Well, July just flew by. August is here—bringing peak mosquito season, back-to-school bustle with lower vaccination rates, and,

unfortunately, Covid-19 and hand, foot, and mouth. Here’s what may impact your health, some communication tips

in our recent NEJM article, and, as always, some good news to start your week!

Let’s dive in.

Disease “weather” report

Covid-19

The summer Covid-19 wave is growing—especially in the South and West—but national levels remain relatively low compared to this time

last year. Infants under 6 months old are the most impacted right now, accounting for the highest rate of emergency room visits

for Covid-19.

How high will this wave get? No one knows for sure, but I wouldn’t be surprised if it passes last winter’s peak.

That season was mild, and many people haven’t been infected in a while, leaving them more susceptible to infections.

If you squint, overall hospitalizations are starting to increase, which makes sense given they still lag the early indicators like wastewater.

But each year we are getting fewer severe diseases in a step-like fashion. I expect this year to be no different.

Hand, foot, and mouth disease

Pediatricians and parents are anecdotally reporting more cases of hand, foot, and mouth disease than usual for this time of year.

It’s hard to confirm in the data, as this disease isn’t a “nationally reportable disease” (i.e., clinician and public health department

reporting not required). But among the few states that do track, like Maryland, New Jersey, and Virginia, reports are above normal.

People are also searching for it on Google more than usual.

• Who it affects: Most common in children under 5, but anyone can get it.
• Symptoms: Low-grade fever and red rashes on the hands, feet, and mouth, which can turn into painful sores.
• How it spreads: It’s very contagious for 7-10 days through saliva, mucus, sneezing, and stool.
• What to do:
  • Wash hands frequently
  • Disinfect shared surfaces
  • Keep sick kids home
  • Watch for dehydration, especially if sores make drinking water painful

Peak mosquito season is here

August marks the height of mosquito season—and with it, an uptick in local news about city/county spraying and human cases of

West Nile virus.

This is prime time for mosquito-borne diseases because mosquitos are cold-blooded and transmission is a bit like a chemistry experiment.

If it’s too cold (below ~16°C, or ~60°F), the mosquito life cycle slows down too much to spread disease.

Closer to the “magic temperature” of ~25°C (77°F), mosquitoes are happier—and diseases spread a little more easily mosquito to human.

What’s being done: Public health departments around the country are randomly testing mosquitos by collecting them in traps to give a good view of risk. If there are consistent positives, vector control units will then go to these areas and spray mosquito repellent in mass.

Is climate change making mosquito-borne illnesses worse? It depends. Diseases like Dengue are rising with climate change. But West Nile remains fairly stable. For more, check out our deep dive:

How to protect yourself: Risk of disease is low, but that doesn’t make mosquitos any less annoying.

While mosquito spraying is safe for humans and pets, it can exacerbate symptoms of asthma or other respiratory conditions.

It’s a good idea to try to stay inside during the spraying time. Also, in general, cover up with protective clothing (permethrin-treated is ideal), apply EPA-registered repellents (search tool here), and use screens on windows and doors. Turn on the AC, if you have it.

Vaccine Injury Compensation Program at risk. Let’s remember why we have it in the first place.

Last week, RFK Jr. announced his plans to “change” the Vaccine Injury Compensation Program (VICP).

No medical intervention is without risk, and vaccines—while overwhelmingly safe—can rarely cause serious adverse reactions.

If that happens, you can’t sue a pharmaceutical company directly. Instead, you must file a claim through the VICP,

which was established by the National Childhood Vaccine Injury Act (NCVIA) of 1986. Since its creation, the program has paid over $5.4 billion in awards, which turns out to be ~1 individual compensated for every 1 million doses.

The VICP has long been a target for vaccine skeptics, who argue that pharmaceutical companies should be held more accountable for alleged harms and that the program should compensate claims even when there’s no clear evidence that a vaccine caused the injury.

