to adults 65 and older or those at high risk for severe COVID-19 outcomes. And in late August, he fired Monarez, the CDC director,  for refusing to rubber-stamp ACIP’s vaccine recommendations in advance, she wrote in her Sept. 4 opinion piece in the Wall Street Journal. 

Read More: What We’ve Learned from the Texas Measles Outbreak

Sen. Elizabeth Warren directly asked Kennedy about his interaction with Monarez in the hearing.

“Did you tell the head of the CDC that if she refused to sign off on your changes to the childhood vaccine schedule, that she had to resign?” Warren said.

“No, I told her that she had to resign because I asked her, ‘Are you a trustworthy person?’ and she said, ‘No,’” Kennedy responded. 

“So you’re saying she’s lying?” Warren said.

“Yes,” Kennedy replied. 

Warren also questioned Kennedy about the FDA’s decision to recommend the updated COVID-19 vaccine only for people 65 or older and children and adults with risk factors for developing severe disease. Those recommendations have caused much confusion, and both CVS and Walgreens have limited access to the vaccines in some states to people with a prescription.

“Last November, while you were under consideration to become Secretary of Health and Human Services, Mr. Kennedy, you said, ‘If vaccines are working for somebody, I’m not going to take them away,’” Warren said. “Then last week, you announced the COVID-19 vaccine is no longer approved for healthy people under the age of 65. Obviously, both things cannot be true at the same moment.”

“Anybody can get the booster,” Kennedy said. 

“So you’re saying that is now the official rule of HHS: anybody is eligible to get a booster by just walking into the pharmacy?” Warren asked.

“It’s not recommended for healthy people,” he said. “No.” 

Read More: The Clashing Advice Over COVID-19 Shots for Kids

Almost all Republican members of the Senate voted to confirm Kennedy earlier this year. But in the Senate hearing, some challenged Kennedy’s recent actions on vaccines. They included Sen. Bill Cassidy, a physician from Louisiana who had said he had “reservations” about Kennedy’s past positions about vaccine safety at the confirmation hearing, but who ultimately supported Kennedy’s nomination.

Cassidy began by saying he believed that President Trump deserved a Nobel Prize for Operation Warp Speed, the public-private partnership that accelerated the development of the COVID-19 vaccine. He then asked Kennedy if he agreed; Kennedy said he did. 

That “surprises me,” Cassidy said. “You canceled—or HHS did, but apparently under your director—$500 million in contracts using the mRNA vaccine platform that was critical to Operation Warp Speed—again, an accomplishment that I think President Trump should get a Nobel Prize for.”

Cassidy also read letters he had received from friends and doctors who expressed concern about the confusion surrounding who was able to get a COVID-19 vaccine. One friend said that his wife, who has Stage IV lung cancer, was unable to get the vaccine at CVS “thanks to the mess at HHS.” Another wrote Cassidy that doctors are confused about who can get the COVID-19 vaccine, and that they are turning to attorneys to get opinions. 

“I would say, effectively, we’re denying people vaccines,” Cassidy concluded. 

“You’re wrong,” Kennedy said. 

Sen. John Barrasso, a physician and Republican from Wyoming, said that he, too, had gotten messages from concerned doctors he used to work with.

“There are real concerns that safe, proven vaccines like measles, like Hepatitis B and others, could be in jeopardy, and that would put Americans at risk and reverse decades of progress,” he said. 

Kennedy’s clearest statements about where he stands on vaccines came during an exchange with Sen. Michael Bennet, a Democrat from Colorado, who questioned one of the new members Kennedy appointed to the vaccine advisory panel, Dr. Retsef Levi. “Are you aware that another one of these new members, Dr. Levi, wrote that ‘Evidence is mounting and indisputable that mRNA vaccines cause serious harm including death, especially among young people’?” Bennet asked. 

“I wasn’t aware that he said it, but I agree with it,” Kennedy answered. 

It’s not true,” Bennet said. “It wasn’t true when he said it. It’s not true when you said it.”

Thom Tillis, a Republican Senator from North Carolina, brought up the exchange later in the hearing, seemingly surprised that Kennedy so blatantly called into question a technology that had been lauded by President Trump.

