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New Infectious Threats Are Coming. The U.S. Probably Won’t Contain Them.

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New Infectious Threats Are Coming. The U.S. Probably Won’t Contain Them.

If it wasn’t clear sufficient in the course of the Covid-19 pandemic, it has grow to be apparent in the course of the monkeypox outbreak: The US, among the many richest, most superior nations on the planet, stays wholly unprepared to fight new pathogens.

The coronavirus was a sly, sudden adversary. Monkeypox was a well-recognized foe, and exams, vaccines and coverings have been already at hand. However the response to each threats sputtered and stumbled at each step.

“It’s type of like we’re seeing the tape replayed, besides a few of the excuses that we have been counting on to rationalize what occurred again in 2020 don’t apply right here,” stated Sam Scarpino, who leads pathogen surveillance on the Rockefeller Basis’s Pandemic Prevention Institute.

No single company or administration is in charge, greater than a dozen specialists stated in interviews, though the Facilities for Illness Management and Prevention has acknowledged that it bungled the response to the coronavirus.

The worth of failure is excessive. Covid has killed multiple million Individuals up to now, yielding untold distress. Instances, hospitalizations and deaths are all falling, however Covid was the third main explanation for dying in the USA in 2021 and appears prone to hold killing Individuals for years.

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Monkeypox is spreading extra slowly now, and has by no means posed a problem of Covid’s magnitude. However the USA has reported extra monkeypox instances than some other nation — 25,000, about 40 p.c of the worldwide whole — and the virus is prone to persist as a continuing, low-grade risk.

Each outbreaks have revealed deep fissures within the nation’s framework for holding epidemics. Add to that plummeting public belief, rampant misinformation and deep schisms — between well being officers and people treating sufferers, and between the federal authorities and states. A muddled response to future outbreaks appears nearly inevitable.

“We actually are poorly, poorly ready,” stated Larry O. Gostin, director of the O’Neill Institute for Nationwide and World Well being Regulation at Georgetown College.

New infectious threats are actually on the way in which, largely due to the dual rises in international journey and vaccine hesitancy, and the rising proximity of individuals and animals. From 2012 to 2022, for instance, Africa noticed a 63 p.c enhance in outbreaks of pathogens that leap to individuals from animals, in contrast with the interval from 2001 to 2011.

“In individuals’s minds, maybe, is the concept that this Covid factor was such a freak of nature, was a once-in-a-century disaster, and we’re good for the subsequent 99 years,” stated Jennifer Nuzzo, director of the Pandemic Heart at Brown College College of Public Well being.

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“That is the brand new regular,” she added. “It’s just like the levees are constructed for the one-in-a-100-years disaster, however then the floods hold taking place each three years.”

Ideally, right here’s how the nationwide response to an outbreak would possibly unspool: Experiences from a clinic wherever within the nation would sign a brand new pathogen’s arrival. Alternatively, ongoing wastewater surveillance would possibly sound the alarm for identified threats, because it has just lately for polio in New York State.

The knowledge would circulate from native well being departments to state and federal authorities. Federal officers would quickly allow and provide steering for the event of exams, vaccines and coverings, rolling them out equitably to all residents.

Not one in every of these steps labored easily within the two current outbreaks.

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“I’m very accustomed to outbreak response and pandemic preparedness, and none of it seems like this,” stated Kristian Andersen, a virologist on the Scripps Analysis Institute in San Diego who has spent years learning epidemics.

Dr. Andersen stated he had assumed that the issues uncovered by the coronavirus could be repaired as they grew to become obvious. As an alternative, “we’re worse ready now than we have been early within the pandemic,” he stated.

Public well being in the USA has all the time operated on a shoestring. The information programs utilized by the C.D.C. and different federal companies are laughably outdated. Many public well being employees have been abused and attacked in the course of the pandemic and have fled their jobs, or are planning to.

More cash received’t remedy all the issues, a number of specialists stated. However extra funding may assist public well being departments rent and practice workers, replace their growing older knowledge programs and put money into sturdy surveillance networks.

However in Congress, pandemic preparedness stays a tricky promote.

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Mr. Biden’s price range request for fiscal 12 months 2023 consists of $88 billion over 5 years, however Congress has not proven any inclination to approve it.

The US spends between 300 to 500 instances extra on its army protection than on its well being programs, and but “no warfare has killed 1,000,000 Individuals,” famous Dr. Thomas R. Frieden, who led the C.D.C. underneath former President Barack Obama.