So, what’s the problem? Eliminating this program could backfire. In the 1980s, a wave of lawsuits from parents who believed their children had been harmed by vaccines drove up legal costs and pushed many manufacturers to abandon vaccine production altogether because it didn’t make sense for their bottom line. To ensure vaccines remained available while still providing a path to compensation, Congress created this no-fault system funded by a small excise tax on each vaccine dose.

The system isn’t perfect, but it strikes a delicate balance: compensating those who are harmed while ensuring continued access to lifesaving vaccines.

Can it be improved? Absolutely. Bipartisan proposals over the years have included:

• Hiring more reviewers and improving efficiency
• Raising the maximum compensation amount (unchanged for decades)
• Automatically applying the program’s excise tax to new vaccines without requiring congressional approval

RFK Jr.’s proposals, however, remain vague, and based on his recent actions in the vaccine world, it’s likely he’s looking to dismantle the system altogether.

What does this mean for you? Nothing yet. But if the VICP were eliminated, the future availability of vaccines could be at risk. We’re watching closely.

Vaccination rates in the past year have decreased in 20 states.

CDC just released kindergarten data from last year. There’s good and bad news.

Good news: On a national level, the number of kindergartners vaccinated against diseases, like measles, is still very high: 92.5%. This is slightly lower than last year (92.7%), but I don’t think it warrants the dramatic headlines I’ve seen.

Bad news: National vaccination rates don’t tell the whole story as outbreaks tend to occur at the hyperlocal level, where local vaccination coverage determines vulnerability.

State-level trends show wide variation in coverage, with 20 states seeing declines in the past year. Idaho, for example—which has the lowest MMR rate in the country—has dropped to 78.5% (from 79.6%). (For context: the herd immunity threshold is 95% for measles and 80% for polio.)

Multiple factors drive declining vaccination rates, but one is the rise in non-medical exemptions—parents opting out for religious or philosophical reasons. While still relatively low nationally (4.4%), in some states, these exemptions are increasing at an alarming pace with no signs of that trend slowing down. In Idaho, it’s up to 15.4% of parents opting out.

What does this mean for you? Expect more outbreaks of vaccine-preventable diseases leading to school disruptions, and heightened concern for immunocompromised individuals and parents of children who are too young to be vaccinated. If you’re up to date on your vaccines, you’re well protected. But with public health infrastructure increasingly under strain, response efforts may be slower and less effective.

Training health communicators: need for a new approach

In a not-so-shameless plug: Kristen Panthagani (YLE contributor), Katelyn Jetelina (YLE) and our co-authors Ted Melnick and Megan Ranney’s perspective piece on training the next generation of health communicators was published in the New England Journal of Medicine.

The top-down model of health communication is broken—people increasingly turn to informal sources like social media and (ahem) newsletters for their health questions.

Yet scientists, doctors, and public health professionals receive little to no training on how to communicate with the masses.

We dove into this world at the beginning of the pandemic out of necessity, but largely had to figure it out on our own—with very little support (and zero training) from academic institutions.

We need more credible voices in informal spaces and that means we need to train them in how to do it. (Katelyn is teaching a course at Yale in Spring 2025!) But in short, training needs to include:

• Distinguishing information dissemination from communication.
• Communicating scientific uncertainty and managing expectations.
• Using empathetic and engaging communication strategies.
• Leveraging interactive media for effective listening.

Read the full piece here, and tune in tomorrow for a chat with lead author Kristen Panthagani on Substack Live.

Good news!

• Big reprieve: In a bipartisan win (26-3 vote), the Senate Appropriations Committee rejected the Executive Branch’s proposed massive cuts to NIH and CDC for the FY2026. Instead, it supported a $400M increase for NIH. (Note: This isn’t finalized; it still has to go through the House and be passed by October, but it’s a huge positive sign for scientific discovery and infrastructure.)
• Exercise saves lives after colon cancer: In randomized trials across 55 research centers, post-chemo exercise programs for colon cancer patients improved survival by 37% compared to health education alone.
• Medicaid ruling: A federal judge blocked cuts to Medicaid funding for Planned Parenthood. The ruling ensures that 600 health centers in 48 states, serving over 2 million patients, can continue providing care.

