A lot is changing in U.S. health policy, and New York is feeling the ripple effects. Changes are showing up in New Yorkers’ appointments, prescriptions, and prevention tools.

This week’s Dose covers disruptions to youth gender-affirming care in NYC, a vaccine access package moving through the state legislature, and an update on measles cases in Rockland County.

Gender-affirming care disrupted at NYC’s major hospitals: what the whole community should know

NYU Langone has closed its gender-affirming care program for trans youth, and Mount Sinai has reduced or cut some services, leaving families scrambling for alternatives.

For a lot of families, gender-affirming care isn’t an abstract policy, it’s part of daily life. It’s a standing appointment. A prescription refill that keeps things steady. A clinician who knows their child, their history, what’s worked, what hasn’t.

So when that care changes suddenly, it can be destabilizing, with families describing abrupt changes and referrals to private clinics.

And this isn’t a small slice of NYC. While we don’t have data available on the number of trans youth in NYC, we do have an estimate for adults. Based on NYC survey data, about 0.6% of NYC adults identify as transgender—roughly 50,000 people. If kids make up about 20% of NYC’s population, the back-of-the-envelope math suggests there may be at least 10,000 transgender youth in NYC, too.

Sexual and gender identification among NYC adults. Gender minority refers to individuals who identify with a gender identity other than cisgender, including transgender. Sexual minority refers to individuals who identify with a sexual orientation other than heterosexual. Figure from the NYC Epi Data Brief.

Why are there disruptions?

These stories are unfolding because federal funding cuts and regulatory pressure are disrupting gender-affirming care for minors across the country, including in New York.

The Trump administration has threatened to pull funding from hospitals and practices associated with hospitals that provide these services. They are also trying to end Medicaid coverage for gender-affirming care, which would mean that even if a family can find non-hospital-based care, they wouldn’t be able to access it if their insurance is through Medicaid.

I also want to call out some of the fear-based language in these federal documents.

Phrases like “sex-rejecting procedures” and “chemical and surgical mutilation” are meant to alarm and make people think of non-reversible treatments or “removing body parts.”

But that’s not what most families are facing right now. Most of the access being cut off is for puberty blockers—medication which pauses puberty and is reversible (when stopped, puberty resumes). Puberty blockers actually give families, children, and their clinical teams more time to make longer-term decisions. For a more detailed explanation, Those Nerdy Girls has a helpful post on puberty blockers.

It’s also worth putting surgery in context: a 2024 analysis of insurance data found that among minors aged 15–17, gender-affirming surgeries were rare—for every 100,000 minors, there were only ~2.1 surgeries.

The ray of light is that New York is pushing back.

The attorney general’s office told NYU Langone to resume care, noting the federal funding threats they cited aren’t currently in effect, and raising concerns the pause could violate state anti-discrimination law.

There is also a bill going through NY state legislature that would ensure that Medicaid covers gender affirming care in the absence of federal funding.

What this means: continuity of care is a health issue

For many families, “just go somewhere else” isn’t a real option—it’s waitlists, insurance challenges, travel across the city (or out of state), and clinical disruption piled onto a situation that can be stressful and sensitive. And when care gets interrupted, the ripple effects aren’t just medical, they also affect mental health, school, stability, and trust.

What to do: practical steps for families and caregivers

If your child is currently receiving care:

• Ask for a written transition plan that includes a timeline, prescription guidance, referral list, a record transfer process, and any important points of contact.

• Request copies of records now (visit notes, medication history, labs, etc.) and keep them for your records and for finding new care.
• Ask for prescriptions with plenty of refills if they are at a stable point in their care.
• Read this amazing piece by my friend MK that describes how to help kids feel emotionally safe during these uncertain times.
• Know these resources are available:
  • Trevor Project hotline for LGBTQ+ young people
  • Trevor Project’s Finding Support & Building Community Amid Political Uncertainty guide
  • Trans Lifeline
  • LGBT National Help Center
  • Organizations hosting in-person support spaces, including HMI, The Center, and The Black Trans Liberation Kitchen, among others
• Encourage hope. Here are some success stories you can share:
  • Society for Research on Adolescence: Trans Stories
  • Human Rights Campaign: Trans Stories are Everyone’s Stories: Daniel
  • The Trevor Project: Stories of Pride: Sophia

If you’re searching for care:

• The NYCHealthMap lists clinicians offering gender-affirming care for adults and youth (select LGBTQ Health Services > Gender Affirming Care >Youth).
• Connect with trusted local advocacy groups that often keep updated provider lists. Community Support Resources are listed on this NYC DOH Transgender Health page.
• When you call practices, ask directly: Are you accepting new adolescent/minor patients? What’s the wait? Do you take my insurance? What documentation do you need?

If you’re a clinician or educator:

• This is a moment to tighten safety nets: proactive check-ins, mental health supports, and warm handoffs are important.
• Don’t assume families have a backup plan. Encourage or help them set one up if possible.

At the end of the day, the most important things for kids affected right now are making them feel safe and maintaining access and continuity of care. This means steady and coordinated, not abrupt and fragmented.

