The problem has gotten particularly acute with a recent wave of misinformation. And when Francis Collins led the National Institutes of Health, the world’s premier medical research agency, he thought he had a solution: to study health communications broadly. “We basically have seen the accurate medical information overtaken, all too often, by the inaccurate conspiracies and false information on social media. It’s a whole other world out there,” he said in 2021 as part of a farewell media tour.

“I do think we need to understand better how — in the current climate — people make decisions,” he concluded.

But Collins’ hopes appear dashed. In a sudden reversal, the NIH’s acting director, Larry Tabak, has paused — some say killed — the planned initiative, Advancing Health Communication Science and Practice. Its advocates fear the agency has, for political reasons, censored itself — and the science that would’ve sprung out of this funding stream.

The agency has offered shifting and inconsistent explanations, sometimes outright contradicting itself in the space of days. Sources familiar with the project insist that whatever the agency’s official story, it has acted unusually, contrary to its normal procedures in deciding what science to fund.

The officials, both in and outside of NIH, believe the agency is acting in response to political pressures over misinformation and is effectively censoring itself. Efforts to study or push back on inaccurate information have become contentious. The Republican-controlled House of Representatives repeatedly has plunged into the issue by investigating social media firms and government agencies for their efforts to regulate online speech. They’ve even targeted academics who merely study information flows online. Meanwhile, in July, a federal court in Louisiana issued a decision on a long-simmering lawsuit brought by a group of Republican attorneys general and anti-vaccine groups to block government officials from communicating with social media companies, with certain exceptions for national security and criminal matters. That ruling has since been stayed.

Even though the NIH has had to navigate political rapids for decades, including enduring controversy over stem cell research and surveys on the sexual behavior of teens, this is a particularly fraught moment. “It is caught up in a larger debate about who gets to decide what is truthful information these days,” said Alta Charo, a professor emerita of law and bioethics at the University of Wisconsin-Madison who has advised the NIH in the past.

For researchers interested in the topic, however, it’s a major loss. The program was deemed potentially so important that it would be supported through the agency’s Common Fund: a designation for high-priority programs that cut across normal institutional boundaries. In theory, it would study how health communication works, not merely at an individual doctor-to-patient level, but also how mass communication affects Americans’ health. Researchers could examine how, for example, testimonials affect patients’ use of vaccines or other therapies.

Serious money was on the table. The agency was prepared to spend more than $150 million over five years on the endeavor.

For researchers, it’s a necessary complement to the agency’s pioneering work in basic research. The NIH has “done a remarkable job discovering the way cells communicate with each other,” said Dean Schillinger, a researcher at the University of California-San Francisco. “When it comes to how people communicate to each other — doctors to patients, or doctors with each other — the NIH has been missing in action.” Now, he said, the tentative efforts to reverse that are met with a “chilling effect.” (Schillinger co-authored an opinion piece in JAMA on these developments.)

After favorable reports from an agency’s advisory body last fall, advocates were anticipating more encouraging developments. Indeed, the NIH’s budget had touted the concept as recently as March. And participants expected the grant application process would begin toward the end of the year.

Instead, researchers have heard nothing through official channels. “Investigators have been asking, ‘What’s the plan?’” said Schillinger. Officially, “it’s been the sound of silence, really.”

That has been a puzzling anticlimax for a program that seemed to have all the momentum. “Given the urgency of misinformation, you would expect — within a year — a formal announcement,” said Bruce Y. Lee, the executive director of the City University of New York’s Center for Advanced Technology and Communication in Health.

Advocates and sources involved with the process had been pleased with its progress leading up to Tabak’s sudden reversal. After Collins publicly floated the concept in late 2021, the agency took some public steps while defining the project, including holding a workshop in May 2022, keynoted by Collins.

Later that year, the project’s leaders presented the concept to the agency’s Council of Councils, a group of outside researchers who provide feedback on policy initiatives and projects. It got a warm reception.

Edith Mitchell, an oncologist at Thomas Jefferson University Hospital in Philadelphia, said the agency had a “major task, but one that is much needed, one that is innovative.” The council gave the proposal a 19-1 seal of approval.

Researchers were happy. “As far as I was concerned, this program had been funded, accepted, and approved,” Schillinger said. (The agency says that it is “not unusual” for programs not to move forward but that it does not track how frequently programs get affirmative votes from the council and later don’t move forward.)

That smooth sailing continued into the new year. In March, the program was mentioned in the NIH budget as one of the agency’s potential projects for the coming years. Then, say sources in NIH and elsewhere in government, came Tabak’s sudden decision in April, which was not communicated to some researchers until June.

Early that month, Schillinger said, he received a call from an NIH official saying, “The program has been killed.” Program officers were reaching out to academics who had made prior inquiries about the initiative and potential research efforts that could garner grants. Schillinger said researchers were told, “You’re not getting an email” from the agency.

A former White House staffer and two current NIH officials — who were granted anonymity because they didn’t have permission to speak on sensitive matters — said the decision, which came as researchers and agency officials were preparing to open grant applications in the last quarter of the year, was made by Tabak. KFF Health News asked Tabak for an interview but instead got an answer from agency spokespeople.

The agency disputes any final decision about this research funding that has been made. Spokesperson Amanda Fine told KFF Health News the project was “still in concept phase” and is “being paused to consider its scope and aims.”

But the agency lists the health communications proposal on the “former programs” part of its website, and sources inside and outside of government disagree with this company line. They point to political fears on NIH’s part as driving the change, which reflects the growing political controversy over studying anything related to misinformation, even though the proposal was set up to examine health communications broadly, not solely misinformation.

A hint of this reasoning is contained in the rest of Fine’s statement, which notes the “regulatory and legal landscape around communication platforms.” When pressed, the agency later cited unnamed “lawsuits.”

That’s likely a reference to the Louisiana case, which was decided weeks after the agency decided to pause or kill the Common Fund initiative.

Fine later offered a new explanation: budgetary concerns. “We must also balance priorities in view of the current budgetary projections for fiscal years 2024 and 2025,” she wrote.

That explanation wasn’t part of a June 6 note on the program page, and one NIH official confirmed it wasn’t part of previous discussions. When pressed further about the agency’s budgetary position — which analysts with TD Cowen’s Washington Research Group think will be flat — spokesperson Emily Ritter said, “The NIH does not have a budget projection.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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New Orleans Emergency Medical Services has been busy this summer, responding to heat-related emergency calls and transporting patients to nearby hospitals.

At the city’s main ambulance depot, the concrete parking lot seemed to magnify the sweltering heat, circulating the air like a convection oven. Capt. Janick Lewis and Lt. Titus Carriere demonstrated there how they can load a stretcher into an ambulance using an automated loading system. Lewis wiped sweat from his brow as the loading arm whirred and hummed, raising the stretcher into the ambulance — “unit,” in official terminology.

But mechanical assistance isn’t the best thing about the upgraded vehicles. “The nicest thing about being assigned a brand-new unit is it has a brand-new air conditioning system,” Lewis said.

The new AC is much more than a luxury for the hard-working crews. They need the extra cooling power to help save lives.