The US was purported to be the easiest at managing outbreaks. An evaluation of world well being safety in 2019, a 12 months earlier than the arrival of the coronavirus, ranked the nation first amongst all others — greatest at stopping and detecting outbreaks, most adept at speaking threat and second solely to the UK within the rapidity of its response.

However all of that assumed that leaders would transfer shortly and decisively when confronted with a brand new pathogen, and that the general public would observe directions. The analyses didn’t account for an administration that underplayed and politicized each side of the Covid response, from testing and masks to using vaccines.

Too typically in a disaster, authorities officers search for simple options, with dramatic and rapid affect. However there are none for managing pandemics.

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“A pandemic is by definition an issue from hell. You’re vanishingly unlikely to have the ability to take away all of its unfavourable penalties,” stated Invoice Hanage, an epidemiologist on the Harvard T.H. Chan College of Public Well being.

As an alternative, he added, officers ought to guess on mixtures of imperfect methods, with an emphasis on pace over accuracy.

In each the coronavirus pandemic and the monkeypox outbreak, for instance, the C.D.C. at first tried to keep up management over testing, as a substitute of disseminating the accountability as broadly as doable. The transfer led to restricted testing, and left well being officers blind to the unfold of the viruses.

The Meals and Drug Administration was sluggish to assist educational labs develop alternate options for testing, and inspired the very best high quality of prognosis. It could be cheap for officers to ask which check is quicker or which one produces the least errors, Dr. Hanage stated, however “all of them are higher than not doing something.”

Mr. Gostin, of Georgetown College, has labored with the C.D.C. for many of his profession, and was amongst its staunchest defenders early within the pandemic.

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However he grew to become more and more disenchanted as the USA was pressured to depend on different international locations for very important info: How efficient are boosters? Is the virus airborne? Do masks work?

“Nearly in each case, we received our info and acted on it from international well being companies, from the U.Ok., from Israel, from South Africa,” Mr. Gostin stated. The C.D.C. “all the time gave the impression to be final and weakest,” he stated.

Many on the C.D.C. and different well being companies gave the impression to be paralyzed, afraid of being held accountable if issues go unsuitable, he added: “They’re overlaying their rear ends attempting to observe the process. All of it boils right down to an absence of fireplace of their bellies.”

Probably the most intractable hurdle to a coordinated nationwide response arises from the division of accountability and sources between federal, state and native governments, together with gaps in communications between the general public well being officers coordinating the response and the docs and nurses really treating the sufferers.

The advanced legal guidelines that govern well being care in the USA are designed to guard confidentiality and affected person rights. “However they don’t seem to be optimized for working with the general public well being system and getting the general public well being system the information that it wants,” stated Dr. Jay Varma, director of the Cornell Heart for Pandemic Prevention and Response.

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Usually, states will not be obligated to share well being knowledge, such because the variety of instances of an infection or demographic particulars of vaccinated individuals, with federal authorities.

Some state legal guidelines really forbid officers from sharing the data. Smaller states like Alaska might not need to hand over particulars that go away sufferers identifiable. Hospitals in small jurisdictions are sometimes reluctant to give up affected person knowledge for comparable causes.

Well being care programs in international locations like Britain and Israel depend on nationalized programs that make it a lot simpler to gather and analyze info on instances, stated Dr. Anthony S. Fauci, the Biden administration’s prime medical adviser.

“Our system isn’t interconnected like that,” Dr. Fauci stated. “It isn’t uniform — it’s a patchwork.”

A C.D.C. official stated the company understood the attitude of the states, however the present guidelines on knowledge sharing created “constraints and hurdles.”

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“I don’t suppose it’s a matter of scapegoating states,” Kevin Griffis, a spokesman for the company, stated. “It’s merely a press release of the truth that we don’t have entry to the data that we have to optimize a response.”

Laws launched in Congress would possibly assist take away these limitations, he added. The measure would require well being care suppliers, pharmacies, and state and native well being departments to report well being knowledge to the C.D.C.

Epidemics are managed by public well being companies, however it’s clinicians — docs, nurses and others — who diagnose and look after sufferers. An environment friendly outbreak response depends on mutual understanding and trade of data between the 2 teams.

The edges didn’t talk successfully in both the Covid pandemic or the monkeypox outbreak. The disconnect has led to absurdly convoluted procedures.

