An Argument in Favor of Competence

“Autism is totally out of control,” Donald Trump told reporters on Friday. “I think we, maybe, have a reason why.” (Röhn, Burns, & Paun, 2025).

The reason why, according to the brain trust hired by the arguably least competent U.S. Department of Health and Human Services (HHS) Secretary in American history?

Tylenol.

No…we’re not kidding.

One of the most popular analgesic over-the-counter medications is being blamed for the fact that, over 80 years after Dr. Leo Kanner first described a pattern of “abnormal behavior” as ‘early infantile autism” (National Autistic Society, n.d.), our government’s top healthcare agency is now peddling a fantastical story that taking Tylenol during pregnancy is what “can be associated with a very increased risk…” of new autism diagnoses in the United States (Christensen, Dillinger, & Tirrell, 2025). Not surprisingly, this claim is devoid of any facts.

If this pronouncement sounds far-fetched, that’s because the use of acetaminophen—one of the key ingredients in Tylenol—has been repeatedly studied since the release of the drug in 1955, particularly in pregnant women. In fact, there’s nary a substance, appliance, or even fabric that hasn’t been studied over the past century in an effort to identify the root causes of virtually every birth defect, genetic condition, chronic ailment, and neonatal ailment. Tylenol itself—arguably the most common pain reliever in the United States—has repeatedly faced scrutiny due to its ubiquity.

Monday’s disorganized pronouncement was made with either complete unawareness or discounting of findings from a study published just last year in JAMA Network that found no link between the use of acetaminophen and children’s risk of autism, attention-deficit/hyperactivity disorder (ADHD), or any intellectual disabilities (Ahlqvist et al., 2024).

What made the Ahlqvist study so important is not just that they repeated similar studies conducted since 1955, but did so on a national scale, including a population sample of 2,480,797 children born between 1995-2019 in Sweden, and was done using a full-match sibling control analysis (analyzing results of full siblings with the same parents) to determine if there were differences in outcomes between siblings.

There were not (Figure 1).

Figure 1 - Risk of Diagnosis by Age 10 by Exposure to Acetaminophen

Note: Ahlqvist et al., 2025

Looking at the crude rate across all subjects, Ahlqvist found that virtually no increased risk of children developing autism, ADHD, or an intellectual disability as a result of prenatal exposure to acetaminophen. The study’s authors go so far as to suggest that studies whose design did not utilize sibling controls likely found associations as a result of familial confounding—failing to take into account shared familial risk factors, including genetic factors, which are either difficult or impossible to account for using statistical adjustments (D’Onofrio et al., 2013).

In our current reality, however, none of these studies conducted by many of the world’s best medical scientists mean anything because it’s apparently more important to indulge the conspiracy theories of the least scientifically literate amongst us. Just last week, at a Senate oversight hearing on the mess at HHS, RFK Jr. essentially accused every physician, healthcare professional, and supporter of science of being bought and paid for by Big Pharma (Griffing, 2025).

The current HHS Secretary needs to deflect criticism away from himself because, increasingly, the American public doesn’t trust him (Austin Jr., 2025). According to an analysis by the Center for Infectious Disease Research and Policy, “only 39% of Americans have confidence that Kennedy is providing the public with trustworthy information regarding public health, while 60% lack confidence in him (Wappes, 2025).

Kennedy, long a vaccine skeptic, has a history of making both purposely misleading and scientifically false accusations against medical institutions, many of which were through the organization he ran from 2015 to 2023, Children’s Health Defense, which regularly targeted minority communities in attempts to stoke fears of vaccination (Berman, 2024).

Beyond his anti-vaccination screeds, Kennedy has also:

• Posited that COVID-19 was “ethnically targeted” to spare Ashkenazi Jews and Chinese people (Koenig & Shelton, 2023)

• Claimed that HIV didn’t cause AIDS, but party drugs do (Firth, 2024)

• Claimed that Wi-Fi radiation causes cancer (Glover, 2024)

• Claimed that 5G damages human DNA, causes cancer, and is being installed in order to carry out mass surveillance (Mostrous, 2020).

