WASHINGTON — Health and Human Services Secretary Robert F. Kennedy Jr. pledged during his confirmation hearing to do everything in his “power to put the health of America back on track.”

Kennedy testified that when he worked as a lawyer he “learned that human health and environmental health are intertwined and inseparable.” He referred to the Make America Healthy Again agenda as “one of the most powerful and transcendent movements I’ve ever seen.”

“The nation is ready for change and recognizes that this is a unique inflection moment,” Kennedy said.

Less than two years into his tenure at the helm of the department responsible for the health of millions of Americans, a string of outbreaks has repeatedly made headlines. Public health experts interviewed by States Newsroom said the upswing is the result of several factors, but that Kennedy’s decision to cut back the country’s safety net while spreading misinformation about vaccines has aggravated the problem. 

“We track serious infectious diseases, and over the last year and a half, the number of diseases we’ve had to put on the list has quadrupled,” said Jennifer B. Nuzzo, director of the Pandemic Center and professor of epidemiology at Brown University.

Old diseases like measles have surged to the highest level in decades after vaccine misinformation left entire communities vulnerable to a virus once eradicated in the United States.

Americans learned about an unfamiliar strain of hantavirus after cruise ship passengers were moved to a quarantine facility in Nebraska and public health officials raced to contact trace those who left the ship before the illness was detected.

Cases of West Nile virus reached the highest level seen in more than two decades as mosquitoes spread that virus as well as several others. Monthly emergency room visits for tick bites spiked in April to their highest level since 2017. And the cyclospora parasite sickened thousands as public health officials struggled to determine the cause.

Disease spread among animals, which could easily become a human health problem if not properly contained, has also cropped up, some more unexpected than others. 

Bird flu continued to decimate poultry flocks and wreak havoc on dairy herds as well as some people, raising concerns about the possibility it would evolve into something more problematic. And New World screwworm reemerged in cattle after more than half a century without a case in this country. 

HHS and the Centers for Disease Control and Prevention did not agree to interview requests or to send a statement on the cause of the myriad of disease outbreaks. 

Outbreaks growing

Environmental changes like deforestation, people moving into new places that used to belong to wildlife and climate change have all contributed to more disease spread among people. But those factors have been exacerbated by cuts and other policy changes put in place during this administration, Nuzzo said. 

“We don’t have the protections against these outbreaks in place at the level that we used to, which allows them to continue,” she said. “We had bad measles before, but we managed to stop them before we got to the point where we’d lose measles elimination status. We’re going to lose measles elimination status this year.”

The CDC has tried to keep track of it all but the agency has experienced both staffing and funding cuts under Kennedy’s leadership. 

Complicating matters, the CDC had a Senate-confirmed director for just 29 days after Susan Monarez was fired for refusing to pre-approve vaccine recommendations or fire career officials for no reason. 

“Most of the activity for public health exists at the state and local level,” Nuzzo explained. “But the CDC is really important for not just providing funding to those state and local health officials, but also to nudge them. To say, ‘Yes, this is worth prioritizing. Or pay closer attention to this now, because what we see in one place might be happening in another place.’ 

“And the more we can collectively learn and act, the more likely it is to be able to stop it in its tracks.”

In addition to hollowing out certain domestic programs, the administration has cut how the U.S. government monitors and responds to disease outbreaks overseas, which are typically just one airplane flight away. That includes how U.S. officials have handled the outbreak of Ebola caused by the Bundibugyo virus in the Democratic Republic of the Congo. 

“The fact that we didn’t hear about this outbreak publicly until nearly 200 cases were identified means that normal checks and balances just weren’t happening,” Nuzzo said. “So that’s the kind of thing where when we contract our overseas presence and our overseas assistance, we lose a protection. 

“Now, do I think Bundibugyo is going to come here? It could. Is it going to spread? No. It’s not going to spread in the same way like a COVID would.”

States stuck with the burden

American Public Health Association CEO Dr. Georges C. Benjamin said public health officials faced severe burnout and “left in droves” following the global coronavirus pandemic.

