Hello from Nairobi.

This week’s newsletter 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

The HV Hondius approaches the Port of Granadilla, carrying passengers possibly infected with hantavirus on board in Tenerife, Canary Islands on Sunday. (Andres Gutierrez / Anadolu via Getty Images) 

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:

1. Deadliness: What are the straight odds this disease kills you? 

2. Existing medical defenses: Do we already have vaccines, treatments, or diagnostics that can fight the illness, or blunt the damage?

3. 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?

4. 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 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

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.

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. 

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. 

ICYMI

Here’s a recap of the latest reporting from Healthbeat:

• Medication access: Why it’s so hard to get better drugs for neglected diseases 

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

• Measles: Possible measles exposure reported at Newark airport

Until next week,

Jay

Thumbnail image by Kent Nishimura / Bloomberg via Getty Images

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 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 mosquitos. 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? Well, 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.” 

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) is 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 have been confirmed, all while Cape Verde has not allowed the remaining passengers to disembark. That leaves 149 people from 23 countries still onboard under “strict precautionary measures.” 

• 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

Thumbnail image by Alexis Huguet / AFP via Getty Images

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 in the United States, 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.

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.

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. 

The lone star tick is identified by the white spot on the back of adult females. (Lauren Bishop / CDC)

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. 

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 the 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.

ICYMI

Here’s a recap of the latest reporting from Healthbeat:

• Measles: What South Carolina learned from the largest U.S. measles outbreak in 35 years

• Vaccines: New York City Council passes plan to step up education on vaccines

• Asian needle ant: Researchers warn of threats – to humans and native plants – from little-known ant

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

Until next week,

Jay

ICYMI

Here’s a recap of the latest reporting from Healthbeat:

• Health equity: Georgia ranks 48th for Hispanic health care, driven by high uninsured rates

• Psychedelics: How the U.S. can deliver on the promise of psychedelics for mental health

• Baby formula botulism: New CDC data show sick infants needed treatment even after hospitalization

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

  • 🌏 Sign up here for the Global Health Checkup, a weekly report that explains how global health matters to all.

The Grapevine 🍇

Happy Birthday to us! 🎂 About one year ago, we launched the Healthbeat Atlanta newsletter. 

I looked back over the past year to see which editions resonated most with readers. Top performers included a look at why the CDC is in Atlanta and what the federal shutdown meant for local public health. 

To me, that indicates that readers are interested in learning about what national and global headlines mean for us here in Georgia. Want to help spread the word? Please forward this newsletter to a friend! 🥳

Please note: I’ll be away next week visiting friends in Portland, Oregon. The newsletter will return May 14.

What I’m hearing from readers:

Upcoming Events

• Saturday, 12:30 to 2 p.m.: Unveiling celebration and artist talk for new sculpture that is part of Compassion Corridor, sponsored by Compassionate Atlanta. Details here.  

• Wednesday, 6:30 to 7:30 p.m.: Infectious Ideas Dinner Club (virtual). Register here. 

• May 14, 5:30 to 8 p.m.: Bonne Fire Atlanta Summer Kick-Off at Azara. Register here.

What Do You Know?

Test your knowledge of public health topics. Today’s question:

Tell Me More

What questions do you have about public health in Atlanta? You can reach me at rgrapevine@healthbeat.org, post a comment, or reply to this email.

In health,
Rebecca

Thumbnail image by EZ Event Photography

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. 

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.

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

A health worker takes care of a young girl with noma in southern Niger. (Issouf Sanogo / AFP via Getty Images)

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:

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.

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. company 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. To me, 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:

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

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.

From left to right, Secretary of Health and Human Services Robert F. Kennedy Jr. and podcaster Joe Rogan look on as President Donald Trump shakes hands with W. Bryan Hubbard, CEO of Americans for Ibogaine, during a ceremony to sign an executive order on psychedelics. (Jim Watson / AFP via Getty Images)

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. 

Alzheirugs: 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. 

ICYMI

Here’s a recap of the latest reporting from Healthbeat:

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

• Child care: NYC is offering 2,000 free child care seats by fall. Can the health department keep up with the background checks?

• Transparency: Advisory or absent? Georgia public health board’s inactivity raises concerns 

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

Until next week,

Jay

ICYMI

Here’s a recap of the latest reporting from Healthbeat:

• DPH board: Advisory or absent? Georgia public health board’s inactivity raises concerns

• Health care coverage: Georgia’s ACA enrollment plunges, raising concerns for rural hospitals and whole health care market

• Vaccines: Most Americans believe vaccines are safe and effective

• Global health: Half the world’s countries still lack a central public health agency

  • 🌏 Sign up here for the Global Health Checkup, a weekly report that explains how global health matters to all.