More damning, however, is that Kennedy has been given carte blanche to do whatever he wishes with little to no real pushback from Congress, where 52 Senators—all Republican—voted to confirm him.

Since then, Kennedy has embarked on a typically Trumpian campaign of instituting drastic changes to programming, staffing, offices, and services without considering the real-world implications of his actions. Since his inception, he has:

• Laid off thousands of employees across the various HHS agencies (Branswell et al., 2025)

• All but eliminated the communications department at the Centers for Disease Control and Prevention (CDC), including those that deal with Freedom of Information Act (FOIA) requests Chen et al., 2025)

• Gutted at least seven minority health offices, eliminating all or almost all of their workers, including directors (Constantino, 2025)

• Attempted to revoke $11 billion in funding for addiction and mental health care (Mann, 2025)

• Demanded that all vaccine studies include placebo controls despite vaccine studies already including placebo controls (Stein, 2025)

• Fired the entirety Advisory Committee on Immunization Practice (ACIP) and replaced them with hand-selected stooges (Schnirring & Van Beusekom, 2025)

• Demanded the retraction of a Danish vaccine study that demonstrated no link between aluminum in vaccines and autism (Fieldhouse, 2025)

• Fired the recently confirmed CDC director after she refused to fire career scientists or approve any recommendations made by an outside advisory panel with no scientific evidence or adequate science (King, 2025).

Every example of Kennedy’s virtually unrestrained power-wielding has resulted in not just the immediate outcomes—firings, funding cuts, and department shuffling—but in vast immediate and long-term consequences designed not to improve trust in the CDC and HHS (despite claims to the contrary), but to destabilize trust in our public health system to such a degree that it is functionally worthless. Our concern is how these actions will undoubtedly fuel health disparities.

RFK Jr’s repeated statements, actions, and decisions bring us around, again, to the reality that literally no reports, studies, or data released yesterday linking autism to Tylenol can be trusted to be scientifically rigorous, accurate, or reliable.

What we are seeing now is the result of decades of efforts on the part of Kennedy and others in the anti-vax space to rewrite history and dismiss scientific evidence fundamentally. His actions depend on the scientific illiteracy of two generations of adults who have rarely, if ever, experienced the true horrors of vaccine-preventable disease outbreaks. We have grown too comfortable believing that measles, mumps, rubella, chickenpox, smallpox, and other diseases, including polio, just “weren’t really all that bad.”

They were that bad, and anyone who thinks that they weren’t needs to visit one of the handful of countries where lack of access to vaccines has allowed them to remain active and devastate the lives of children and families.

And now, after demanding that scientists prove the link between vaccines and autism and coming up blank, our government has decreed that Tylenol is to blame.

What happened yesterday at The White House could be characterized as health misinformation, at best, and health disinformation, at worst, but either way, the true losers were the American public. To put it bluntly, “Are you gaslighting us?”

Disclaimer: PlusInc has received funding from the following industry partners: Genentech, Merck, Bristol-Myers Squibb, and Gilead Sciences. None of the funding received has come with any stipulations that PlusInc mention, market, or aid with the distribution of any specific products, nor have these funders either asked for or received editorial input or control over any publication issued by PlusInc.

Blackout: Draconian Cuts Imperil Health and Safety in the United States

The Trump Administration’s “Skinny Budget,” released on May 2nd, 2025, includes proposals to cut billions in annual federal spending on critical public health and disease data gathering, surveillance, and tracking in the United States, including cuts that will directly impact the lives of many of America’s most vulnerable populations.

The programs and centers the Administration proposes eliminating include (Payne, 2025):

• Those housed in the Centers for Disease Control and Prevention (CDC), such as the National Center for Chronic Diseases Prevention and Health Promotion, National Center for Environmental Health, National Center for Injury Prevention and Control, the Global Health Center, and the Public Health Preparedness and Response;

• Research housed within the National Institutes of Health (NIH), such as the National Institute on Minority and Health Disparities and the National Center for Complementary and Integrative Health; and

• Programs housed within the Substance Abuse and Mental Health Services Administration (SAMHSA), such as funding for harm reduction programs that have repeatedly been shown to reduce drug overdose deaths and the spread of infectious diseases through the sharing of syringes and smoking paraphernalia, and eliminating all funding for the Mental Health Programs of Regional and National Significance, Substance Use Prevention Programs of Regional and National Significance, and the Substance Use Treatment Programs of Regional and National Significance.