Health officials in Mississippi have declared a public emergency over the state’s rising infant mortality rate, which is the highest it’s been in a decade. Data from 2024 show that for every 1,000 infant births in the state, there were 9.7 deaths within the first year of life—up from 8.9 in 2023.

“Every single infant loss represents a family devastated, a community impacted and a future cut short,” said state health officer Dr. Dan Edney in a statement declaring the public health emergency, which allows the state to mobilize resources more quickly than it otherwise would have. 

According to state data, 3,527 babies have died in Mississippi before age 1 since 2014. The state saw a particularly high increase in neonatal deaths, which occur during the first month of life, and a very high overall infant mortality rate for Black families: 15.2 per 1,000 live births, compared to 5.8 per 1,000 live births in white families. 

Poor outcomes for both mothers and babies are not new for Mississippi, which received an “F” on a 2024 March of Dimes report card that ranked maternal and infant health by state. Mississippi had the highest infant mortality rates in the country in 2024, according to the report card, and the highest rates of preterm births, when a baby is born before 38 weeks of pregnancy. (Being born preterm is associated with an increased risk for many short-term and long-term health conditions.) Some of the contributing factors to these bad outcomes include poor physical health of mothers and subpar access to care for both moms and babies.

“Mississippi has historically ranked low when it comes to these birth outcomes,” says Dr. Michael Warren, chief medical and health officer for the March of Dimes, in an interview with TIME. “But they’re not alone.”

Between 2023 and 2024,  infant mortality rates worsened in 24 states, including Arkansas and Louisiana, Warren says. “This is reflective of a large trend.” 

These states had already been struggling with maternal and infant heath, but outside factors are likely worsening these outcomes. Many rural counties have lost ob-gyns or hospital maternity services in recent years, so women have to travel further for prenatal and maternity care. More than half of counties in Mississippi and one-third of counties in the U.S. are considered maternity-care deserts, which means they have no hospitals providing obstetric care, no ob-gyns, and no certified nurse midwives. 

Read More: Why Maternity Care is Underpaid

In Mississippi and in the South, ob-gyns are leaving because of low Medicaid and private insurance compensation rates that make it difficult to keep a practice open. Practices that remain open are often short-staffed, and providers sometimes burn out after being on a 24/7 call schedule. As a result, women having emergencies during childbirth may not be able to get to a doctor in time. 

Mississippi and many other states in the South have also not expanded Medicaid, meaning women may be going into pregnancy less healthy than they would if they had more access to health care. If women do not have health insurance, they may not be visiting a doctor regularly to control chronic conditions like obesity or diabetes. One of the big factors leading to more infant deaths, Warren says, is that many are born premature, and much of prematurity is driven by a mom’s health before she even becomes pregnant. 

Texas health officials on Aug. 18 declared the end of a measles outbreak that had sickened more than 760 people across the state and killed two children. Doctors and public-health officials involved in the outbreak, most of whom had previously never encountered a measles patient, are now taking stock of what they’ve learned about the virus and the best ways to prevent and control outbreaks of the disease.

Measles, they say, is as contagious as feared, and unvaccinated people are the most vulnerable. But while vaccination remains the best way to prevent measles, Texas public-health officials say they could have adopted a more inclusive approach when engaging with vaccine-hesitant communities about the virus and its risks. More investment is also needed, they say, into building trust between rural communities and health officials.

These insights should be taken to heart as measles cases continue to rise in the U.S., Canada, and Mexico, say public-health experts who fear that measles may now be here to stay. More than 1,300 measles cases have been reported nationally this year, the highest number since the disease was declared eliminated in the U.S. in 2000.

“Even though the Texas outbreak looks to be under control, we’re still seeing a lot of cases,” says Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health. “The measles situation is not over.” 

Here are some lessons learned from the Texas measles outbreak.

Measles is as dangerous, contagious, and vaccine-preventable as expected

“What surprised me was how textbook measles is,” says Katherine Wells, the public health director of Lubbock, Texas, where many measles patients were treated during the recent outbreak. 