That has left public health departments to track more disease circulating in their communities with less staff and funding. 

“If you’re in a local or state health department, the same people dealing with measles are the same people that are going to deal with cyclospora, are going to be the same people if you have a Legionella outbreak,” Benjamin said. 

Those challenges were compounded by efforts under the Trump administration to shift more of the responsibility for preventing and containing outbreaks to state governments “without adequate planning,” he said. 

“Half of both state and local health department budgets are from federal dollars. Some whole programs are almost 100% federally funded. Most immunization programs are pretty much federally funded,” Benjamin said. “So when the feds abruptly decide not to fund something, the money just goes out the door. And you just can’t fill that hole overnight.”

The situation doesn’t seem likely to change anytime soon, he said, possibly leading more people to suffer from vaccine-preventable illnesses as well as those that spread from animals to people or from person to person.

“If we don’t pay attention to this, we’re going to be spending more money on the healthcare side of the ledger for people who will be sicker at a higher cost, because we’re not paying attention to the prevention side of the house,” Benjamin said. “I mean, we have the knowledge and tools to mitigate a lot of this stuff. We really do. And the challenge I think we have here is that as a society we’re pretty good at dealing with emergency stuff, but very poor at prevention.”

More infectious diseases expected

Dr. Amesh A. Adalja, senior scholar at Johns Hopkins Center for Health Security, said there has been progress in recent years on some vaccine-preventable diseases even as there’s been backsliding in others. 

“Now we have RSV vaccines for the elderly, we have RSV vaccines for pregnant women and monoclonal antibodies for babies to protect them against RSV,” he said. 

The American Lung Association writes on its website that respiratory syncytial virus, or RSV, “is a common virus that you have undoubtedly been sick with before.” But that it “has the potential to make you really sick.”

Measles, however, isn’t becoming less common as doctors and other healthcare professionals struggle against an undercurrent of misinformation about vaccine safety, including from Kennedy, as they’re trying to treat all the other illnesses circulating. 

“In measles, it’s less about public health burnout, rather, it’s more about the anti-vaccine movement making inroads,” Adalja said. “For cyclospora, that’s always been a threat. We always get cases every year. But the fact that the malaria and parasite division in CDC has basically been gutted does play a role.” 

Overall, he said, the infectious disease trend in the United States has become worse since the coronavirus pandemic. And that’s not likely to change in the near future. 

“If you’re saying, ‘How resilient is the U.S. or should we expect more infectious disease problems in the United States?’ I would say yes,” Adalja said. “But it’s not clear which ones they would be. I definitely would think the vaccine-preventable diseases, the control of them is going to slip. And it’s not just going to be measles.”

Then there are the bugs

Director of the Center for Infectious Disease Research and Policy at the University of Minnesota Michael T. Osterholm said on his podcast the El Nino weather pattern that leads to warmer temperatures in some parts of the country and heavier rainfall in others can be a “perfect breeding ground for mosquitoes.”

“We talked about the El Nino in previous episodes in the context of hantavirus but it can actually play a large role in disease transmission for a number of viruses, West Nile included,” Osterholm said.

That could be one of the reasons the CDC reported in early July it observed “the earliest start to the West Nile virus (WNV) season in the United States with the highest number of human disease cases reported by this time of year since 2004.”

Osterholm said that is likely “a really major underestimation of the true number of infections.”

“Approximately 20% of West Nile infections in humans are symptomatic and less than 1% result in the severe neurologic symptoms for which testing would typically be sought by medical providers,” he said. “I say that not to undermine the public health importance of West Nile, but to highlight that this virus is likely much more widespread than our surveillance data might suggest.” 

Ticks are also leading to more illness among Americans, including Lyme disease and Alpha-gal syndrome.

That second condition, caused by the Lone Star tick, can cause people to become allergic to red meat that contains Alpha-gal sugar. This includes beef, pork, lamb, venison, goat and rabbit, he said. 