“The No. 1 thing you do take care of somebody is get them out of the heat, get them somewhere cool,” Lewis said. “So the No. 1 thing we spend our time worrying about in the summertime is keeping the truck cool.”

Like much of the country, New Orleans has been embroiled in a heat wave for weeks. As a result, New Orleans EMS is responding to more calls for heat-related conditions than ever before, Lewis said. During the third week of July, the city’s public EMS crews responded to 29 heat-related calls — more than triple what they handled during the same period last year.

Scientists say dangerous heat levels — and the stress they put on human bodies and medical systems — will likely keep increasing. Health systems nationwide face serious funding and staffing challenges that could make it harder to keep up.

New Orleans EMS is no exception. In April, it reported operating with only 60% of its needed staff. The city’s chief of EMS has called for increased funding for higher wages to attract more workers. Local private ambulance services like Acadian Ambulance Services pay staffers between $50 and $70 per hour. The city’s EMS department can’t compete.

Lewis said they’re making do with the resources they have and prioritizing one-time expenses like new ambulances to help them meet the challenges they’re facing.

“We’re going to provide the care everybody needs, regardless of how hot it gets,” Lewis said. “We’d love to have all the help in the world, but we’re getting the job done with what we have right now.”

When a human being is exposed to high levels of heat for too long, their core body temperature rises. Once core body temperature exceeds 100 degrees Fahrenheit, hyperthermia can develop. If not quickly addressed, that can prompt an escalating cascade of health problems.

The first stage is heat exhaustion, Carriere explained: “That means you’re hot, you may have an elevated temp, but you also have what’s called diaphoresis, which means your body is sweating, is still trying to compensate and cool yourself off.” You’ll also likely have other symptoms like weakness, dizziness, or a headache.

Carriere said that if a person can quickly get out of the heat and into an air-conditioned place, generally they’ll recover from heat exhaustion on their own. Otherwise, their core temperature will continue to rise.

As internal body temperature approaches 104 degrees, people start to suffer from heatstroke.

“Once you move to heatstroke, your body stops compensating,” Carriere said. “You stop sweating. You’re hot. You’re dry. And your organs are basically frying themselves from the inside out.”

When a person stops sweating, it becomes even harder for the body to cool itself down. During heatstroke, people may experience other severe symptoms like an altered state of mind, confusion, and a rapid, erratic pulse. They may even lose consciousness.

Without medical intervention, heatstroke can be deadly. EMS responders start treatment immediately after they arrive on the scene. “We’ll get them on a gurney, get them into the unit, start removing their clothing, and put ice packs wherever applicable to try to cool them down,” said Carriere.

Once a heatstroke patient is loaded into the ambulance, the crew races them to a nearby hospital, Carriere said. At University Medical Center, New Orleans’ largest hospital, doctors and nurses will continue efforts to quickly lower the person’s body temperature and replace fluids by IV, if necessary.

“When the patient ends up at the hospital, we’re going to continue that cooling process,” said Jeffrey Elder, medical director for emergency management at UMC. “We’re going to put them in an ice water bath,” and, he added, “we may use some misting fans and some cold fluids to get their body temperature down to a reasonable temperature while we’re supporting all the other bodily functions.”

Getting a patient’s core temperature down as quickly as possible is what will ultimately save their life. One way doctors can speed that along is by burying a patient in ice. In some parts of the country, doctors have placed patients inside body bags prepacked with pounds of ice. Body bags are especially useful in these cases because they are waterproof and designed to closely fit the human form.

UMC’s emergency room doesn’t use body bags, but during the summer staffers keep bags of ice ready at all times.

“On the stretcher, we’ll use some of the sheets as kind of a barrier,” Elder said. “And while they’re on the stretcher, we’ll just put the ice on them right then and there.” Hospital staffers will continue to work to cool a patient down until their temperature gets below 100.

Elder said that while it always gets hot in New Orleans during the summer, his emergency room has been treating more heat-related illnesses in 2023 than ever before. A few patients have died from the heat. UMC has been struggling with staffing challenges since the beginning of the pandemic, just like many other hospital systems elsewhere. But to prepare for an influx of patients with heat-related illnesses, UMC has prioritized staffing of the emergency department, Elder said.

Across the country, meteorological events like heat waves and heat domes will become more frequent and intense in the future, according to the Centers for Disease Control and Prevention.

“Extreme summer heat is increasing in the United States,” said Claudia Brown, a health scientist with the CDC’s Climate and Health Program. “And climate projections are indicating that extreme heat events will be more frequent and intense in the coming decades.”

Health infrastructure will be challenged to keep up to treat patients suffering from extreme heat exposure. In New Orleans, both first responders and doctors say they expect to see more patients with heat-related illnesses.

“We haven’t even gotten to the hottest part yet, which is typically August to September,” said Carriere. “So I’m expecting it to get pretty bad.”

This article is from a partnership that includes Gulf States Newsroom, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Kids can also become dizzy, lose consciousness, and suffer dangerous drops in blood pressure. In the most severe case he’s seen, doctors put another boy on a ventilator in the intensive care unit because he couldn’t breathe, said Marino, of Case Western Reserve University School of Medicine.

Thousands of kids a year are exposed to the liquid nicotine in e-cigarettes, also known as vapes. For a toddler, even a few drops can be fatal.

Cases of vaping-related nicotine exposure reported to poison centers hit an all-time high in 2022 — despite a 2016 law, the Child Nicotine Poisoning Prevention Act, that requires child-resistant packaging on bottles of vaping liquid. In what doctors call a major oversight, the law doesn’t require protective packaging on devices themselves.

Refillable vapes are designed to hold liquid nicotine in a central reservoir, making them dangerous to kids, Marino said. Even vapes that appear more child-resistant — because their nicotine is sealed inside a removable cartridge — present a risk, because the cartridges can be pried open. And some disposable e-cigarettes, now the top-selling type on the market, allow users to take thousands of “puffs” and contain as much nicotine as multiple packs of cigarettes.

Many e-cigarettes and liquids seem designed to appeal to kids, with pastel packages, names such as “Candy King,” and flavors such as bubble gum and blue raspberry. That makes vapes far more tempting — and hazardous — than traditional cigarettes, which have lower doses of nicotine and a bitter taste that often prompts children to quickly spit them out, said Diane Calello, the executive and medical director of the New Jersey Poison Information and Education System.

“Nicotine liquid is an accident waiting to happen,” Calello said. “It smells good and it’s highly concentrated.”

Sen. Richard Blumenthal (D-Conn.), who co-sponsored the 2016 legislation, said he would push to expand the childproof packaging requirement to disposable and pod-based e-cigarettes.

“Every day that FDA allows flavored e-cigarette products to remain on the market is another day that children can be enticed by these dangerous, and sometimes deadly, products,” he said.

Although the FDA declined to comment for this article, on Aug. 2 the agency included a special feature about nicotine poisoning in children in its “CTP Connect” newsletter.

The number of reports to poison control centers about e-cigarettes has more than doubled since 2018, according to an FDA analysis. Poison control centers reported more than 7,000 vaping-related exposures in people of all ages from April 1, 2022, to March 31, 2023.