Trivia

It’s peak summer, and we are all sweating. I just returned from Houston (who goes to Houston in August?) and it was… hot.

POLL Which of the following can actually make you feel hotter in a heatwave? Drinking hot tea Eating spicy food Taking a cold shower Wearing cotton

Scroll down for the answer.

Bottom line

You’re all set for this week! Have a healthy, beautiful summer day.

Love, YLE

Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife. YLE is a public health newsletter that reaches over 375,000 people in more than 132 countries, with one goal: to translate the ever-evolving public health science so that people are well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:

Authors: Katelyn Jetelina, Nicole Deziel, Megan Ranney, Elizabeth Frost, Brinda Adhikari

A few months ago, some of us in public health began having conversations with grassroots members of the Make America Healthy Again (MAHA) movement, facilitated by a mutual friend, journalist and co-host of the podcast Why Should I Trust You, Brinda Adhikari. Every month, she’s been hosting conversations, and several of us have been regular participants.

To MAHA, this moment in America is filled with opportunity and momentum. To many of us in public health, in contrast, it feels like a collapse—whether of budgets, infrastructure, or evidence-based public health practice. In public health, we often feel like we are stuck triaging: What can we save? What must we let go? What do we need to reimagine completely? It feels like plugging holes in a sinking ship with paper towels.

Our conversations began with curiosity and uncertainty. Nonetheless, we continue to show up, asking whether and how we can move from conversation to collaboration. Could we find common ground? Could this strange alliance (like so many alliances in public health) actually do some good?

To our surprise, we suspect that the answer is yes. Here are two stories of how and why.

Saving a Medicaid innovation program

Medicaid is best known for providing healthcare coverage. But since the 1970s, some states have taken it a step further asking: What if we used Medicaid not just to treat illness, but to prevent it? What if we addressed the root causes of poor health—like food insecurity—and in doing so, saved lives and money?

One morning, over coffee, I (Katelyn) came across an op-ed about a program on the chopping block. It wasn’t just another budget cut. This program used Medicaid funds to pay for groceries for high-risk patients—those with diabetes, heart disease, or other chronic conditions.

Why groceries? Because food is medicine. Give people access to healthy food, and you can lower their blood pressure. Improve their blood sugar. Reduce ER visits. It’s a simple idea with strong evidence behind it. And it was working.

Early results showed promising outcomes: better health, fewer hospitalizations, lower costs. It wasn’t perfect, but it was exactly the kind of innovation we should be fighting for. Instead, it was being dismantled.

I then connected with a MAHA grassroots leader to see if this was something they would champion. The person I was working with from MAHA wasn’t MAGA—a distinction that matters—but was deeply committed to local wellness and upstream solutions.

Together, we connected with the broader MAHA grassroots network in the state. We co-authored a short policy brief. And next month, we’ll walk into the state capitol together, side by side, meeting with lawmakers as a united front: public health meets grassroots wellness.

I still can’t quite believe it.

Investigating a toxic spill, together

A few states north, another unexpected partnership was forming.

In 2023, a train derailed in East Palestine, Ohio, releasing toxic chemicals into the air, water, and soil. The headlines eventually faded. But for residents, the concerns haven’t: fear of long-term health effects, distrust of environmental testing, anxiety, worsening chronic conditions, and the feeling that no one is truly listening.

I (Nicole) have long ties to eastern Ohio. Years ago, as a new professor, I brought students there to study fracking and its health impacts. We talked with farmers, community leaders, and residents. That work sparked a decade of research and relationships that far outlasted the initial project grant.

So when a new funding opportunity was announced to study the health effects of the East Palestine spill, it caught my attention. It required deep understanding of the issue and strong community engagement, and as I pored over data and measurements and articles, I quickly realized this was something that couldn’t be done from a desk in New Haven.