Michigan Department of Health and Human Services Public Information Officer Lynn Sutfin wrote in a statement that even though “infectious disease threats have been trending up in general, there are several practices and issues that are contributing to the increased awareness of outbreaks.” 

“Outbreak definitions, modernized reporting, investigative capacity, improved diagnostics, genetic sequencing and even declining vaccination rates are all having an impact on disease spread and information about their spread,” Sutfin wrote. “Globally, additional considerations like climate change, antibiotic overuse, modern travel, industrialization and deforestation also need to be considered.”

WASHINGTON — Dr. Anthony Fauci, one of the nation’s most visible public health officials during the coronavirus pandemic, declined to answer questions from a U.S. Senate committee in a tense and confrontational hearing Wednesday, citing his Fifth Amendment rights. 

Fauci said during a brief opening statement he believed Homeland Security and Governmental Affairs Committee Chairman Rand Paul, R-Ky., was trying to get him to make statements under oath that would lead to criminal charges. 

“Given Senator Paul’s obvious obsession with calling for my prosecution, his repeated slanderous comments about me, and recently his publicly releasing my unredacted personal diary aimed at embarrassing and intimidating me, the only conclusion I can reach is that the sole reason he is calling me before this committee is to get me to say something, anything that could vindicate his repeated public pledges that I end up, in his words, ‘behind bars,’” he said.  

Fauci added that “any reasonable person who has followed his unhinged obsession with me would readily come to the same conclusion.” 

“Therefore, although it pains me to do so, because of the respect I have for the legislative branch of government and my decades-long record of cooperating with Congress, under the advice of my attorneys, I will invoke my right under the Fifth Amendment of the Constitution, to refrain from answering your questions,” he said. 

Fauci was a member of the coronavirus task force during President Donald Trump’s first administration and a chief medical adviser on COVID-19 during President Joe Biden’s term. 

Repeated testimony

Fauci has testified publicly 13 times before Senate committees and 11 times before House committees since January 2020. This was the first time he declined to answer any questions from lawmakers.

Paul noted that former President Joe Biden pardoned Fauci for any actions he might have taken from Jan. 1, 2014 through Jan. 20, 2025. But he said that doesn’t cover any actions since then, including any statements to Congress that may not have been entirely accurate.  

“A pardon may protect a person from criminal prosecution. It doesn’t rewrite history,” Paul said. “It does not erase documents. It does not convert a misleading statement into a truthful one.”

Paul said the committee will hold a vote next week to hold Fauci in contempt for declining to answer questions under a subpoena. 

“There will be repercussions to your refusal to testify today,” he said. 

A member of Fauci’s legal team, seated beside him at the witness table, tried to speak several times but Paul refused to recognize him before having U.S. Capitol Police remove that lawyer from the room. 

Paul then said for the record that Fauci would “still have the advice of the other half a dozen attorneys that he brought along today.”

Origins of COVID-19

Paul alleged during his opening statement that Fauci, who was the director of the National Institute of Allergy and Infectious Diseases when the pandemic began, didn’t give enough credit to theories the COVID-19 virus may have been created in a laboratory in China. 

He asked Fauci a series of questions about the pandemic and the types of research the federal government funded leading up to the outbreak. Each time, Fauci responded, “On the advice of counsel, I respectfully decline to answer, based upon my rights under the Fifth Amendment of the Constitution.”

Homeland Security and Governmental Affairs Committee ranking member Gary Peters, D-Mich., sought to remind his Republican colleagues that when he ran the panel, there was a bipartisan effort to look into the origins of the pandemic.  

“Rather than building on that work to strengthen our preparedness against future disasters, we are instead relitigating the past,” he said. 

Peters raised concerns that the country would likely face another pandemic at some point and that lawmakers should focus their efforts on the future, making sure public health agencies have the staff and funding they need. 

“COVID-19 exposed serious deficiencies in our nation’s public health infrastructure. We know that. More than one million Americans lost their lives and this committee should absolutely continue to examine how we can better prepare our nation against future biological threats,” he said. “Those are the kinds of forward-looking, life-saving questions that will help our nation be better prepared to protect the health and the safety of Americans when the next emergency occurs.”