According to the FDA, 43 of those exposures resulted in hospitalization and an additional 582 in other medical treatment. About half of poison center reports had no information about whether patients needed medical care.

Nearly 90% of exposures involved children under 5. Authors of the report say their numbers likely underestimate the problem, given that poison control centers aren’t contacted in every case.

A 1-year-old died from vaping-related nicotine poisoning in 2014. The new FDA report also mentions the apparent suicide of an adult via e-cigarette poisoning.

A spokesperson for the vaping industry said companies take safety seriously.

“All e-liquid bottles manufactured in the United States conform to U.S. law,” said April Meyers, the president of the board of directors and CEO of the Smoke-Free Alternatives Trade Association, which represents the vaping industry. “Not only are the caps child-resistant, but the flow of liquid is restricted so that only small amounts can be dispensed.”

Yet many vaping products are made outside the U.S., which has recently been flooded with illegal e-cigarettes, mostly from China.

The increasing number of nicotine exposures among kids — especially curious toddlers who put virtually everything they can grab into their mouths — likely reflects the sheer volume of e-cigarette sales, said Natalie Rine, the director of the Central Ohio Poison Center at Nationwide Children’s Hospital.

E-cigarette unit sales grew 47% from January 2020 to December 2022, rising from 15.5 million every four weeks to 22.7 million, according to a report published by the Centers for Disease Control and Prevention.

“This isn’t something that parents see as a really big risk,” Marino said. “But with the popularity of e-cigarettes, the risk isn’t going away anytime soon.”

One effective strategy to reduce e-cigarette sales has been to ban flavored products. California, Massachusetts, New Jersey, New York, Rhode Island, and Washington, D.C., have banned all flavored e-cigarettes, while Utah and Maryland have banned some flavors. A study showed overall e-cigarette sales dropped 25% to 31% in states after flavor bans, compared with states that didn’t ban them.

Some doctors say the country needs to do more to protect children.

“If the numbers are rising, then the law ain’t working,” said Carl Baum, a professor of pediatrics and emergency medicine at Yale School of Medicine.

Pediatrician Gary Smith said the lack of child safety requirements for e-cigarette devices is a major problem. Refillable e-cigarettes are relatively easy for kids to open.

Although most poison control center reports don’t include brand information, disposable e-cigarettes — including Elfbar, Puff Bar, and Pop Vape — were some of the most common products mentioned in the FDA analysis. Elfbar is now known as EB Design.

Expanding the federal law to include devices would be “an important step,” said Smith, president of the Child Injury Prevention Alliance, an Ohio-based advocacy group that works to prevent injuries in children.

In addition, federal officials should limit the nicotine concentration in vape juices to make them less toxic, as well as ban candy-like flavors and colors on packaging, Smith said.

“The public health response should be comprehensive,” Smith said.

Kids have been known to pick up a vape and begin puffing, in imitation of their parents, Calello said.

Even if children don’t inhale the aerosol, sucking on a vape exposes their skin to nicotine, which can be absorbed into the bloodstream, said Robert Glatter, an assistant professor of emergency medicine at Lenox Hill Hospital in New York City. Glatter noted that e-cigarette liquids also contain numerous harmful chemicals, including arsenic and lead, which is toxic at any dose; carcinogens such as acetaldehyde and formaldehyde; and benzene, a volatile organic compound found in auto exhaust.

Fortunately, children who inhale nicotine get a much lower dose than those who ingest it, reducing the risk of serious harm, said Marc Auerbach, a professor of pediatric emergency medicine at Yale School of Medicine.

Only about 2% of exposures in the FDA study were recorded as having a moderate or major effect.

That may be because little kids who get into dangerous liquids — from vape juice to household cleaning products or gasoline — usually spill most of it, Baum said. “They often end up wearing it rather than swallowing it,” Baum said.

Although Stephen Thornton has seen a lot of children with nicotine exposure, he said, the human body has ways of protecting itself from toxic substances. “Fortunately, when kids do ingest these e-cig nicotine products, they self-decontaminate. They vomit — a lot — and this keeps the mortality rate very low, but these kids still often end up in emergency departments due to all the nausea and vomiting,” said Thornton, an emergency medicine physician and medical director of the Kansas Poison Control Center.

The FDA urges parents and guardians of young children to keep e-cigarettes and vaping liquid out of reach and in its original container.

For emergency assistance, call Poison Help at 800-222-1222 to speak with a poison expert, or visit poisonhelp.org for support and resources.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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By the mid-1970s, India’s smallpox eradication campaign had been grinding for over a decade. But the virus was still spreading beyond control. It was time to take a new, more targeted approach.

This strategy was called “search and containment.” Teams of eradication workers visited communities across India to track down active cases of smallpox. Whenever they found a case, health workers would isolate the infected person then vaccinate anyone that individual might have come in contact with.

Search and containment looked great on paper. Implementing it on the ground took the leadership of someone who knew the ins and outs of public health in India.

Episode 2 of “Eradicating Smallpox” tells the story of Mahendra Dutta, an Indian physician and public health worker who used his political savvy and local knowledge to pave the way to eradication. Dutta’s contributions were vital to the eradication campaign, but his story has rarely been told outside India. To conclude the episode, host Céline Gounder and epidemiologist Madhukar Pai discuss “decolonizing public health,” a movement to put leaders from the most affected communities in the driver’s seat to make decisions about global health.

The Host:

In Conversation With Céline Gounder:

Voices From the Episode:

Podcast Transcript Epidemic: “Eradicating Smallpox” Season 2, Episode 2: Do You Know Dutta? Air date: Aug. 1, 2023 

Editor’s note: If you are able, we encourage you to listen to the audio of “Epidemic,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

TRANSCRIPT 

Céline Gounder: 

This season, the “Epidemic” podcast is about the eradication of smallpox in South Asia. And to understand the breakout public health strategy that ultimately made eradication possible, we’re taking a quick detour … to West Africa. 

[Nigerian music begins to play.] 

Céline Gounder: It was 1966 — and Bill Foege found himself in Nigeria. The young physician and epidemiologist from Iowa was a long way from home — but in good company as part of a team of health workers sent to the region by the CDC [the Centers for Disease Control and Prevention]. Their mission was to vaccinate as many people as possible to stop smallpox. 

They traveled from one remote location to the next on electric bikes. [Electric bikes whir.] To coordinate the work and respond quickly to each new outbreak, they had two-way radios. [Radio static crackles.] 

[Music fades to silence.] 

Bill Foege:  On Dec. 4, 1966, I got a message saying, “I think we have smallpox. Could you come and look?” 

We went to the place, 8 miles off of a road, and it was immediately clear that the first person I saw had smallpox. And so, we started looking at: What did we have in the way of vaccine? 

Ordinarily, you would’ve done a mass vaccination campaign around the area. 

Céline Gounder:  At the time, the standard procedure was to vaccinate every single person in the region. But there was a problem: There wasn’t enough vaccine. Bill was still waiting on a big shipment. Without enough doses to vaccinate everyone, his team had to break protocol and get creative. 