The proposed cuts follow prior cuts that included billions of dollars in federal grant funding allocated for data collection, surveillance, and disease tracking in the United States, including approximately $11.4 billion from the CDC and roughly $1 billion from SAMHSA. Many of these grants were created explicitly through the legislative process, meaning that these funds have been appropriated and allocated for specific uses. Several lawsuits are currently winding their way through various federal courts in efforts to restore Congressionally mandated funding.

The majority of the cuts proposed by this Administration are designed to remove federal funding from programs that “do not align with this administration’s priorities,” which demonstrably do not include ensuring the health and safety of vulnerable populations. The justifications provided for these cuts consistently and incorrectly accuse programs and funding of being duplicative, of engaging in illegal and/or unethical practices, and of committing the greatest sin: promoting diversity, equity, and inclusion (DEI). The cumulative effect is likely to result in a blackout for critical public health surveillance.

Moreover, many of the programs they would cut serve as the backbone to infectious disease testing, surveillance, and prevention in the United States. Due to the structure of our nation’s healthcare system and governance, each state’s respective departments of health and epidemiology receive significant funding from the CDC, NIH, and SAMHSA, which allows them to function and provide the services they are designed to provide. Congress allocates these funds to the respective federal departments and agencies, which then distribute them to individual states using a combination of formula-based and competitive grants. This model provides funding to states to conduct testing, disease surveillance, and outbreak tracking, as well as to provide services that they would otherwise be unable to provide due to their respective state budgets consistently failing to provide sufficient funding to support these activities.

The Skinny Budget proposal explicitly intends to eliminate that support, openly stating that these are activities that states should fund.

So long, and thanks for all the fish.

These cuts would, of course, hit the poorest states the hardest—states located primarily in the South, Midwest, and Mountain West—where testing, surveillance, and tracking have already been struggling, at best, and failing, at worst.

One of the best lessons learned from the COVID-19 pandemic and MPOX outbreak in 2023 was that, when properly funded, resourced, and staffed, disease surveillance and reporting can, in fact, work in the United States to prevent the spread of infectious diseases and avoidable deaths.

Those days, however, are over.

Sitting Secretary of Health, Robert F. Kennedy, Jr., has already exacted draconian job cuts within the various agencies under his purview, including (Gardner, 2025):

• Eliminating ~1/3 of jobs at the National Center for Chronic Disease Prevention and Health Promotion, including the wholesale elimination of the Office on Smoking and Health, Oral Health, Population Health, and some of the Reproductive Health divisions;

• The Office of Health Equity;

• The National Institute for Occupational Safety and Health (NIOSH);

• The Birth Defects Center;

• ~1/4 of the staff at the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention;

• ~1/3 of the staff at the CDC’s Injury Center;

• The Division of Environmental Health Science and Practice;

• The elimination of the partnership and health equity branch at the National Center for Immunization and Respiratory Diseases; and

• 81 staff from the Administration for Strategic Preparedness and Response.

The cuts perpetrated by this administration have already hit the states, resulting in the elimination or laying off of dozens of epidemiologists and data scientists (Mandavilli, Sanger-Katz, & Hoffman, 2025).

Essentially, this leaves the hen house unmonitored while the foxes gleefully attack.

Graham Mooney, a public health historian at Johns Hopkins University, put it best:

“If the U.S. is interested in making itself healthier again, how is it going to know, if it cancels the programs that helps us understand these diseases” (Stobbe, 2025).

We are entering perilous times, and it remains unclear how public health efforts in the United States will fare. Indeed, we can expect to see significant negative impacts in poor and minority communities, but those impacts are unlikely to remain contained within those communities: diseases spread beyond their initial bounds, and people will die.

The bigger question remains: how will we be able to save lives if we don’t know whose lives we’re trying to save?