The C.D.C. has not but included monkeypox in its illness reporting pc system, for instance. Meaning state officers should manually kind in knowledge from case studies, as a substitute of merely importing the recordsdata. A request for testing should typically be faxed to the state laboratory; the outcomes are sometimes routed via a state epidemiologist, then to the supplier, then to the affected person.

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Few public well being officers perceive how well being care is delivered on the bottom, some specialists stated. “Most individuals within the C.D.C. don’t know what the within of a hospital seems like,” stated Dr. James Lawler, co-director of the College of Nebraska’s World Heart for Well being Safety.

Dr. Frieden, who as soon as led New York Metropolis’s well being division, instructed that embedding C.D.C. workers into native well being departments would possibly assist officers perceive the obstacles concerned in responding to an outbreak.

Dr. Frieden has additionally proposed what he calls a “7-1-7” accountability metric, loosely modeled on a method employed to deal with the H.I.V. epidemic. Each new illness must be recognized inside seven days of emergence, reported to public well being authorities inside sooner or later and responded to inside seven days.

The technique might give the federal government a clearer sense of the issues impeding the response, he stated.

In the USA, “what we have now is repeated cycles of panic and neglect,” Dr. Frieden stated. “The only most necessary factor we have now to do is break that cycle.”

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California communities are banning syringe programs. Now the state is fighting back in court

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California communities are banning syringe programs. Now the state is fighting back in court

As Indiana officials struggled to contain an outbreak of HIV among people who injected drugs, then-Gov. Mike Pence reluctantly followed the urgings of public health officials and cleared the way for an overwhelmed county to hand out clean syringes.

Pence was far from enthusiastic about launching the program in Scott County, but after it rolled out in 2015, the percentage of injection drug users there who said they shared needles dropped from 74% to 22%. Within a few years, the number of new HIV infections plummeted by 96% and new cases of hepatitis C fell by 76%.

The Sierra Harm Reduction Coalition wanted to keep those same diseases in check in California. The tiny nonprofit got approval from the state to deliver syringes in El Dorado County to prevent the spread of life-threatening illnesses.

Yet when the program was discussed at a December meeting of the county’s Board of Supervisors, the success story in Indiana held little sway. Faced with complaints about discarded needles and overdose deaths, the supervisors voted to prohibit syringe programs in the county’s unincorporated areas.

“These programs may work in other parts of California and throughout the United States, although I have my doubts,” Sheriff Jeff Leikauf said at the meeting. “El Dorado County does not want or need these types of programs.”

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El Dorado is among a growing number of California communities that have banned syringe programs, testing the state’s power and political will to defend them as a public health strategy. It is part of a broader pushback against “harm reduction” — the practical philosophy of trying to reduce the negative effects of drug use — as overdose deaths have soared.

Now California is fighting back. In a recently filed lawsuit, the Department of Public Health argued that local ordinances prohibiting syringe programs in El Dorado County were preempted by state law, making them unenforceable.

The state is seeking a court order telling El Dorado County and the city of Placerville, its county seat, to stop enforcing their bans and allow syringe programs to resume.

An El Dorado County spokesperson said Monday that the county does not comment on pending legal issues. Its district attorney, however, said he was outraged to learn of the lawsuit, saying that state leaders were “seeking to impose the normalization of hardcore drug use.”

“Don’t come into our county and double down on your failed policy,” El Dorado County Dist. Atty. Vern Pierson said in a statement. “Allowing addicts to use fentanyl and other hardcore drugs is exactly what has caused other California counties to experience a death rate that is out of control and getting worse.”

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Mona Ebrahimi, the city attorney for Placerville, said the city had put a 45-day temporary moratorium in place “to study the ongoing effects of syringe service programs in the city.”

“The city wants to protect the health, safety and welfare of its residents,” Ebrahimi said.

The California Department of Public Health has long endorsed handing out sterile syringes as a proven way to prevent dangerous infections from running rampant when people share contaminated syringes. Researchers have linked syringe programs with a roughly 50% reduction in HIV and hepatitis C.

“It sounds crazy: ‘Wait, you want to give out the tools to people to do this thing that we all agree is a bad idea?’” said Peter Davidson, a medical sociologist at UC San Diego. But it works, said Davidson, who called the programs “probably the best studied public health intervention of the last 70 years.”

Public health officials also see them as a crucial way to reach people who use drugs and link them to addiction and overdose-prevention services. In Seattle, for instance, researchers found that injection drug users who started going to a needle exchange were five times more likely to enter drug treatment than those who never went.