Bill Foege:  We knew what we should do, but we couldn’t. So, at 7 o’clock that night, with maps in front of me, I divided the area and sent runners to the villages to see if they had smallpox. Twenty-four hours later, we got back on the radio [radio static], and now I could pinpoint the exact villages where there was smallpox. And we used the rest of our vaccine on those areas. 

[Music begins.] 

Bill Foege:  Much to our surprise, smallpox simply stopped in weeks. We just were so fortunate — so lucky that with our limited vaccine, we were able to hit the right people. And by July, we were working on the last outbreak in all of eastern Nigeria. 

Céline Gounder:  The health workers began to wonder: Could this approach also work in other parts of the world? The new vaccine strategy — the innovation that Bill and his team stumbled upon, out of necessity — came to be known as “search and containment.” 

That meant …  

First searching for anyone with an active case of smallpox. 

Then isolating the infected person. 

And finally, tracking down and vaccinating everyone that person had come into contact with. 

It worked in West Africa. Could it work in South Asia? 

[Music fades to silence.] 

Céline Gounder:  Getting locals there to adopt search and containment was going to take an ally, a leader with a big personality who knew the ins and outs of public health in India. Someone who could make things happen. Someone whose story you’ve probably never heard. 

Yogesh Parashar: Things look very rosy and very nice in a textbook. You never get the feel of what actually happened, how much sweat it entailed, what blood it entailed. 

Céline Gounder: I’m Dr. Céline Gounder and this is “Epidemic.” 

[“Epidemic” theme music plays then fades to silence.]  

[Music begins.] 

Céline Gounder:  By 1973, countries from Nigeria to Brazil to Indonesia had recorded their final cases of smallpox. But in India, the campaign to end the disease was still grinding along. The population was roughly 600 million people — and the goal to vaccinate every single person in the country was daunting. 

Epidemiologist Bill Foege was older now — in his late 30s — and leading the CDC’s global program to eradicate smallpox. 

He turned his attention to Bihar, a state in eastern India. It was the biggest smallpox hot spot in the world. There, Bill found an ally and a good friend in another physician, a man named Mahendra Dutta. Mahendra was in charge of the smallpox eradication program in Bihar. 

[Music fades to silence.] 

Yogesh Parashar:  He had a booming, loud voice. 

Céline Gounder:  That’s his son Yogesh Parashar, a pediatrician living in Delhi. 

Yogesh Parashar: My father was known for his honesty. He would help people. He had that nature. 

Céline Gounder: Mahendra Dutta died a few years ago. And Yogesh was just a boy during the eradication campaign. But his father shared stories from his years in the trenches fighting smallpox. And there was no battle bigger — or more lifesaving — than persuading the vaccinators to change their way of doing things. 

After a decade of mass vaccination, smallpox raged on. Yogesh says his father could see that the strategy wasn’t working quickly enough to stop the virus. 

Yogesh Parashar:  The standard way of doing things is not going to get us anywhere. Being nice, doing the right way, is not going to get the disease away. 

Céline Gounder: It was time to try something new. But getting India to adopt search and containment would prove challenging. 

Yogesh Parashar:  People who were trained in the previous school of thought could never believe that smallpox could be got rid of in this strategy. 

Céline Gounder:  Luckily, Mahendra could be very persuasive. 

Yogesh Parashar: My father did all the dirty work. He got enemies also in the process, I’m sure he did, but that is what he did. 

[Music begins.] 

Céline Gounder:  Mahendra Dutta was a gifted political strategist who built relationships with magistrates and commissioners throughout his work in public health. He was an insider who moved comfortably through the halls of power in India. 

Once, over dinner and a glass of whisky — Chivas Regal, to be specific — a senior official told Mahendra to come to him in the future if he ever needed a favor. Later, when it was time to build support for search and containment, Mahendra knew exactly how to cash in on that promise. 

Yogesh Parashar:  My father gifted him the Chivas Regal. 

“Now do you remember? You had told me that if I need any help, I should come to you. And here I am asking for help now.” This is how he did it. 

Céline Gounder:  You might call it “Dutta diplomacy.” 

[Music fades to silence.] 

Céline Gounder: Using charm and his extensive personal network, Mahendra recruited a staff of workers dedicated to the new strategy of search and containment — instead of trying to change the minds of people invested in the old ways of doing things. 

Yogesh Parashar:  So, practically, a parallel health system was set up. 

Céline Gounder:  The stakes were high. 

Yogesh Parashar:  Any outbreak was an emergency, because if you don’t move within hours and contain it, you do not know how many contacts will be there, how much it would spread, and your work would increase exponentially. 

[Suspenseful music begins.] 

Céline Gounder: Instead of waiting for smallpox cases to be reported, the workers headed out into the community to look for them. 

Bill Foege:  At first, we went and we talked to the village headmen, the teachers, and some children. And gradually, we went from that to actually going house by house in every village. 

Céline Gounder: But some cases were still falling through the cracks. 

Bill Foege:  And so, we developed secondary surveillance teams who would go around to the markets with a smallpox identification card. 

Yogesh Parashar:  There were WHO [World Health Organization] cards, which had photographs of cases of smallpox, their face, their body, and so on. So, the people would go out and ask the students, ask the people in the market, “Have you seen such a person with this kind of an illness?” This was one way of actively searching. 

Céline Gounder:  Everyone was willing to help. 

Yogesh Parashar:  The vehicle driver would also ask. Why would the foreign epidemiologist ask? The vehicle driver will talk in the local language: “OK, I’m looking for this.” They will tell him, “Yes, this is here.” 

Céline Gounder:  And, as soon as a case was identified, a team of containment workers would spring into action, isolating the patient, tracking down their recent contacts, and vaccinating anyone they could have transmitted the virus to. 

[Suspenseful music fades to silence.] 

Céline Gounder:  By 1974, the scale of the smallpox surveillance operation was gigantic. Over 100 million households across India were visited every single month in the search for active cases. Over 130,000 field workers were mobilized. 

Bill Foege:  At that point, we were having 1,500 new cases of smallpox a day in Bihar. 

Céline Gounder:  To manage all these moving pieces, the workers documented their efforts meticulously. 

Bill Foege:  I mean, you can’t imagine the millions of forms that we had. We had forms for everything. Forms for the containment team, forms for the assessors, forms for the watch guards. 

I often said, “We’ve just buried smallpox in forms.” 

Céline Gounder:  Search and containment was working in Bihar. Mahendra and Bill could finally see a path to eradication. 

Then, they hit a very public stumbling block that threatened to derail their work. 

[Sound of bomb exploding.]  Céline Gounder:  In May 1974, journalists from all over the world flooded into the country to cover a major news event. 

Here are a few lines from a New York Times article from that time. 

[Voice actor reading a headline from the May 20, 1974, edition of The New York Times. An audio filter gives it a grainy ’70s newscaster’s sound. Typewriter sound effects play.]  

Newscaster:  India conducted today her first successful test of a powerful nuclear device. The surprise announcement means that India is the sixth nation to have exploded a nuclear device. 