Something to watch: a vaccine package going through the NY Senate

In response to the rapidly shifting federal vaccine landscape, New York State Senate Democrats are moving a package of vaccine-access bills through the state legislature this week.

Together, these seven bills would protect insurance coverage for vaccines regardless of changes in federal recommendations, expand who can vaccinate (like pharmacy techs, nursing students, and medical assistants), and ensure clinicians are reimbursed for the full cost of vaccination.

These bills still need to pass through the state assembly and be signed by Governor Hochul to become law, and the package could reach the Assembly as early as next week.

This isn’t about changing the science, it’s about protecting the infrastructure that helps maintain vaccine access in New York—insurance coverage, staffing, reimbursement—when federal guidance is actively damaging those systems.

Infectious disease “weather report”

Measles: Three measles cases were just reported in Rockland County, all international tourists visiting the county. Residents who were exposed to these measles cases have been notified and are being closely monitored.

Rockland County has had large outbreaks of measles previously—last year there were more than 20 cases, and in 2019 there were more than 300. The county has some pockets vulnerable to measles—in some zip codes, fewer than 50% of eligible infants are vaccinated, far below the 95% needed for community protection.

The best thing to do right now is check the vaccination status of everyone in your family, and get up to date if needed. If you’re unsure whether you or your child is immune, talk to your healthcare provider.

RSV: For the tenth week in a row, RSV remains quite high.

Who should pay extra attention right now because of RSV risks:

• Older adults
• People with chronic conditions
• Pregnant people (to protect newborns)
• Families with young infants

RSV cases in NYC. Figure from the NYC Department of Health Respiratory Illness Dashboard. Annotations by YLE.

What to do:

• Same as last week—if you’re eligible and haven’t gotten protected yet this season, it’s still worth doing because we have weeks ahead of us of elevated activity.
• Layer in protections when you can: avoid visiting newborns or older people when sick, mask in crowded indoor spaces, and keep an eye on breathing symptoms in little kids (fast breathing, retractions—when the skin sucks in around the ribs, collarbone, or stomach with each breath—or dehydration).

Flu: Across New York state and in NYC, flu cases have increased slightly. Flu is still relatively low compared to the season so far, but it’s something to keep an eye on.

New York state flu hospitalizations, this season and last season. Figure from New York state respiratory report. Annotations by YLE.

Covid: Covid cases are holding steady, while ED visits are going down. Overall, Covid remains low compared to previous winters.

Covid cases in NYC. Figure from the NYC Department of Health Respiratory Illness Dashboard. Annotations by YLE.

Bottom line

If you or your loved ones are affected by disruptions to gender affirming care, prioritize continuity (records, refills, and a written transition plan) and supporting mental health. For other community members, now’s the time to support the kids and families navigating these disruptions.

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health expert. This newsletter exists to translate complex public health data into actionable insights, empowering New Yorkers to make informed and evidence-based health decisions.

Somehow, it’s already March! And there’s a lot unfolding right now at the intersection of society and health. I’ve been especially thinking about Iranians—including my own family—and hoping we can all take a moment to listen, learn, and show support. If you’re looking for a place to start, I highly recommend the book All the Shah’s Men.

In the health world, we have flu hanging on, RSV making a surprisingly late appearance, and falling vaccination rates that will cost us more than most people realize. Plus, a reader question worth unpacking: Does the surgeon general actually need an MD?

Here’s what’s going on and, most importantly, what it means for you.

She grew up unvaccinated, she’s an immunologist, and she’s our colleague.

YLE’s own Liz Marnick published an op-ed in the NYT on Friday. I know I’m biased, but it’s a must read. Liz shares her story of growing up unvaccinated, hard conversations with her mother, and going on to study the immune system. And yet, when it came time to vaccinate her own child, she paused:

“In that one exhausted moment, what was loudest in my head was not the science I knew well. It was the stories I had heard growing up.”

Her message: shame doesn’t work. Please read it; it’s a masterclass in approaching this moment with empathy.

Disease “weather” report

This respiratory season just won’t quit. Flu activity is holding steady. One strain (flu B) is rising while another (flu A) is falling, and together they’re canceling each other out. That kind of plateau is unusual; most seasons follow a smoother up-and-down curve. But the timing isn’t surprising. In bad flu years, activity has stayed above epidemic levels well into mid-March.

Source: NREVSS

What is unusual is that RSV infections and hospitalizations continue to climb. It’s incredibly late in the season for RSV to show its teeth. Babies are most at risk.

What this means for you: It’s not too late to get your vaccines!

For RSV: If your infant received monoclonal antibodies (like Nirsevimab) this season, they’re likely still protected. Most monoclonal antibodies fade quickly, but the RSV ones were specifically engineered to last longer. Nirsevimab has a half-life of about 70 days—meaning the amount in the body decreases by half roughly every 70 days. Even so, studies show protective levels can persist for more than a year. So even doses given early in the season should still be providing coverage.

RSV NAb GMC through day 361 by treatment and medically attended, diagnostic-confirmed RSV infection. Source: Nature. Annotated by Your Local Epidemiologist.