Peters then sharply criticized the Trump administration, saying officials’ decisions on funding and staff have eroded the country’s safety net, including at the Centers for Disease Control and Prevention.  

“The administration has hollowed out the public health workforce,” he said. “They have fired, pushed out and cut funding for public health personnel, shrinking the CDC workforce by a quarter.” 

Fauci’s decision not to answer questions didn’t stop Republicans and Democrats on the committee from asking him questions and making lengthy statements throughout the three-hour hearing. 

Measles cases this year have surpassed all of 2025 to become the worst since the disease was declared eliminated in 2000, with cases now in 44 states and the District of Columbia, according to a federal report released Friday. 

There were 2,318 confirmed cases as of July 23, compared with 2,289 in all of 2025, with 93% of cases for both years being among unvaccinated people, mostly younger than 20. 

There have been fewer hospitalizations this year, 151 compared with 243 last year, and no deaths yet, compared with three in 2025. The highest number of new cases was in mid-January 2026, when there were almost 300 new cases. 

The largest number of current cases are in South Carolina (670), Utah (522), Texas (188), Virginia (176), Florida (141) and Pennsylvania (134). Except for Virginia, all those states have childhood vaccination rates below the 95% level considered necessary to prevent outbreaks among unvaccinated people as of the 2024-25 school year. 

Virginia’s statewide rate was 95.6%, but the measles outbreak was in two rural counties west of Richmond where measles vaccination rates are less than 75%. 

The last time national cases were higher than 2025 and 2026 was in the 1990s as national vaccinations were still ramping up, with 9,643 cases in 1991 and almost 28,000 in 1990. 

Most states now have childhood vaccination rates below the 95% level considered necessary to prevent outbreaks among unvaccinated people, including people who choose not to be vaccinated and small children too young for the shots. 

Oklahoma has a low childhood vaccination rate of 88.7% and saw 20 cases last year, but only one so far this year. A foundation has sent a mobile health van around the state to vaccinate thousands of children. 

Delaware declared a new outbreak this week. The state’s first measles cases in a decade climbed to five cases in a few days. The state’s child vaccination rate is 94.1%. 

“High vaccination coverage has protected even the unvaccinated and undervaccinated because of herd protection, keeping measles at bay for the past few decades,”  said Dr. William Moss, director of the International Vaccine Access Center at Johns Hopkins University, in a published statement. 

“But in communities with pockets of susceptible individuals across a broad age range, measles has been able to take hold, infecting those who are susceptible and spreading rapidly,” he said.

The center used its own measles tracker to declare more cases in 2026 than last year as of July 21. 

The Pan American Health Organization is scheduled to review the U.S. measles status in November and consider revoking “elimination” status as it did for Canada last year.  

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

WASHINGTON — Advocates and public health experts urged Republicans in Congress on Wednesday to implement a two-year delay on requiring states to begin sharing the costs for Supplemental Nutrition Assistance Program benefits. 

Provisions of the Republican-backed law that President Donald Trump signed last year that go into effect in October 2027 will require states with high SNAP error rates — the percentage of benefits that are overpaid, underpaid or go to recipients who are ineligible — to begin covering some of the program’s costs. It marks a stark change for SNAP, which is solely funded by the federal government. 

In an online briefing hosted by the left-leaning think tank Center on Budget and Policy Priorities, the American Academy of Pediatrics and Invest in Louisiana, speakers said Congress should use the government funding process to protect access to affordable food for American families. 

Sharon Parrott, the center’s president, said that Republicans are “looking right past this emergency” and using their current budget resolution to help farmers struggling with increased costs that have resulted from Trump’s tariffs and oil prices that have been driven up by the war with Iran — but not low-income grocery shoppers.

“Republican leaders in Congress are ignoring the urgent need to help low-income families and kids who are losing SNAP and can’t afford groceries,” she said. “Congress could use the budget process to help both farmers and families. At a minimum, Congress needs to slow down the hasty implementation of the massive cost-shift in SNAP costs to states.”