Céline Gounder:  The code name for the nuclear bomb test was Operation Smiling Buddha. And with it, the country joined a short list of superpowers. All eyes were on India. 

[Dramatic music begins playing.] 

Céline Gounder:  And … those international journalists on the hunt for interesting things to report came across another big story: Smallpox cases appeared to be exploding. 

Bill Foege:  And then suddenly the newspaper articles come out saying, here’s India working on nuclear weapons and they can’t even control smallpox. 

Céline Gounder:  In actuality, the new search-and-containment strategy was just a lot better at uncovering cases of smallpox. 

But those glaring headlines — accurate or not — put the eradication program in the spotlight. 

[Dramatic music fades to silence.] 

Céline Gounder:  Indian health officials were worried. And they threatened to pull their support for search and containment. 

The famous Dutta diplomacy was about to be put to the test … 

Bill Foege:  The minister of health for all of India came to Patna, and Mahendra Dutta went to the airport to meet him. 

Yogesh Parashar:  He said, “I have to address a meeting, and it would be difficult to talk to you separately. So why don’t you get into my car?” 

Céline Gounder:  During the ride, the minister of health told Mahendra that he was on his way to a press conference to announce that the smallpox program would switch back to the strategy of mass vaccination. 

To Mahendra, giving up on search and containment meant giving up on their best shot at eradication. 

Bill Foege:  And that’s when Mahendra Dutta said, “Before you do that, you have one more thing to do.” And he said, “What’s that?” He said, “You have to fire me.” 

Yogesh Parashar:  My father tells the minister that “if we are going to follow vaccinating everyone, then I think I should give you my resignation.” 

Bill Foege:  And the minister was irate. He said, “Do you know who you’re talking to?” And he said, “I do. And that’s how important this is.” 

Céline Gounder:  Mahendra told him the latest figures. He explained how the team was finally slowing the virus — that things were coming under control. 

And the health minister listened. 

Yogesh Parashar:  And, within a few minutes, when they had reached the venue, the health minister was addressing the other officials, and he said, “OK, we have a new strategy of search and containment, which is very successful, has been tried in a number of countries, and we will bring forward this strategy and get rid of the disease.” 

[Triumphant music begins playing.] 

Bill Foege: All he did was praise the smallpox workers for what they had done, never said a word about switching back to mass vaccination. 

That’s how close we came, I think, to losing the program in India. And, of course, if we lost it in India, we lost it everyplace. 

Céline Gounder:  If India, with its population of over 600 million people, failed to stop smallpox, then the virus would have remained a threat to the entire world. 

Yogesh Parashar: My father has done the dirty job of saying what is to be said and got away with it. 

He diplomatically bought time, allowed the search and containment to go on and get “smallpox zero.” 

[Triumphant music fades to silence.] 

Céline Gounder:  While some of his American collaborators have been celebrated around the world for their work to end smallpox, Mahendra Dutta’s story — and his contributions — aren’t well known outside of India. 

But we managed to find this recording of his voice …  

[Brief pause.] 

Mahendra Dutta:  In public health, community approach, your conviction, your devotion, and team effort, that’s what matters the most. 

Céline Gounder:  That’s Mahendra Dutta in 2008, when he was in his late 70s. He and Bill Foege sat down together to reminisce about the history of smallpox eradication as part of a CDC event. 

The two old friends reflected on what they’d learned together. 

Bill Foege:  I think that’s the lesson of smallpox in India, that the team worked as a unit. It was a coalition in truth. 

Mahendra Dutta:  Devoted efforts, team efforts always matter in community health work.  

[Music begins playing.]  Céline Gounder:  Search and containment was one of the public health innovations that made eradication possible — that, and the collaboration among international health workers and local public health leaders. 

Here, we followed the story of Mahendra Dutta, but there were many names — thousands — working together toward a common goal. 

[Music begins.]  

Céline Gounder:  I have a friend who thinks about that a lot. Madhukar Pai is a community medicine physician, an epidemiologist — and he teaches global health. 

His big thing is he wants rich countries to stop trying to use their own lens to solve health problems around the world. He says that just doesn’t work. 

He’s calling for a “radical shift.” But … 

Madhu Pai:  It is hard to give up on power and privilege. No powerful person wants to ever give it up. 

Céline Gounder:  More from Madhu after the break. 

[Music fades to silence.] 

Céline Gounder:  Wiping out smallpox nearly 50 years ago required the skill of thousands of local people who are largely unrecognized in any history book — or podcast. 

Putting locals in the driver’s seat is one part of a growing movement to “decolonize” public health. 

That term might sound wonky. But Madhukar Pai, a professor of epidemiology and global health at McGill University [in Montreal], says decolonizing public health is exactly what’s needed to get to health equity around the world. 

But Madhu is frankly pretty pessimistic about the current system. 

Madhu Pai:  I sometimes wonder how the hell did we eradicate smallpox. I mean, today, I don’t think we would have. Honestly, if there was a virus like smallpox today, there’s zero chance of eradicating it. 

Céline Gounder:  So what was it about smallpox eradication that allowed us to do it? 

Madhu Pai:  I think those were simpler days, right? And then WHO said, you know what? Let’s just get all together and just help end this disease. That collaboration was unprecedented in smallpox. 

But I think it was, in the end, remarkable numbers of people, you know, essentially armies of community health workers, vaccinators, front-line staff, field workers. And that was a mobilization kind of an effort that I think we definitely tried to do during covid. But probably not as unified as we could have been. 

Céline Gounder:  We did try to do something like that. It was called COVAX. 

It was an alphabet soup of international groups — from Gavi to the WHO — that wanted to pool buying power and scientific resources. 

COVAX was an attempt to make sure that there was covid vaccine for the whole world. 

So … why did COVAX fail? 

Madhu Pai:  First of all, I think COVAX was conceived by “global north” white people, and it was conceived with all good intent, but essentially the “global south” was left behind even in the design of COVAX. Now that in essence is global health, right? That is, privileged people in the global north are constantly making decisions, thinking that we know best. 

Céline Gounder:  In case our audience isn’t familiar with that term, when Madhu says “global north,” that’s a shorthand for talking about wealthy industrialized nations. 

Madhu Pai:  Relying on the global north time and time and time again is doomed as an idea because we’ve seen there is no end to our greed and myopia and self-centeredness. 

Céline Gounder:  What would that have looked like? Centering international efforts to provide vaccines to low-income countries? 

Madhu Pai:  To me, centering on them rather than us and saying, “What do you need from us to succeed in your plan?” Right? “How can we be allies to you?” We need to get behind that and respect the desires and the aspirations of global south countries. 

If there is a new pandemic and there’s a new vaccine or medicine, that technology should be transferred very quickly. 

That’s what allyship genuinely is about. And that’s what our country should have done. We could … should have been allies as countries, right? We should have given the vaccine recipe. We should have helped out way better with the vaccine donation — the opportunity of a lifetime to be good allies. But we left it on the table. 

Céline Gounder:  If you had to give a grade to our global health response to covid, what would it be and why? 