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Signs direct visitors to the syringe-exchange program at the Austin Community Outreach Center in Austin, Ind., in 2015. The program was set up to curb an outbreak of HIV among people who injected drugs.

(Darron Cummings / Associated Press)

And in California, harm reduction groups have been particularly effective in getting Narcan — a nasal spray that can reverse opioid overdoses — into the hands of people who need it.

It’s “hugely important to reduce overdose in the community, and these are the programs that do that,” said Barrot Lambdin, a health policy fellow at RTI International who studies the implementation of health interventions.

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Yet leaders in some cities and counties have strenuously rejected the health benefits of syringe programs.

In El Dorado County, local leaders asserted that the efforts of the Sierra Harm Reduction Coalition had not “meaningfully reduced” HIV or hepatitis C cases since its syringe program began four years ago and said the free needles were ramping up the risk of deadly overdoses, which they argued were a bigger threat.

Street scene shows trees with fall colors, cars and old buildings

The El Dorado County Courthouse in Placerville, Calif.

(Max Whittaker / For The Times)

Alessandra Ross, a harm reduction expert at the California Department of Public Health, disputed such arguments in a letter to county officials. Ross pointed out that in just one year, the coalition handed out more than 2,200 doses of medication to reverse opioid overdoses, saving at least 421 lives. Without the group’s efforts, she wrote, “El Dorado County could have potentially lost more than ten times as many people to overdose.”

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Under state law, the California Department of Public Health has the authority to approve syringe programs anywhere that deadly or disabling infections might spread through used needles, “notwithstanding any other law” that might say otherwise.

The agency argued that the “significant state and public interest in curtailing the spread of HIV, hepatitis, and other bloodborne infections extends to every jurisdiction in the state, especially since Californians travel freely throughout the state.”

After El Dorado County prohibited syringe services in unincorporated areas, the state public health department adjusted its authorization for the Sierra Harm Reduction Coalition program, limiting its operations to Placerville. In the court filing, the agency said it made the change out of concern for the coalition’s staff and volunteers, who could be at risk of arrest if they provided syringes in the unincorporated areas.

The nonprofit said when it stopped providing syringes outside of Placerville city limits, roughly 40% of its clients were cut off. In February, Placerville city officials passed their own urgency ordinance banning syringe programs for 45 days, exempting needle provision at health facilities.

Ebrahimi, its city attorney, said officials took that step “after CDPH concentrated their use by authorizing them only in Placerville and nowhere else in the county.”

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The Sierra Harm Reduction Coalition stopped providing syringes in Placerville as well, according to the state lawsuit. The coalition did not respond Monday to requests for comment on the suit.

El Dorado County and Placerville are not alone: A wave of local bans went into effect last year in Placer County after a harm reduction group from Sacramento sought state approval to hand out clean syringes. The county’s sheriff and its probation chief said in a letter to the state that the syringe program proposed by Safer Alternatives thru Networking and Education, or SANE, would “promote the use of addicting drugs” and lead to more “dirty needles discarded recklessly in our parks.”

The Placer County Board of Supervisors voted unanimously to ban syringe programs in its unincorporated areas. Cities including Auburn, Loomis and Rocklin banned them too.

“We are the ones who should make these kinds of decisions,” then-Mayor Alice Dowdin Calvillo said at a September meeting of the Auburn City Council, “and not allow the state to just bully us.”

Public health researchers stress that studies have found that free needle programs do not increase crime or drug use, or worsen syringe litter. Yet as much of Placer County became a no-go zone, SANE withdrew its application for a syringe program there.

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“Our political processes are not well set up for us to make reasoned, scientifically sound judgments about public health,” said Ricky Bluthenthal, a USC sociologist whose research has documented the effectiveness of syringe programs. It doesn’t help that “the populations at risk are often marginalized or not politically active.”

Our political processes are not well set up for us to make reasoned, scientifically sound judgments about public health.

— Ricky Bluthenthal, a USC sociologist who studies syringe programs

The California Department of Public Health declined to address whether it planned to challenge local bans on syringe programs elsewhere in the state, saying it “cannot comment on active litigation strategy.”

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Syringe programs have long faced public skepticism: In a 2017 survey, only 39% of U.S. adults said they supported legalizing them in their communities.