Ideological Crusade Against DEI Will Yield Dire Consequences for Medical Research

“The tenets of DEI demand that you discriminate against white people by giving preferential treatment to other races,” said right-wing activist Robby Starbuck on Jordan Peterson’s podcast on February 2nd, 2025 (Jordan B. Peterson, 2025)

This conspiracy theory is the underlying sentiment being used by the current Trump Administration to justify its targeted actions against people of color, women and gender-nonconforming people, and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in the United States. Unfortunately, it will yield dire consequences for medical research…and undercut efforts to achieve health equity!

How these actions have played out across the federal government’s various agencies and throughout the medical and scientific research spaces has been both stark and shocking:

An analysis conducted by the chairs of dozens of boards at the National Institutes of Health (NIH) in March found that, of the 43 experts whose review board positions were eliminated without notice or reasons—scientists with expertise in the fields of mental health, cancer, and infectious disease—38 were female, Black, or Hispanic:

According to the analysis, six percent of White males who serve on boards were fired, compared with half of Black and Hispanic females and a quarter of all females. Of 36 Black and Hispanic board members, close to 40 percent were fired, compared with 16 percent of White board members. The analysis calculated the likelihood that this would have happened by chance as 1 in 300 (Johnson, 2025).

National Institutes of Health

Board members generally serve terms lasting five years; several members’ terms had just begun in the past year.

Beyond the firing of non-White males serving in the NIH, funding has also been stripped from dozens of NIH-funded research efforts, including those studying Black maternal and fetal health, as well as cancer and HIV. These efforts, according to the termination letters received by the researchers, are “antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness” (Hellmann, 2025).

“At HHS, we are dedicated to restoring our agencies to their tradition of upholding gold-standard, evidence-based science. As we begin to Make America Healthy Again, it’s important to prioritize research that directly affects the health of Americans,” said U.S. Department of Health and Human Services (HHS) spokesman, Andrew Nixon. “We will leave no stone unturned in identifying the root causes of the chronic disease epidemic as part of our mission to Make America Healthy Again” (Hellmann, 2025).

Similar to the justification for terminating non-White male employees, the underlying sentiment of this statement implies that any research efforts that seek to identify the root causes of why chronic diseases disproportionately impact minority populations are scientifically invalid, and that we should instead be generalizing research rather than investigating how to help those who bear the greatest impacts.

This is the “new normal” in the United States, and the impacts that the conspiracy-laden politics of revenge and white grievance will have on scientific research could potentially take a generation to correct and repair. Many of the scientists, themselves, have chosen to abandon the United States, quickly sliding into dysfunction, for safer pastures:

• Since the current administration began occupying The White House, universities in European nations have been opening their doors to scientists fleeing ‘censorship” and “political interference” (Kassahm, 2025a). So far, opportunities for relocation have been posted in Belgium, Canada, France, and the Netherlands (Duster, 2025), with other countries in active discussions on how to capitalize on the desires of U.S. scientists to leave the country.

…and these countries will have thousands of takers. According to a survey conducted the scientific journal, Nature, of the 1,608 scientists who responded to their poll question asking, “Are you a U.S. researcher who is considering leaving the country following the disruptions to science prompted by the Trump administration,” 75.3% (n=1,211) responded that they were considering doing so (Witze, 2025).

• Aix-Marseille University set up a program called “Safe Place for Science” (Mokhtarthu, 2025), which created 20 positions for fleeing scientists:

At a time when academic freedom is sometimes called into question, Aix-Marseille University is launching the Safe Place For Science program, providing a safe and stimulating environment for scientists wishing to pursue their research freely (Mokhtarthu, 2025).

This program received 298 applications in a month, of which 242 were deemed eligible, and included applicants from Johns Hopkins University, NASA, Columbia, Yale, and Stanford (Kassam, 2025b).

An article also published in Nature clearly defines what is occurring in the United States.:

Many countries have tried to emulate this model of science-led growth, and to stop the ‘brain drain’ of talent to better-resourced laboratories in the United States. Now, the actions of the administration run the risk of slowing, if not halting, that trend, as the country seeks to devalue scientific evidence in policymaking and attack the structures supporting the domestic knowledge ecosystem, including universities, libraries, and museums (Nature, 2025).