That’s when I got a surprising email. A few MAHA Ohio organizers had reached out to Brinda, who has spent time building relationships with them, to say folks in East Palestine were continuing to express concern and worry since the train derailment. Would Brinda want to do anything to further amplify or investigate their concerns? Brinda said she wanted to look into it and amplify this on her podcast. She then contacted Megan Ranney, Dean of the Yale School of Public Health, to see how they might want to be involved, and Megan flagged this opportunity for me. The ball was set in motion.

Elizabeth was planning a visit to East Palestine, OH and asked if I wanted to come along. They were going door to door, talking with residents and collecting insights. It wasn’t a press tour or a formal meeting. This was public health. And they invited me to join.

A week after that initial contact, I traveled to Ohio and met the team at a Subway in town. I wasn’t nervous to talk with people—that’s public health. But I’ll admit: I was worried about how my presence would be received—by both the community and MAHA. I’m from a northeast Ivy League university. I don’t necessarily talk like the community. I don’t always share the same views. Despite my Ohio connections, I worried: Would I be seen as an outsider? Would my expertise be considered out of touch? Would my academic background just emphasize institutions that have let people down?

Turns out, not at all.

It was nearly 100 degrees and humid. We knocked on about 50 doors, had real conversations with about a dozen residents, and heard stories that you’ll never get from a published study. One woman talked about her child’s worsening asthma. Another family showed us bottled water they had stacked in their kitchen, still afraid to drink from the tap. Several people spoke about their distrust of the existing data, and the worry that new research would yet again take advantage of them. They talked about how science could feel “extractive” unless paired with resources for the community.

MAHA approached these conversations not with clipboards, but with humility. They metaphorically, as well as physically, opened doors to researchers. And they approached conversations with me in the same vein, building connections between my work and theirs during our water breaks.

What I learned in just one day reshaped the research proposal I was developing—changing what questions we would ask, what resources we’d offer, and how we’d engage the community over time. Because the truth is: you can’t do responsive science from afar. Especially not in environmental health. You have to show up. Sometimes that means being present for a high-level briefing. Sometimes it means standing in someone’s driveway in 100-degree heat.

This wasn’t just data collection. It was relationship-building. And acknowledging and supporting the work of other teams like Ohio State University, plus government scientists and community workers.

And the person who helped make that possible wasn’t a federal agency official. Or a university partner. It was a member of MAHA.

That’s public health now, too.

(By the way, Brinda will be hosting a series of conversations on the WSITY pod tracking the work in East Palestine, elevating the stories and concerns of the stakeholders, and seeing where we can provide support.)

Reigniting public health roots

Public health isn’t just about technical expertise. It also requires relationships, humility, and a willingness to engage with stakeholders, even those who may oppose or challenge your work. It starts with listening and sharing ideas.

Public health takes all of us, and is for all of us. This alignment requires us to engage with folks who are doing and practicing public health in their own communities, with lived experience and moral urgency. Especially ones who can say, “I’m not a public health expert—but I am a mom, or a veteran, or a farmer, or a survivor, or a small business owner—and I know this program helped my neighbor.”

These new public health + MAHA + journalist partnerships are an extension of what public health has always tried to do, whether working to reduce opioid overdoses or childhood lead poisoning or car crash prevention. However, we recognize that people may not be aware of them and often feel excluded.

We don’t yet know the outcome of this particular policy battle or this particular research proposal. But we know one thing for sure: if we are successful, it will be because of unlikely coalitions—ones that defy the usual red-blue, urban-rural, expert-layperson divides.

And we’re hopeful that these examples, along with others’ work in cities and states across the U.S., can help remind us all of how and why we do this work. Together, we can advance the public’s health with good science, good communication, and most of all good action.

Bottom line

In a moment of so much uncertainty and division, the world needs odd bedfellows. This work isn’t easy. It’s slow. It’s uncomfortable. And it requires trust-building in a time when trust is in short supply. However, if the public’s health is to survive this moment—let alone thrive in the future—we need to lean in. Not just because we want to save a grocery benefit program. And not just because individuals deserve health answers about a toxic spill. But because this is what public health is: local, relational, collaborative.

And maybe—just maybe—more resilient.