Wells has been in public health for almost 25 years and had never before seen a measles case. But as patients streamed into Lubbock’s hospitals and clinics, a clear clinical pattern—which Wells had learned about in the medical literature—emerged. Unvaccinated people with measles first develop a runny nose and conjunctivitis, then a high fever and rash. 

The disease also proved to be as contagious as feared. In Lubbock, an unvaccinated child became ill with the virus after sitting in the same waiting room as someone with measles, Wells says. “Seeing those cases on the ground confirmed what was in the books.”

Read More: Former CDC Director: RFK Jr. is Dangerously Wrong about Vaccines

About one in five measles cases are severe, says Dr. Leila Myrick, a family medicine and obstetrics physician in Seminole, Texas, who treated more than 20 people with measles this year, most of them children. Several of Myrick’s patients developed pneumonia and required breathing treatments including supplemental oxygen, she says.

Almost 100 people, mostly children, were hospitalized in Texas because of complications from measles. Most people who have contracted measles in the U.S. this year have been unvaccinated.

Throughout the outbreak, U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. downplayed the risk of measles, saying in a Fox News interview in March that it’s “very, very difficult for measles to kill a healthy person.” The two children in Texas who died from the disease were unvaccinated but had no preexisting conditions, officials have said. 

“Measles is not a little cold. It can cause very high fever that can become very rapidly life-threatening,” said Richard Plemper, a Georgia State University biomedical scientist whose lab is developing an antiviral treatment for the virus family that includes measles. There is currently no approved treatment for the disease. 

About 0.1% of measles cases in developed countries are fatal, Plemper says. “Yes, that’s a small number, but if it’s your child, what comfort is that? Measles is vaccine-preventable. In a country like the U.S., nobody has to die from measles.”

Public-health experts say there is still more to learn about the disease’s longer-term effects on patients who have recovered. Measles can cause yearslong “immune amnesia,” in which the body forgets how to fight other infections. In very rare cases, the disease can also cause a deadly type of brain inflammation that strikes several years after the initial infection.

Better testing and wastewater surveillance can hinder disease spread 

At the start of the Texas outbreak, measles testing was a major hurdle, state public-health officials say. It took up to a week for test results to come back, which stymied efforts to curb the spread of the virus.

It wasn’t until about six weeks into the outbreak that testing capabilities improved, and people were able to get test results the next day, says Wells, the Lubbock public-health director. 

Wastewater surveillance for measles could also have been instituted earlier, public-health experts say. Such testing, which was started midway through the Texas outbreak, can flag the presence of a disease even before people come forward with symptoms. Recently in Idaho, wastewater surveillance detected measles activity at least a week before the state’s first case in 30 years was reported. 

Pushing vaccination is important—but so is meeting people ‘where they are’

The Texas outbreak started in a Mennonite community in Gaines County where vaccination rates are low. State health officials say they pushed hard to get people in the community vaccinated, setting up mobile vaccine clinics and educating people on the safety and efficacy of the shot. 

In the end, more than 300 people in the county were vaccinated as part of this campaign, says Zach Holbrooks, executive director of the South Plains Public Health District, which includes Gaines County.

But officials said they could have done a better job at providing not just vaccines but also information and other resources that could have helped families that chose not to vaccinate and had sick kids at home. Many children showed up to the hospital with dehydration, for instance, and could have benefited from information on the importance of keeping children hydrated, Wells says.

Read More: The Public Health Community Needs to Tell the Whole Truth About the History of Measles

The Texas Department of State Health Services said in an email that in future outbreaks, it would continue to share information about the measles, mumps, and rubella vaccine, but it might also introduce more general messaging that does not focus on vaccines, such as when people with measles symptoms should seek emergency care, sooner.

“We have to meet people where they are,” says Lori Freeman, CEO of the National Association of County and City Health Officials, which represents local health departments across the country. 

Freeman says that building trust with communities—and doing so before an emergency strikes—is indispensable. “Our work is only as successful as our ability to partner with communities,” she says.

People do listen to official advice, and the quality of that advice matters 

The Texas outbreak demonstrated that the public does heed official recommendations, says Plemper of Georgia State University, and highlights the heavy responsibility that health leaders shoulder when doling out advice.