Experts say the programs have faced increasing jeopardy as public concern wanes about the threat of HIV and frustration swells over other problems like soaring numbers of overdose deaths and the spread of homeless encampments. Even in Indiana’s Scott County, local leaders voted three years ago to shutter its needle exchange.

Clashes are also arising because programs are making moves into new parts of California, bolstered in some cases by state funding. California officials also have taken steps to help syringe programs overcome local opposition, including exempting them from review under the California Environmental Quality Act.

“It’s not surprising that cities and counties are motivated to protect the public health and safety of their residents through whatever tools they have at their disposal,” said attorney David J. Terrazas, who represented a group that successfully sued to overturn state approval of a syringe program in Santa Cruz County.

In that case, a state appeals court ruled last year that the California Department of Public Health conducted an insufficient review of a program run by the Harm Reduction Coalition of Santa Cruz County. The department didn’t do enough to consult with law enforcement agencies in the area, among other shortcomings, the court said.

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Although the state health department had considered some comments from law enforcement, “it never engaged with them directly about their concerns,” the appeals court concluded. Internal records showed department staff had decided not to respond to some of their comments and called one police chief an “imbecile.”

Terrazas said local officials are best poised to know what works for their communities. But Denise Elerick, founder of the Harm Reduction Coalition of Santa Cruz County, argued it made no sense for law enforcement to hold sway in public health decisions.

“We wouldn’t consult with them on what to do about COVID,” Elerick said.

A bag is filled with boxes of Narcan nasal spray for distribution to people living on the street in Los Angeles.

A bag is filled with boxes of Narcan nasal spray, one of several harm-reduction supplies distributed to people living on the street in Los Angeles.

(Francine Orr / Los Angeles Times)

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Weeks after the court ruling, the state health department rolled back its approval for a syringe program in Orange County that would have been run by the Santa Ana-based Harm Reduction Institute, saying it wanted to consult more with local officials.

The decision was celebrated by city leaders in Santa Ana, who had banned syringe programs in 2020 and sharply opposed efforts to restart one. At a recent meeting, interim city manager Tom Hatch said a previous program was “an epic failure” that left its downtown littered with used syringes.

Orange County is currently the most populous county in the state without any syringe services programs — to the alarm of health researchers who found that syringe reuse increased after a local program was shut down.

The Santa Cruz court ruling was also invoked by the Santa Monica City Council, which directed city officials to investigate how Los Angeles County came to approve a program run by the Venice Family Clinic. That program sends outreach workers into Santa Monica parks once a week to offer clean syringes, Narcan and other supplies and connect people with healthcare, including for addiction.

A woman hands out Narcan to a man at Tongva Park in Santa Monica

Devon O’Malley, left, a harm reduction case manager with the Venice Family Clinic, hands out Narcan to Ken Newark at Tongva Park in Santa Monica.

(Mel Melcon / Los Angeles Times)

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Critics want the program to relocate indoors, which they say would better protect parkgoers from discarded syringes. In addition, “if someone has to walk inside, there’s a chance for counselors to suggest strongly that it’s time for them to get off the drugs,” said Santa Monica Mayor Phil Brock, who wants the city to formally express its opposition to the program. “We can’t just facilitate their demise.”

Last month, a group called the Santa Monica Coalition filed suit to get L.A. County to halt the program it approved, saying it should instead be in a government building.

But Venice Family Clinic staffers said unhoused people can be reluctant to leave behind their belongings to go elsewhere. Even offering services out of a van reduced participation, said Arron Barba, director of the clinic’s Common Ground program.

“Bringing the service directly to the people is what we know works,” Barba said.

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Opinion: How measles reemerged as a threat in California and elsewhere

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Opinion: How measles reemerged as a threat in California and elsewhere

The measles virus is resurging in the U.S. despite the long-standing availability of a vaccine that provides nearly life-long immunity. In the past few weeks, hundreds of people were exposed to a child with the virus in a Northern California healthcare facility; our state is one of 17 jurisdictions with reported measles cases in 2024, higher than seen in recent years.

Measles is an extremely transmissible pathogen: On average, one infected person infects 12 to 18 unvaccinated people. The airborne virus can linger in floating aerosols long after someone has left a room, and the common symptoms, which include rash, a high fever, watery eyes, cough and a runny nose, typically take a week or two to appear.

Infections can also cause immune amnesia, in which your immune system becomes better at fighting measles and worse at fighting other infections you were previously protected against. In rare cases it also leads to death, more often in children than adults, from respiratory or neurological complications, including a type of brain swelling in young children that can appear years after the initial measles infection.