Madhu Pai:  I would probably give it a “D” because I think, as humankind, we genuinely failed. There’s no reason at all so many people should have died. That’s inexcusable. The fact that 2.3 billion people, mostly in low-income countries, middle-income countries have not received even one dose is a very telling statement on how this all unfolded. That’s political failure. It’s got nothing to do with science, technology, or availability, or money. 

Céline Gounder:  So let’s say another pandemic hits us tomorrow. How is that gonna play out, then? 

Madhu Pai:  Exactly like it played out in covid, I do not expect anything different, honestly. Which is bloody sad, really. 

Céline Gounder:  You said before that the big global health programs have good intentions. So, what should they be doing differently? 

Madhu Pai:  Global health, as you know, is full of these examples where the global north person always gets the, you know, the shining credit and the medal on the wall. 

We need to kind of flip the switch and re-center global health away from this, what I call default settings in global health, to the front lines. Right? People on the ground. People who are Black, Indigenous. People who are in communities. People who are actually dealing with the disease burden. People who are dying of it, right? People who have actually lived experience of these diseases that we are talking about, right? Having them run it is the most radical way of reimagining and shifting power and global health. 

Céline Gounder:  As Madhu and I were talking, he reminded me about Bill Foege. He’s the American eradication worker from Iowa we already met in this episode. The one who worked closely with local partners like Mahendra Dutta. 

But near the end … he stepped out of the spotlight. 

I asked Bill about this: 

Céline Gounder:  You left India before smallpox was declared eradicated. And as I  understand it, that was important to you to no longer be in the country at the time. Why is that?  

Bill Foege:  I had the feeling that it should be an Indian victory. That foreigners should be happy and pleased that they had a chance to be part of it but don’t get carried away with being celebrated. 

Madhu Pai:  People like Foege are the exception in global health and not the norm. Finding ways to completely disappear and then center on people who really matter, I think is a, is a great gift. 

The ability to do Dr. Foege’s ego-suppression work, uh, allyship work, that’s where the next frontier lies. And I’m not sure if we are ready for it, right? Because it is hard to give up on power and privilege, right? No powerful person ever wants to give it up. 

Céline Gounder:  So if you had a call to arms to your colleagues about preparing for the next pandemic, what would you say? 

Madhu Pai:  Yeah, I would say, anything that is led by global south, anything that is led by communities, must be on top of the agenda because that is how this is all gonna work. 

So I don’t think climate change, or conflicts, or covid will be magically solved by global north institutions or individuals. So, de-center, de-center, de-center away from us, and be good allies to the global south. 

Everybody’s agreed that we gotta do better, you know, we’ve got to decolonize global health. But it isn’t meaningfully moving the needle in the right direction. Because when rubber hits the road, our allyship only goes so far as just talking about it, which is not allyship at all in the first place. 

[“Epidemic” theme music begins playing.]  

Next time on “Epidemic” …  

Bhakti Dastane:  We have to achieve “zeropox,” so it was our motto: “zeropox.”  

CREDITS   

Céline Gounder: “Eradicating Smallpox,” our latest season of “Epidemic,” is a co-production of KFF Health News and Just Human Productions. 

Additional support provided by the Sloan Foundation. 

This episode was produced by Taylor Cook, Zach Dyer, Jenny Gold, and me. 

Our translator and local reporting partner in India was Swagata Yadavar. 

Taunya English is our managing editor. 

Oona Tempest is our graphics and photo editor. 

The show was engineered by Justin Gerrish. 

We had extra support from Viki Merrick. 

Music in this episode is from the Blue Dot Sessions and Soundstripe. 

Audio of Mahendra Dutta via the Global Health Chronicles recorded at the David J. Sencer CDC Museum at the U.S. Centers for Disease Control and Prevention. 

We’re powered and distributed by Simplecast. 

If you enjoyed the show, please tell a friend. And leave us a review on Apple Podcasts. It helps more people find the show. 

Follow KFF Health News on Twitter, Instagram, and TikTok. 

And find me on Twitter @celinegounder. On our socials, there’s more about the ideas we’re exploring on the podcasts. 

And subscribe to our newsletters at KFFHealthNews.org so you’ll never miss what’s new and important in American health care, health policy, and public health news. 

I’m Dr. Céline Gounder. Thanks for listening to “Epidemic.” 

[“Epidemic” theme music fades to silence.] 

Bill Foege:  It was great to work with you then, and it’s great to hear you reminisce now. 

Mahendra Dutta:  I’m also pleased that I’d worked with you. 

Credits

Additional Newsroom Support

Lydia Zuraw, digital producer Tarena Lofton, audience engagement producer Hannah Norman, visual producer and visual reporter Simone Popperl, broadcast editor Chaseedaw Giles, social media manager Mary Agnes Carey, partnerships editor Damon Darlin, executive editor Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chiefChris Lee, senior communications officer 

Additional Reporting Support

Swagata Yadavar, translator and local reporting partner in IndiaRedwan Ahmed, translator and local reporting partner in Bangladesh

Epidemic is a co-production of KFF Health News and Just Human Productions.

To hear other KFF Health News podcasts, click here. Subscribe to Epidemic on Apple Podcasts, Spotify, Google, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“We didn’t even know germs caused disease back then,” said Kristin Lyerly, an obstetrician-gynecologist who lives in Green Bay.

Like undertakers and garbage haulers, obstetricians see the nitty-gritty of human existence that can be ghastly and grotesque. A fetus with organs growing outside its body. A woman forced to birth a baby with no skull to push open her cervix.

OB-GYN Anna Igler regularly performed abortions for medically indicated reasons before the Supreme Court overturned the right to abortion last year. She is beyond fed up.

“I’m at a different level with it now,” she said. “Part of me is so upset at people for sticking their head in the sand.” With her world inside a Green Bay hospital in turmoil, she said, she cannot fathom that people might be oblivious to the government’s incursion into their medical care. “So many people I’ve talked to have no idea what our laws are in our state.”

Even now, a year later, Igler said, expectant parents come into her office with the assumption that if their fetus has a lethal genetic disorder, like anencephaly or trisomy 13 or 18, they can end the pregnancy safely.

“They are shocked when I tell them they can’t,” Igler said, “and they are shocked when I tell them we are following the law from 1849.”

She was referring to the state’s original abortion law, which was passed before the Civil War, when women could not vote or own property. The law makes it a felony to perform an abortion at any stage of pregnancy, unless it would prevent the death of the pregnant person.

It had been some time since these women were together, and they were eager to compare notes. The certified midwife spoke on the condition of anonymity because she’s not authorized to talk to the media and is concerned about losing her job at a local health system. “My biggest issue right now is getting medication to end a pregnancy that has already passed,” she said. “I’m finding locally that pharmacists just won’t dispense the medication.”

She offered a rundown: One pharmacist told her patient that misoprostol, a drug that causes cramping to expel the pregnancy tissue, had expired. Another, at a Walgreens, simply canceled the order. A third said he needed preauthorization, noting, “It’s a $3 pill, and we’re not going to get preauthorization on a weekend.”