She said that since the GOP law, called the One Big Beautiful Bill Act, altered SNAP eligibility requirements, more than 4.5 million people have stopped receiving food assistance benefits. Nearly one-third, 1.5 million, are children. 

The nonpartisan Congressional Budget Office estimated the changes to SNAP would reduce federal spending by nearly $190 billion over the next 10 years.

Local leaders push back

Wednesday’s briefing comes amid similar calls from community organizations and state and local leaders from across the country. 

On Monday, the United States Conference of Mayors sent a letter to leaders of the Senate Agriculture Committee asking them to reconsider SNAP changes enacted over the last year and shifting funding to states. 

“At a time when many Americans continue to face economic challenges, we should be working to expand opportunity and food security, not create new barriers to assistance,” the letter, signed by more than 200 mayors, read. 

Senate Minority Leader Chuck Schumer said in a statement Monday that Republicans and Democrats must work together to draft a farm bill that restores SNAP and protects funding for food assistance. 

Schumer added that he will not support any farm bill that does not provide states more time to prepare to shoulder the program’s costs. 

Time is running out to get a cost-shift pause through Congress. 

The House is scheduled to adjourn Friday, and won’t be back in session until Aug. 31. Even then, it will just be back for a few weeks, before again adjourning for almost all of October. The Senate will adjourn after the first week in August and will similarly be out for the beginning of September and almost all of October. 

All about the error rates

The One Big Beautiful Bill Act will require most states with error rates of above 6% to cover between 5% and 15% percent of the benefits’ total cost. States under a 6% error rate will be exempt. 

But some states with the highest SNAP error rates — of about 13.3% or higher — will be given an extension to lower their error rates before being forced to bear some of the program’s costs. Depending on the error rate, the states will be granted up to an extra two years to begin sharing costs. 

“Congress can act right now to stop the bleeding and steer us away from this oncoming childhood hunger crisis by extending that same two-year delay to every state — not just the few that benefit from the existing carveout,” said Ty Jones Cox, the budget and policy center’s vice president for food assistance. 

States with the highest error rates in fiscal 2025 included Alaska at 23%, and Delaware and New Mexico both at approximately 16%, according to U.S. Department of Agriculture data. 

Cox said the center estimates nearly half of U.S. states will likely have to pay $100 million or more because of the cost-sharing changes. 

“These are huge costs,” she said. “States are working hard to reduce their error rates, but they’re up against the wall. The law didn’t give them any time or resources to do so.”

Cox said that states that plan to maintain SNAP benefits will have to find the funding from other places, if they are unable to generate more revenue. She said some states may choose to eliminate summer EBT or end universal school meals to continue funding the program. 

Given the steep costs, some states, such as Alabama, have floated the possibility of cutting their SNAP programs entirely if they are unable to lower error rates, Parrott said. 

Public health impacts

The effect of losing SNAP benefits extends beyond food insecurity, said Andrew Racine, president of the American Academy of Pediatrics. 

Besides clean air and water, and a supportive family and environment, he said, food is the most important determinant of a child’s health and future success. 

Racine added that the long-term benefits of SNAP are not being taken into account when decisions regarding its future are made. 

“The benefits of SNAP accrue to that child, accrue to that family, but they accrue to people around them,” he said. “[If] you have a child who’s not suffering from hunger in the classroom, and their ability to concentrate is improved, that has impact on their fellow classmates who are not on SNAP.”

The tiniest menace of summer doesn’t care if you’re hiking through the woods, walking the dog or pulling weeds in your backyard.

It just wants a ride and a meal.

As ticks spread into new parts of the country and emergency room visits for tick bites climb higher than usual, states are scrambling to monitor where the pests are showing up, what diseases they may be carrying and how to warn residents before a bite turns into something far more serious.

The federal Centers for Disease Control and Prevention reported in April that emergency department visits for tick bites were higher than expected across much of the United States and at their highest levels for that point in the year since 2017. 