The Grapevine 🍇

The Atlanta Symphony Orchestra performs its annual concert in Piedmont Park on Sunday. (Rebecca Grapevine / Healthbeat)

I had the pleasure of hearing the Atlanta Symphony Orchestra perform its annual concert in Piedmont Park on Sunday evening.

I was reminded of all the ways the park provides a boost to Atlanta’s health: by offering green space anyone (even dogs) can access; by providing a gathering point for all kinds of events, from Atlanta Pride to the Peachtree Road Race to the symphony to fitness classes to recreational sports to fishing; by providing a community garden; and so much more.

When was the last time you visited the park?  

What I’m hearing from readers:

Upcoming Events

• Today, April 23, 5:30 to 7:30 p.m.: Bonne Fire Atlanta happy hour, Three Taverns Ponce Brew Terminal. Register here.  

• Through Friday, April 24: Annual Epidemic Intelligence Service conference. Virtual; free, and open to the public. Details here.   

• Tuesday, April 28, 10 a.m. to 2 p.m.: The State of Everything - Volume 2, sponsored by Neighborhood Nexus. Details here.  

• Wednesday, April 29, 9 a.m. to noon: Georgia Public Health Association virtual annual conference. Details here.

What Do You Know?

Test your knowledge of public health topics. Today’s question:

Tell Me More

What questions do you have about public health in Atlanta? You can reach me at rgrapevine@healthbeat.org, post a comment, or reply to this email.

In health,
Rebecca

Hello from Nairobi.

This week we’re heavy on 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 the 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:

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

Thumbnail image by Getty Images

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 focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

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?

Illustration by Hiram Henriquez for Healthbeat

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.

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. 

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.

ICYMI

Here’s a recap of the latest reporting from Healthbeat:

• Global public health: Half the countries in the world still lack a central public health agency

  • 🌎 Sign up here for the Global Health Checkup, a weekly report that explains how global health matters to all.

• Research: How a student is helping the CDC alert doctors to heat’s effects on medications

• Artificial intelligence: AI could help save lives by easing delivery of treatments we know work

Until next week,

Jay

ICYMI

Here’s a recap of the latest reporting from Healthbeat:

• Research: How an Emory medical student is helping the CDC alert doctors to heat’s effect on medications

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

• Artificial intelligence: AI could help save lives by easing delivery of treatments that we know work 

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

• Global health: The next U.S. aid disruption: HIV, malaria drugs for Africa and Asia

  • 🌏 Sign up here for the Global Health Checkup, a weekly report that explains how global health matters to all.

The Grapevine 🍇

Violinist Itzhak Perlman contracted polio as a child growing up in Tel Aviv and has expressed his anger about the disease’s resurgence. (Rebecca Grapevine / Healthbeat)

I spent a recent evening listening to violinist Itzhak Perlman play and tell stories about his life. I was surprised when Perlman rolled out onto the stage in a wheelchair; I hadn’t known that Perlman contracted polio as a child in Tel Aviv.

Listening to Perlman talk about his experience with polio reminded me of what the late Dr. Bill Foege, who worked to help eradicate smallpox, told me last year: “When I was young, you had no trouble convincing people to take the polio vaccine, because they saw what happened, the crippling of polio.”

What I’m hearing from readers:

Hear from Healthbeat on other platforms:

• On 11 Alive and Fox 5, I discuss what wastewater testing for measles can tell us.

• Georgia Health Report: I discuss which public health bills passed during this year’s legislative session. Listen here on WUGA.

Upcoming Events

• Today, April 16, 6 p.m.: Screening of documentary “Me Period” with accompanying distribution of menstrual products. Register here.   

• April 23, 5:30 to 7:30 p.m.: Bonne Fire Atlanta happy hour, Three Taverns Ponce Brew Terminal. Register here. 

• April 21-24: Annual Epidemic Intelligence Service conference. Virtual; free, and open to the public. Details here.  

• April 28, 10 a.m. to 2 p.m.: The State of Everything - Volume 2, sponsored by Neighborhood Nexus. Details here. 

• April 29, 9 a.m. to noon: Georgia Public Health Association virtual annual conference. Details here.

What Do You Know?

Test your knowledge of public health topics. Today’s question:

Tell Me More

What questions do you have about public health in Atlanta? You can reach me at rgrapevine@healthbeat.org, post a comment, or reply to this email.

In health,
Rebecca

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 northern white rhinos on Earth, who live at the Ol Pejeta wildlife conservancy in Kenya. Scientists are working to save the species from extinction. (William Herkewitz / Healthbeat)

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.

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.

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:

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 that framework down, 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.

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:

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

Thumbnail image by Getty Images