Before the measles vaccine was introduced and licensed in 1963, the Centers for Disease Control and Prevention cites an annual average of 549,000 cases (with likely millions more going unreported), 48,000 hospitalizations, nearly 500 deaths and 1,000 people with chronic disability. By 2000, thanks to vaccination, measles was declared eliminated in the U.S. But because of cases from people arriving here from other countries, combined with pockets of low vaccination, we are seeing outbreaks among unvaccinated people.

Policy can worsen the issue. Last month in Florida, following an outbreak at an elementary school, the state’s surgeon general left the decision to parents whether to send their children to school, citing high levels of community immunity as the rationale for not following the usual protocols. That cavalier response risked a much worse outbreak. A more standard response would have called for unvaccinated students and staff to be vaccinated and quarantine for 21 days (the time frame in which the disease could develop).

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It might be tempting to Californians to dismiss this as a Florida problem. But our state has a measles time bomb on our hands. Ideally communities should hit at least 95% vaccination to achieve herd immunity. But a recent nationwide survey found that Southern California alone has 350 schools falling short of the desired vaccination threshold, meaning a single measles case in these schools could easily become an outbreak among the unvaccinated.

Misinformation around the measles vaccine has been an issue for years. A debunked but influential 1998 research paper in the Lancet, a British medical journal, suggested a link between the vaccine, which babies can receive starting at the age of 12 months, and autism. The paper was retracted in 2010 (and the authors were later reported to have committed fraud). But measles vaccine rates dropped in England throughout the early 2000s.

In California, a 2014 outbreak at Disneyland was connected to more than 140 cases in North America, with declining vaccination rates one contributing factor. A recent systematic review of the reasons why parents reject measles vaccination for their children found fear of autism the most cited concern. Those who were hesitant more frequently cited the internet and social media as information sources on vaccines than those who were not hesitant.

In recent years hesitancy has grown as misinformation about the COVID vaccine has made some parents doubtful of routine inoculations. Vaccination exemptions during the 2022-23 school year reached the highest level ever reported in the U.S., increasing in 40 states and Washington, D.C., and 10 states reaching exemption rates of above 5%. According to the CDC, the 93.1% vaccination rate among eligible children puts about 250,000 kindergarten students at risk for measles.

Encouragingly, we’ve seen in our own state that vaccine hesitancy can be reversed. Marin County had among the lowest measles vaccination rates in the state in 2011 and now has coverage close to 99% among children entering school. State contact tracing efforts that were strengthened during COVID-19, including the California Connected program, have been useful to track the contacts of measles cases.

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But as the recent scares remind us, we still aren’t where we need to be with vaccination. Following the Disneyland outbreak, in 2015 California passed a law to remove the “personal belief” exemption from required childhood vaccines, meaning people must provide a medical reason to decline it. The law broadened the criteria for medical exemptions, which increased the year after it passed. Although the state tightened up medical exemptions with a new law in 2019, with the pandemic disrupting routine vaccinations and increasing homeschooling, the percentage of kindergarteners not up to date on vaccinations went up by 2021.

Vaccine exemption laws vary widely across the U.S., with some states allowing only medical exemptions, some also allowing religious exemptions and others permitting philosophical exemptions too. And outbreaks from one state can spill over across borders quickly.

That means decisions by Florida’s public health department, and vaccine hesitancy anywhere, can affect us all. California has to close the gap for communities that are not well-protected against measles.

Abraar Karan is an infectious disease doctor and researcher at Stanford University, where Julie Parsonnet is a professor of infectious diseases and of epidemiology and population health.

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Video: SpaceX Launches Starship for Third Time

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Video: SpaceX Launches Starship for Third Time

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SpaceX Launches Starship for Third Time

The rocket, a version of which will eventually carry NASA astronauts to the moon, traveled almost halfway around the Earth before it was lost as it re-entered the atmosphere.

“Five, four, three, two, three, one.” “This point, we’ve already passed through Max-Q, maximum dynamic pressure. And passing supersonic, so we’re now moving faster than the speed of sound. Getting those on-board views from the ship cameras. Boosters now making its way back, seeing six engines ignited on ship. Kate, we got a Starship on its way to space and a booster on the way back to the Gulf.” “Oh, man. I need a moment to pick my jaw up from the floor because these views are just stunning.”

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