This type of exodus from scientific minds and expertise is called a “brain drain,” a term coined after World War II to describe the emigration of scientists and technologists to North America from post-World War II Europe. We are now seeing this again…but in reverse. The United States has long served as a safe haven for scientists and experts escaping political influence and authoritarian regimes across the planet; we are now the country to which they are fleeing.

Missing from many of these discussions is the very real concern of what this means for any data publications released during the current administration:

The current administration has made no efforts to hide that they will be actively directing and controlling the release of information from federal agencies and departments:

One of the first official actions under this administration was to immediately pause all external communications from health agencies, including social media posts, scientific reports, website updates, and Federal Register notices (Association for the Advancement of Blood & Biotherapies, 2025). This pause ordered all documents and communications to be reviewed by a presidential appointee before issuing, directed federal employees not to speak at any public speaking engagements, and required coordination with political appointees before corresponding with Congress or state governors.

Further evidence comes from Robert F. Kennedy, Jr., who has ordered the Centers for Disease Control and Prevention (CDC) and the NIH to disregard decades of scientific studies and findings in order to find the “environmental factors” that are “causing” the “autism epidemic” (Wadman, 2025).

Both incidents, along with a litany of other incidents of overt attempts by this administration to not only control the flow of information but to force research to be rewritten to comply with a conspiracy-driven ideology, raise troubling questions that have yet to be fully confronted:

Can anything put forth by the Trump Administration be considered trustworthy?

How can any data released during these troubling times be considered valid when this administration has made clear that only data that agrees with their worldview is acceptable?

For example, the CDC releases its annual HIV Surveillance Report, and its current year’s findings vastly differ from those of previous years.

What if demographic data are missing? What if states whose governments align with the regime receive glowing reports, while those that don’t receive black marks? After scientists have drafted their findings, how can we guarantee that the data has not been tampered with and altered to support the regime’s positions?

More importantly, how vast will the devastation be to our institutions and to public trust in them, particularly at a time when the regime has spent nearly a decade sowing conspiracy theories and disinformation against them?

We need to grapple with these questions and consider their implications for the future of equity research and our nation.

RSV Surveillance After the Pandemic and the Growing Risks to Life in Appalachia

Respiratory Syncytial (sin-SISH-uhl) Virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States.

In 2022, PlusInc published summaries highlighting the disparities in the incidence and mortality rates of RSV between various regions, states, and populations. In 2024, PlusInc, in collaboration with the Appalachian Learning Initiative (APPLI, pronounced like “apply”), will be focusing on highlighting the risks that RSV poses in the 13 states, 423 counties, and 8 independent Virginia cities that make up the Appalachian Region.

In our 2022 report, we highlighted the following trends:

• The incidence of RSV in the 2020-2021 RSV season—which generally runs from early August through late July—saw record low rates of antigen test detections and polymerase chain reaction (PCR) test detections for RSV in every U.S. Census Region except for South, which includes the following states: Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, and West Virginia. This historically low level of infections was likely the result of COVID-19-related pandemic shutdowns and the proliferation of public masking and social distancing policies.

  • The Midwest Region, which typically has the highest rates of detection out of any region, saw just 610.0 antigen test detections and 5,142.0 PCR detections.

  • By comparison, the South saw 3,220.0 antigen detections and 14,148.2 PCR detections during the same period.

    • This is likely due to the fact that many states in the Southern region began attempting to “return to normal” in 2021, after the first year of COVID-19-related shutdowns. These decisions to “normalize” were made in large part because of public and political outcries against what some believed to be “government overreach,” and were accompanied by legislative changes in many Southern states that highly limited the legal ability of state and local departments of health to enact public health protocols in response to disease outbreaks.

• The 2021-2022 season saw a resurgence of RSV across every region, with a total of 10169.1 antigen detections and 42,880.7 PCR detections, with the Midwest leading the nation with 42,880.7 PCR detections and the Northeast with the fewest, at 13,353.7.

  • The likely reason behind this increase was, again, a return to normal daily interactions and a move away from pandemic protocols.