In June, there were 112 tick-related ER visits per 100,000 people, compared with 110 per 100,000 during the same period last year, according to the CDC’s online tick bite tracker. That suggests this year’s summer trend may be in line with 2025.

Nationwide, the latest available data show an estimated 65 tick bite-related emergency department visits per 100,000 people, up from 47 per 100,000 last year. This year’s current figures are preliminary and subject to change, but if they hold, this year’s rate may be the highest since 2017.

Health officials say the trend reflects a combination of expanding tick populations, changing environmental conditions and increased human exposure during warmer months.

The concern extends well beyond Lyme disease.

The lone star tick, once found primarily in the Southeast, has steadily expanded its range and is known for its aggressive host-seeking behavior, often actively crawling toward people and animals. An adult female is distinguished by a white dot or “lone star” on her back.

The species has been linked to alpha-gal syndrome, an allergy that can cause people to develop severe reactions after eating beef, pork and other mammalian products. Researchers also continue to monitor ticks that carry Rocky Mountain spotted fever, anaplasmosis and other illnesses.

Tick surveillance by state health officials varies widely across the country. Some states maintain active surveillance programs that collect and test ticks to identify where disease-carrying species are becoming established. Other states rely more heavily on human disease reports or passive tick submissions, making it harder to detect changes before infections begin to rise.

Those differences can leave public health officials with an incomplete picture of how quickly tick populations are changing — and where people may face the greatest risk.

Several states, including Massachusetts, Missouri and Oklahoma, have expanded surveillance efforts in recent years or launched public education campaigns as tick habitats shift. All three joined the list of states that now or will soon mandate reporting of alpha-gal syndrome. Other states are studying the spread of lone star ticks and the increasing recognition of the syndrome, which experts believe remains underdiagnosed. 

Some experts say warmer winters in many parts of the country have allowed ticks to remain active for longer periods each year while expanding into regions where they were once uncommon. At the same time, growing white-tailed deer populations and changing land use have created more opportunities for people and ticks to cross paths.

Public health officials say the best defense remains preventing bites altogether. They recommend using insect repellents registered by the Environmental Protection Agency, wearing permethrin-treated clothing, including long sleeves and pants in wooded or grassy areas, checking people and pets for ticks after spending time outdoors and removing attached ticks as soon as they’re found.

For states, the challenge is becoming less about responding to tick season and more about adapting to a future in which, in many places, the season is lasting longer — and the tiny hitchhikers are turning up in places they never did before.

Stateline reporter Amanda Watford can be reached at awatford@stateline.org.

WASHINGTON — The Centers for Disease Control and Prevention announced Friday that public health officials have linked the ongoing outbreak of cyclosporiasis in five states to shredded iceberg lettuce from Taco Bell restaurants.

The fast food chain wrote in a statement that it plans to remove the “potentially impacted lettuce” from its “supply chain nationwide and will be replaced within 24 hours in select states.”

“While no official advisory has been issued, we believe public health is a shared responsibility among restaurants, their suppliers, and authorities, and we are proud to have consistently acted quickly and proactively to protect our guests,” the statement said. “Taco Bell has taken precautionary action, and we encourage all relevant restaurants, retailers, and foodservice operators to do the same.”

The CDC statement said it had linked the ongoing outbreak to Taco Bell restaurants in Indiana, Kentucky, Michigan, Ohio and West Virginia. The statement didn’t say whether the lettuce was the cause of the severe gastrointestinal illness caused by a parasite in other states. 

Taylor Farms wrote in a statement that based on information from the U.S. Food and Drug Administration “Taylor Farms de Mexico is voluntarily removing all iceberg lettuce sourced from central Mexico.”

“While the FDA traceback is indicating a specific independent farm that represents less than 1% of the U.S.’s iceberg lettuce supply as the potential source of the outbreak, we have removed all iceberg lettuce from the region indefinitely,” the statement said. 

Taylor Farms added that none of their “salads or kits are associated with this outbreak.”