The midwife said she and physician colleagues in her practice have half-joked that they’d send a gift basket to one pharmacist in town she’d found who will fill their prescriptions for abortion pills.

Now, when a patient miscarries, the midwife said, “we warn patients that this might happen, and they are like, ‘But my baby is dead,’ and I tell them, ‘I’m sorry. I don’t know why, but a lot of pharmacists in Green Bay think it’s their job to police this.’”

A year into this new era of compulsory birth for most women with pregnancies, the dismay and disorientation of those first few months have settled into, if not acceptance or resignation, a kind of chronic fear. Obstetricians and gynecologists are fearful of practicing medicine as they were trained.

A recent survey by KFF pollsters of OB-GYNS in states with abortion bans found 40% felt constrained in treating patients for miscarriages or other pregnancy-related medical emergencies since the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision last summer. Nearly half of them said their ability to practice standard medical care has become worse.

The specter of felony charges and losing a medical license has led to futile exercises.

Under the Wisconsin abortion ban — and bans in at least 13 other states — physicians who cannot detect fetal cardiac activity should, in theory, not face criminal charges for prescribing pills for a medication abortion or performing abortions. But physicians here in Green Bay, and others interviewed in Madison, said they — and the litigation-averse hospitals they work for — are requiring patients whose pregnancies are no longer viable, or who have gestational sacs that do not contain an embryo, to return for multiple ultrasounds, forcing them to carry nonviable pregnancies for weeks.

Before Wisconsin’s abortion ban, Igler would typically use the ultrasound machine in her office to detect when a patient’s pregnancy had ceased. She would break the news to expectant parents there. In some cases, a patient wanted further ultrasounds and she would refer them to the fetal-imaging department. It might help with their grieving, and “I was happy to do that for them,” Igler said.

But her bedside ultrasound can’t record and save the images that Igler would now need to prove that her medical judgment was reasonable during a criminal prosecution, so she is compelled to send all her patients for additional imaging.

“It seems cruel to show a woman her nonviable, dead baby and then say, ‘Well, now I have to bring you over to fetal imaging so we can record a picture and you have to see it again,’” she said.

In March, Rep. Ron Tusler, a Republican who represents a rural swath of Wisconsin south of Green Bay, posted on Facebook, “Thank God for the Dobbs decision!” In response, a local resident asked, “If my non-verbal, non-ambulatory 14-year-old daughter is assaulted, should she be forced to carry?”

The exchange escalated into a confrontation. “Is her health jeopardized?” Tusler asked. “Is she unable to leave the state? Can she provide consent?”

In the torrent of vitriol, certain moments stand out. Igler was incensed at the callous response and jumped in, writing: “Are you a monster, Ron Tusler? Do you know what compassion is? Come the next election, you will feel the backlash of your inhumane and outdated views. Get your hands off women’s bodies and out of the exam room. I’m an obstetrician. I’m the expert, not you.”

Tusler shot back that Igler was “angry she can’t kill babies until and occasionally after birth” and asked whether “I’m a monster for stopping her.” He wrote, “Honestly, how many babies have you aborted? How much money have you made from it? Did your hospital harvest the bodies for stem cells?”

The lunchtime rush at the restaurant in Green Bay had eased, and the women stared at the Facebook post on Igler’s phone.

She shook her head in baffled amusement. “This doesn’t even make sense,” she said. “It’s a conspiracy theory. I make so much more money if people actually have their babies. And if I don’t give out birth control, I would make a lot more money.”

Those sitting at the table laughed at the absurdity.

The salad bowls were empty. Everyone had told their own abortion stories. Igler was forced to travel to Colorado after her baby, at 25 weeks, was ravaged by a viral infection; Lyerly had lost a pregnancy at 17 weeks and did not want to endure the trauma of a vaginal birth.

Some 22 million women living today have had an abortion. It doesn’t take much effort to find a few of them.

Igler has found a community of women to grieve with, in a Facebook group called “Ending a Wanted Pregnancy.” There are an untold number of other online groups.

“Politicians would like to believe we live in a perfect world where these things don’t happen,” she said.

The Wisconsin Legislature is one of the most gerrymandered in the country, according to Princeton University’s Gerrymandering Project. Republicans hold a majority in the state Senate and Assembly, and last month Senate Republicans voted unanimously to keep the 1849 abortion ban.

But a judicial alternative to restoring abortion rights has begun to unfold. In April, Janet Protasiewicz, an abortion rights supporter promoted by Democrats, won a seat on the Wisconsin Supreme Court, giving liberal justices a narrow majority and opening a path for a ruling on the legitimacy of the 1849 law. On July 7, a Circuit Court judge in Dane County, Diane Schlipper, appeared to doubt the validity of the pre-Civil War-era ban, allowing a lawsuit by Attorney General Josh Kaul, a Democrat, to proceed.

For now, Lyerly is driving across the border to work in rural Minnesota. “I want to practice medicine here,” she said, “but first we have to get rid of this law.”

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The Republican governor signed House Bill 2127 — known as the Texas Regulatory Consistency Act but dubbed the “Death Star” by critics — the same month the state saw at least 13 heat-related deaths amid a scorching heat wave that’s on track to break records.

The measure, heavily backed by business and building sectors, was designed to replace “the regulatory patchwork” of county and municipal rules across the state “with a single set of predictable, consistent regulations,” according to a fact sheet circulated by its supporters. That means cities would no longer have the authority to enforce local ordinances related to agriculture, natural resources, finance, and labor; and local protections against extreme heat, such as water break requirements, would be rolled back.

The group of about three dozen people stood in the early-afternoon sun and held signs that read “Working Shouldn’t Be a Death Sentence,” “Water Breaks = Basic Right,” and “People Over Profits,” sweating and squinting. In the nation’s capital, the heat index had already reached 91 degrees. But protesters were focused on the plight of employees working in their even-hotter home state, where the thermostat had been reaching triple digits.

Rep. Greg Casar (D-Texas), who organized this week’s protest, joined more than 100 other U.S. legislators in signing a letter urging acting Labor Secretary Julie Su to continue the development and implementation of federal standards for rest and water breaks to prevent occupational heat illness and death.

Casar, along with others in the group, including members of San Juan, Texas-based La Unión del Pueblo Entero and civil rights activist Dolores Huerta, didn’t eat or drink from 10:30 a.m. to 6:30 p.m., both to push for national action to reverse Abbott’s law and as a sign of solidarity with Texas employees, especially those who work outside.

“A basic thing like the right to a water break, a basic thing like being able to go to work and know that working is not a death sentence, is the baseline of what our democracy should be able to do,” Casar said, with sweat dripping from his forehead.

Huerta, 93, who worked alongside the legendary labor activist Cesar Chávez to create organizations like La Unión, reminded the crowd that in the 1960s farmworkers in California went on strike to protest poor and dangerous working conditions, including the lack of job security, bathroom access, and water during the day.

“This is such a cruel thing,” Huerta said.