After that initial disparities report, PlusInc continued to gather data about the disease and the following trends have occurred:

• The 2022-2023 season saw an explosion of new RSV detections across the United States, with a total of 14,129.1 antigen detections and 203,193.9 PCR detections, with the Midwest again leading the nation with 73,559.9 PCR detections, followed by the West with 67,286.2. The number of detections in the South continued to climb in that season with 36,023.3 PCR detections.

• In the 2023-2024, to date, the nation has seen 10,603.5 antigen detections and 148,382.1 PCR detections, with the Midwest again leading the nation at 48,710.6. This year, however, the South has already surpassed the 2022-2023 season, with 38,095.4 PCR detections, while both the Midwest and West regions are unlikely to reach the same levels as the year before (Centers for Disease Control and Prevention, 2024a)

So—why are these data from the South so concerning?

10 of Appalachia’s 13 states—Alabama, Georgia, Kentucky, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia—are located in this region (Figure 1).

Figure 1 – United States Census Regions

Notes: Retrieved from the Centers for Disease Control and Prevention (CDC), 2023. (https://www.cdc.gov/surveillance/nrevss/downloads/us-census-regional.pdf)

When breaking down surveillance into the 13 states, we gathered data for the 2021-2022, 2022-2023, and 2023-2024 RSV seasons. The findings are troubling for a number of reasons:

• As is the case with all diseases, the states with the higher populations are going to have higher incidence numbers both because there are more people and because there are larger population centers with tighter population density.

• Georgia, North Carolina, and Tennessee are seeing incredibly concerning trends:

  • Georgia saw a 14% increase in PCR detections from the 2021-2022 season to the 2022–2023 season, and has seen a 45.4% increase in PCR detections this season, to date, above the previous season.

  • North Carolina saw a 279.4% increase in PCR detections from the 2021-2022 season to the 2022-2023 season, and has seen another 23.8% increase in PCR detections this season, to date, above the previous season.

  • While the overall incidence of RSV detections is traditionally low in Tennessee, the state still saw a 47.6% increase from the 2021-2022 season to the 2022-2023 season, and has seen another 54.5% increase in the current season.

However…the more concerning issue with the state of Tennessee lies a bit deeper and actually extends to the state of Alabama, as well:

An unusual trend has occurred in the current RSV season, where antigen tests in both Alabama and Tennessee are showing significantly higher detection levels than PCR detections for the same period of time. Normally, the antigen detections are lower than the PCR detections because PCR testing is more definitive. Essentially, the antigen tests can only determine if you have an active virus in the body and cannot detect small amounts of the virus or asymptomatic cases as accurately as PCR testing.

When we see a trend of antigen testing results being much higher than PCR testing results, it can mean a couple of things:

1. Finalized testing data may not be finalized for those periods. This may occur early in the report stages when the individual clinics and state agencies have either not received all of the data, there are duplicate data, or other issues with the data exist, or;

2. A more concerning issue exists where patients are testing positive for RSV using rapid test but are not following up those rapid tests with definitive PCR testing. This may be the result of lacking access to facilities that provide that testing, being unable to afford additional testing, being afraid or hesitant to follow up with confirmatory testing, or simply choosing not to proceed with additional testing for whatever reason.

Another dangerous trend is emerging in West Virginia:

When looking at the 2021-2022 RSV season, infections coincided with the start of the first full year of in-person school attendance during the second year of the COVID-19 pandemic, and essentially ending shortly after the New Year going into 2022. In the 2022-2023 season, infections didn’t really start to get going until late September, again trailing off after the New Year going into 2023.

In the 2023-2024 season, however, RSV got a very late start, with infection rates not really spiking until early-November, and continuing to stay high throughout January. Across the state of West Virginia, anecdotal reports of respiratory illnesses are showing up all over social media and in school district Facebook pages. And, while the state may not have already surpassed the numbers from 2022-2023, many residents are concerned about that possibility, particularly in a state where vaccine uptake rates across all disease states are starting to see sharp declines (CDC, 2024b).

Aside from these trends, another risk is posed, particularly in Central Appalachian counties located in Kentucky, North Carolina, Tennessee, Virginia, and West Virginia: the terrible ravages that have resulted from drug addiction.