The CDC has confirmed more than 1,600 cases in 34 states since the outbreak began. Nearly 150 of those people were hospitalized, though no deaths have been reported so far. 

The CDC writes on a webpage about the outbreak that it expects the number of confirmed cases will continue to increase given the six-week “reporting lag between illness onset and case reporting to CDC.”

As federal officials consider whether to reclassify marijuana under federal drug law, a new study has found that more American teenagers seeking treatment for cannabis use disorder, known as CUD, are facing longer wait times before receiving care.

The study, published in the American Journal of Preventive Medicine, analyzed national data from more than 124,000 adolescent admissions to publicly funded substance use treatment facilities between 2012 and 2022. Researchers found that after several years of decline, the share of young people experiencing delays in accessing treatment increased sharply.

While overall adolescent cannabis use has leveled off or declined slightly over the past decade, some young people who use cannabis regularly develop CUD that requires treatment. 

About 11% of adolescents who use cannabis or marijuana develop CUD within a year, according to the study. With continued use, that risk rises to about 20%. Other research suggests that about 4.7% of adolescents aged 12-17 meet the diagnostic criteria for CUD, a condition in which marijuana use becomes difficult to control and begins interfering with daily life.

According to the study, nearly 34% of adolescents, defined as children aged 12-17, seeking treatment for cannabis use disorder in 2022 experienced an admission delay — defined as waiting several days to more than a month after their initial request for treatment. The authors noted that elevated wait times in 2020 through 2022 may partly reflect COVID-19-related disruptions to treatment services, as well as increased demand for care.

“Just to address these delays, it will require coordinated efforts across health care,” said Yiota Kitsantas, the lead author of the study. Kitsantas is a professor of biostatistics and epidemiology, and interim chair of the Department of Health Administration and Policy at George Mason University. 

“Having proactive screening in primary care and school settings could promote early identification and hopefully then ensure timely access to care,” Kitsantas said. 

The percentage of adolescents reporting delayed treatment represents a significant increase from a low of about 25% in 2015. Longer waits also became more common: The share of adolescents waiting a week or more peaked in the years following the COVID-19 pandemic, with about 5% waiting at least 30 days to enter a treatment facility in 2022.

Adolescents referred to long-term rehabilitation or intensive outpatient programs had significantly higher odds of experiencing delays compared with those entering acute detoxification services.

The study also found differences in treatment delays based on living arrangements and referral sources. Youth living with parents or guardians experienced longer waits than unhoused youth, while adolescents referred by health care providers faced higher odds of delays compared with those who sought treatment themselves.

Male adolescents had 11% higher odds of experiencing treatment delays compared with female adolescents. While older teens ages 15 to 17 accounted for most admissions, the increase in wait times from 2018 to 2022 was more pronounced among younger adolescents ages 12 to 14, according to the study.

Non-Hispanic white adolescents had 29% higher odds of experiencing an admission delay compared with Hispanic adolescents. Black, Asian, and American Indian or Alaska Native youth had lower odds of experiencing delays than their Hispanic peers, according to the study.

While moving marijuana from Schedule I to Schedule III could ease research restrictions, it would not immediately address local shortages or capacity issues within treatment systems. The potential shift also comes as states grapple with how to regulate increasingly potent cannabis products and address concerns about their potential links to cannabis use disorder and other public health impacts.

During this year’s legislative sessions, several states considered proposals to change or lower cannabis potency limits, though most did not advance.

In Connecticut, lawmakers reinstated a 35% THC cap on cannabis flower just weeks after removing it, citing concerns about the public health effects of increasingly potent products. And Oklahoma approved new packaging and labeling requirements aimed at preventing cannabis products from resembling candy or appealing to children.

Stateline reporter Amanda Watford can be reached at awatford@stateline.org.

WASHINGTON — President Donald Trump’s pick to lead the Centers for Disease Control and Prevention didn’t appear to secure the support needed to take over the public health agency during a lengthy and often tense confirmation hearing Wednesday. 