A steady stream of lawmakers came by to express support for the rally, including House Minority Leader Rep. Hakeem Jeffries of New York and well-known progressives like Sen. Bernie Sanders (I-Vt.), Rep. Alexandria Ocasio-Cortez (D-N.Y.), and other members of “The Squad,” a small group of liberal House Democrats. And from California, another state in the midst of a heat wave, Democratic Reps. Katie Porter, who is running for the Senate, and Ro Khanna also made appearances. California is among those states that have rules in place to protect workers from extreme heat.

Rep. Joaquin Castro (D-Texas) was in attendance and challenged Abbott to spend a day without water. “One day in the governor’s mansion, the air-conditioned governor’s mansion, without water,” he said. “Or better yet, one day with the folks who are out in the fields, the folks who are out on top of roofs, the folks who are at construction sites.”

At the front of the crowd were Jasmine and Daisy Granillo, younger sisters of Roendy Granillo, a construction worker of Fort Worth, Texas, who died in July 2015 from heat exhaustion. He was 25 and was installing hardwood flooring in a house without ventilation. The temperature was in the high 90s, he was wearing extra layers of protection because of the chemicals in the wood, and his request for a water break was denied. “My parents were told that his organs were cooked from the inside,” Jasmine said.

On the day Roendy passed away, he told his sisters he would take them to the flea market when he came home from work. He didn’t come home. They’re now committed to making sure others don’t suffer from heat exhaustion as he did. “I know that a simple water break, a simple water break, could have prevented his death,” Jasmine told KFF Health News.

This is the second time Jasmine and her family have rallied for water breaks for outdoor workers. After her brother died, she and others pushed the Dallas City Council in 2015 to pass an ordinance establishing 10-minute rest breaks every four hours for construction workers. In 2010, Austin passed its own such rule. Abbott’s law, set to take effect Sept. 1, will dissolve those ordinances and prohibit local governments from passing similar ones.

The protesters gathered at the Capitol steps also said they worried that corporate interests would try to block the national rule from seeing the light of day. “They delay them as long as they can until they die a slow death, and we’re here today to make sure that doesn’t happen,” Casar said.

Taylor Critendon, a registered nurse who specializes in critical care at Ascension Seton Medical Center in Austin, attended the event to monitor the congressman’s vitals and keep an eye on the group’s well-being. She said she has been treating more patients because of heat exhaustion than before. “It’s definitely taking a toll on our community,” she said.

She emphasized that not drinking enough water while outside in hot temperatures can cause someone’s heart rate to rise and blood pressure to drop. Often, patients start to feel weak and faint and lose blood flow, she said, referencing the body’s internal mechanism to cool itself down. People shouldn’t wait to experience these symptoms before drinking water.

“When you’re thirsty, then you’re already farther down the line of dehydration,” Critendon said, explaining why outside workers need regular water breaks. “You can’t really wait until your body says, ‘Oh, I’m thirsty,’ because by that time it’s already late.”

Tania Chavez Camacho, president and executive director of La Unión del Pueblo Entero, also participated in the daylong hunger and thirst strike. The union has historically protected the rights of migrant farmworkers in South Texas but has more recently expanded to include others, such as construction workers.

“We’ve been here for just about an hour,” she said. “We’re sweating” and “it’s really, really hot,” she added. “Can you imagine what it is like for construction workers every single day?”

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The Biden administration continued a bipartisan, decades-long effort to ensure that health insurance treats mental illnesses the same as other ailments, with a new set of regulations aimed at ensuring that services are actually available without years-long waits or excessive out-of-pocket costs.

Meanwhile, two more committees in Congress approved bills this week aimed at reining in the power of pharmacy benefit managers, who are accused of keeping prescription drug prices high to increase their bottom lines.

This week’s panelists are Julie Rovner of KFF Health News, Anna Edney of Bloomberg, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Sarah Karlin-Smith of the Pink Sheet.

Panelists

Among the takeaways from this week’s episode:

• The Biden administration’s new rules to enforce federal mental health parity requirements include no threat of sanctions when health plans do not comply; noncompliance with even the most minimal federal rules has been a problem dating to the 1990s. Improving access to mental health care is not a new policy priority, nor a partisan one, yet it remains difficult to achieve.
• With the anniversary of the 988 Suicide & Crisis Lifeline, more people are becoming aware of how to access help and get it. Challenges remain, however, such as the hotline service’s inability to connect callers with local care. But the program seizes on the power of an initial connection for someone in a moment of crisis and offers a lifeline for a nation experiencing high rates of depression, anxiety, and suicide.
• In news about the so-called Medicaid unwinding, 12 states have paused disenrollment efforts amid concerns they are not following renewal requirements. A major consideration is that most people who are disenrolled would qualify to obtain inexpensive or even free coverage through the Affordable Care Act. But reenrollment can be challenging, particularly for those with language barriers or housing insecurity, for instance.
• With a flurry of committee activity, Congress is revving up to pass legislation by year’s end targeting the role of pharmacy benefit managers — and, based on the advertisements blanketing Washington, PBMs are nervous. It appears legislation would increase transparency and inform policymakers as they contemplate further, more substantive changes. That could be a tough sell to a public crying out for relief from high health care costs.
• Also on Capitol Hill, far-right lawmakers are pushing to insert abortion restrictions into annual government spending bills, threatening yet another government shutdown on Oct. 1. The issue is causing heartburn for less conservative Republicans who do not want more abortion votes ahead of their reelection campaigns.
• And the damage to a Pfizer storage facility by a tornado is amplifying concerns about drug shortages. After troubling problems with a factory in India caused shortages of critical cancer drugs, decision-makers in Washington have been keeping an eye on the growing issues, and a response may be brewing.

Also this week, Rovner interviews KFF Health News’ Céline Gounder about the new season of her “Epidemic” podcast. This season chronicles the successful public health effort to eradicate smallpox.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Nation’s “The Anti-Abortion Movement Gets a Dose of Post-Roe Reality,” by Amy Littlefield.

Joanne Kenen: Food & Environment Reporting Network’s “Can Biden’s Climate-Smart Agriculture Program Live Up to the Hype?” by Gabriel Popkin.

Anna Edney: Bloomberg’s “Mineral Sunscreens Have Potential Hidden Dangers, Too,” by Anna Edney.

Sarah Karlin-Smith: CNN’s “They Took Blockbuster Drugs for Weight Loss and Diabetes. Now Their Stomachs Are Paralyzed,” by Brenda Goodman.

Also mentioned in this week’s episode:

• CNN’s “Medicaid Disenrollments Paused in a Dozen States After Failure to Comply With Federal Rules,” by Tami Luhby.
• Abortion, Every Day’s “Why Are OBGYNs Being Forced to Go to Texas?” by Jessica Valenti.
• Politico’s “GOP Looks to Spending Fights for Wins on Abortion, Trans Care, Contraception,” by Alice Miranda Ollstein.
• KFF Health News’ “A Year With 988: What Worked? What Challenges Lie Ahead,” by Colleen DeGuzman.

KFF Health News’ ‘What the Health?’Episode Title: Another Try for Mental Health ‘Parity’Episode Number: 307Published: July 27, 2023

[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]