Since the mid-2000s, the rates of drug addiction and overdose deaths as a result of drug use have increased nationwide, and few regions have been more impacted than Central Appalachia. While finalized drug overdose data for 2022 have not yet been released by the CDC, West Virginia, Tennessee, and Kentucky occupied the first, third, and fifth spots for the highest rates of overdose deaths per 100,000 residents in 2021, at 90.9, 56.6, and 55.6, respectively. Unfortunately, due to changes in the CDC drug overdose reporting systems, access to previous surveillance reports and dashboards appears to have disappeared in the process of transitioning to the new systems. However, state-level reporting outside of the CDC appears to remain unchanged, which allows us to access older records.

Because these states and counties have experienced high rates of overdose deaths, as well as non-fatal overdoses and drug charge-related incarceration, the impacts of drug addiction tend to stretch far beyond the individual living with substance use issues. According to a 2020 interview with Katrina Harmon, Executive Director of the West Virginia Child Care Association, over 90% of children currently in West Virginia’s foster care system are there due to drug-related issues. However, the foster system isn’t the first choice for the Department of Child Protective Services; CPS always tries placing a child whose life has been upended by drug-related issues with a family member. This has led to a broad increase in intergenerational households, with children being raised by grandparents and great-grandparents, all of whom are particularly susceptible to RSV. These circumstances mean that children who attend school and pick up colds, flus, RSV, and other respiratory ailments then bring those illnesses home to their loved ones, which can result in entire families being all but incapacitated by disease with normally high survival rates.

These concerns are further complicated by growing reports, both scientific and anecdotal, about growing vaccine hesitancy and distrust of healthcare providers, particularly in Southern, Appalachian, and largely rural states (Vestal, 2023). While child-age vaccination rates decreased during the pandemic shutdowns and reduction of healthcare services provision, these rates have not returned to their pre-pandemic rates.

After vaccine requirements were legally instituted by federal and state governments for COVID-19, many states have begun to reexamine their own general vaccination requirements for children prior to attending schools. Prior to the pandemic, relatively few state-level bills related to vaccines were introduced. With the release of the vaccine in 2021, several states began enacting legislation preventing COVID-19 vaccine requirements, specifically, but also began looking at the possibilities of either eliminating or expanding exemptions to existing routine immunization requirements for students (Roth, 2023).

As the RSV continues, we will continue to monitor national, regional, and state-level surveillance as we work to raise attention about.

Patients Have a Stake in Health Equity, too

In recent years, “health equity” terminology has become increasingly used in the national conversation about healthcare in the United States. Health equity is often used interchangeably with another term, health disparities, although each one has its own unique meaning. According to the U.S. Centers for Disease Control & Prevention (CDC), “Health equity is when everyone has the opportunity to be as healthy as possible. Health disparities are differences in health outcomes and their causes among groups of people. Many health disparities are related to social determinants of health, the conditions in which people are born, grow, live, work and age.” (CDC, 2020) To achieve greater health equity, our healthcare infrastructure needs to identify the health disparities that exist in the United States, and how they can vary from one health condition or another.

In 2016, a multimodal survey of mayors and health commissioners was conducted by Jonathan Purtle, et al. and it yielded some interesting findings. First of all, less than half of the mayors and health commissioners contacted took the time to complete the survey — which in and of itself, is a sad indictment on how those officials prioritize public health in their respective jurisdictions. That aside, Purtle reported, “Forty-two percent of mayors and 61.1% of health commissioners strongly agreed that health disparities existed in their cities. Thirty percent of mayors and 8.0% of health commissioners believed that city policies could have little or no impact on disparities.” Not surprisingly in today’s political climate, ideology is strongly associated with opinions about disparities. (Purtle, 2018)

Maybe part of the problem is the terminology, health equity and health disparities, is not defined explicitly. Nearly a decade ago, Paula Braveman, MD, MPH warned, “Ambiguity in the definitions of these terms could lead to misdirection of resources.” Dr. Braveman outlined the why explicit definitions are needed, because “not all health differences are health disparities” (Brakeman, 2014).

Health disparities exist, as defined by Dr. Bravemen through a social justice lense, and they are getting worse. Whereas numerous organizations committed to health equity exist, none approach health disparities specific to health conditions from the patient perspective. This is why PlusInc exists.