While Dr. Erica Schwartz told lawmakers on the U.S. Senate Committee that oversees health policy she would “never betray the science,” she didn’t seem to win the trust of Democrats or key Republicans needed to advance. 

Chairman Bill Cassidy, R-La., repeatedly questioned Schwartz about whether she would follow the example set by former CDC Director Susan Monarez, who testified last year that she was fired after refusing to pre-approve vaccine recommendations or fire career officials for no reason.

“We need unbiased leaders who make decisions based upon science, not politics or ideology, and are committed to protecting children’s health,” Cassidy said in his opening statement. 

More than two hours later, at the end of the hearing, Cassidy told Schwartz he believed administration officials had overprepared her and that some of her answers missed the mark. 

“I felt like you were always trying not to answer my question, which was disappointing,” he said. 

Cassidy, or any Republican on the committee where the party holds a thin 12-11 majority, could effectively block Schwartz’s nomination if Democrats unanimously oppose it.

Restoring trust

Schwartz, who worked as a Navy occupational medicine physician, earning the rank of admiral, and deputy surgeon general, testified that, if confirmed, she would work to rebuild the CDC’s reputation among all Americans. 

“My first priority will be restoring trust in public health institutions through radical transparency and unwavering scientific integrity,” Schwartz said. “As CDC director, my sacred responsibility is to provide the American people with public health guidance that is clear, honest and evidence-based.”

Schwartz said she would work to “modernize the CDC into a near real-time public health enterprise” while ensuring local, state and tribal governments become the “operational backbone of American public health.”

Schwartz testified in response to questions from both Democrats and Republicans on the Health, Education, Labor and Pensions Committee that she “accept(s) that evidence” that vaccines don’t lead to an autism diagnosis. She said mRNA vaccine “technology is safe and effective.”

Tracking abortions

Missouri Republican Sen. Josh Hawley asked Schwartz to look into the possible health implications for people who live close to a data center, saying his constituents regularly ask him about it and he doesn’t know what to tell them. 

Schwartz said she didn’t know whether the National Institute for Occupational Safety and Health, which is housed within the CDC, had done any research on potential data center health implications. If confirmed, she committed to working with Hawley and his staff to look into the issue. 

Hawley also asked Schwartz if she would ensure the CDC secures data from every state in the country on when and how abortions take place. 

“The CDC collects data on abortions that are committed in the United States of America through a system called the Abortion Reporting System,” Hawley said. “This system is voluntary, and so a number of states, not coincidentally large blue states, do not turn over any data, so that it’s difficult to get a picture of just how many abortions and under what circumstances are committed in this country.” 

Schwartz testified she would look into the issue if confirmed, adding that “abortion surveillance is absolutely a critical component of what the CDC is currently doing.”

“But I also want to also make sure that certain states are not conflating emergency services and hiding abortions in that emergency services case definition,” she said. “We need to make sure we’re pulling out true abortions and making sure that we’re really having clear case definitions regarding abortions, so the data is actually accurate.” 

Cyclosporiasis

Washington Democratic Sen. Patty Murray asked about the ongoing outbreak of cyclosporiasis and the CDC’s disease monitoring programs during her round of questions. 

Schwartz said she believed “that one of the core missions of the Centers for Disease Control and Prevention is tracking outbreaks domestically and also internationally.” 

Schwartz said she was unaware the Trump administration moved to make reporting of cyclosporiasis optional last year after Murray asked whether there would be “any scientific or medical justification for CDC having eliminated mandatory reporting of that parasite.”

“The CDC used to conduct surveillance on this very infection through a program called FoodNet, but in July of ’25, thanks to Trump, CDC made reporting on that illness optional,” Murray said. “Now we are here a year later, and we’re already seeing over 7,000 confirmed or under investigation cases and over 100 hospitalizations with no single cause having yet been identified.”

Schwartz didn’t commit to reinstating mandatory reporting of cyclosporiasis if confirmed to run the CDC, but said she would work with Murray and her staff to understand why that stopped and what the options would be moving forward.