AI tools aren’t ready to triage you… yet

People want more control over their own health. Health care is expensive, hard to access, and appointments aren’t always easy to get. There is a lot of promise for AI, and people are already using it for their health: 230 million people ask ChatGPT health questions every week. So if AI tools could reliably help people decide when to seek care, that would be a big deal.

But a new study suggests we’re not there yet.

Researchers published a study last week in Nature Medicine testing ChatGPT Health, a new consumer health AI tool, on a basic but critical task: triage. Given a set of symptoms, could it correctly tell you whether to stay home, schedule a routine appointment, get seen urgently, or go to the ED?

The results were mixed, and concerning at the extremes:

• For people who didn’t need a doctor at all, it sent them to one 65% of the time. A waste of time and money.
• For routine visits, it correctly recommended seeing a doctor 95% of the time.
• For people who needed emergency care, it only recommended the ED about half the time. It handled classic emergencies well, like allergic reactions or stroke, but struggled to recognize how sick someone was about to become, like the early stages of a diabetic complication.
• More detailed medical data improved accuracy, but adding irrelevant information confused it. For example, when normal lab results were included alongside a note that a patient was suicidal, ChatGPT got it wrong. That’s obviously deeply concerning.

What this means for you: For straightforward health questions, AI tools can genuinely help and can certainly supplement a visit with a clinician. Add more details for more accuracy, but proceed with caution and certainly do not use it for emergency health issues.

And so it begins: Hep B birth vaccine rates are going off a cliff

One of the biggest open questions right now is how far vaccination rates will fall in the current climate before they level off and begin to climb again. Tracking vaccination rates in the United States is surprisingly difficult because we do not have a single, centralized, easily accessible system like countries such as Denmark do. Instead, data are fragmented across states and systems.

Still, early numbers are starting to come in, and the picture is not encouraging.

A group of researchers analyzed de-identified medical records from 2016–2025 to track hepatitis B vaccination trends. They asked: How far have we drifted from the expected path?

It turns out, quite a lot. For every 100 live births, 10 fewer newborns received the hepatitis B vaccine than models predicted. The decline began in late 2024 and now appears to be accelerating. (Note: The study period ended before RFK Jr. made the unilateral decision to stop recommending the hepatitis B vaccine for all newborns. That means the downward trend will continue.)

Source: Rothman et al., 2026

This is unsurprising in a way, but very concerning. I would love to see the findings repeated using other data sources. Unfortunately, this research is brief, and the methods aren’t described in great detail. But clearly, we aren’t going in the right direction in protecting babies’ health and wellness.

What this means for you: Continue to follow the AAP immunization schedule, which includes the hepatitis B birth dose. If you have questions, talk to your pediatrician.

• If you’re navigating Hep B birth dose conversations with parents, what questions about routine immunizations are you getting? Do you believe this trend given what you’re seeing on the ground? Drop in the comments below.
• Remember, YLE has this one-pager that includes the recent routine childhood immunization changes and reminders on why we vaccinate for these diseases, like Hepatitis B, in the first place. Feel free to print and distribute!

	Vaccination Schedule Change-SPANISH 71.8KB ∙ PDF file
Download

	Vaccination Schedule Change- ENGLISH 67.2KB ∙ PDF file
Download

More measles = more economic cost

Infectious diseases mean people stay home sick and miss out on work, and health care bills are higher. They are also expensive for public health departments to combat. They’re not just a health problem. They’re an economic problem.

Thanks to a Common Health Coalition report, the U.S. now has economic numbers tied to declining MMR vaccination rates.

A 1% annual decline in MMR vaccination rates would lead to:

• More suffering. Specifically, more than 17,000 measles cases, 4,000 hospitalizations, and 36 preventable deaths each year.
• Major economic costs. On average, one measles case costs the U.S. health system $76,000. With the projected number of cases over 5 years, the estimated cost would be $1.5 billion. This breaks down to:
  • $41 million in medical costs (i.e., medical bills)
  • $947 million in outbreak responses (e.g., contact tracing, community outreach, surveillance)
  • $510.4 million in lost productivity and missed work costs

Childhood immunization is as essential to health system stability as it is to community health.

Source: Common Health Coalition

Importantly, this isn’t inevitable. It can be stopped. This report included solutions highlighting that everyone, from health insurers to health departments to clinicians, has a role to play.

What this means for you: As vaccine rates continue to decline, costs will be borne by you, your state, and your health insurance companies. Continue to urge your insurance company to cover routine childhood immunizations at no cost.

• For those advocating for immunizations with local, state, or federal decision-makers, be sure to include economic costs. This can be compelling to those who prioritize budgets and resource allocation, since framing immunization as a cost-saving investment (rather than just a health measure) can be persuasive.

Question grab bag

“Serious question: Shouldn’t the surgeon general have a license to practice medicine?”

Short answer: Yes.

Most people know the surgeon general as “America’s doctor,” which is essentially a megaphone for public health. They have delivered landmark messages like those linking smoking to cancer. That role alone demands real expertise and credibility, but I would argue someone with a PhD in public health could do that as easily as an MD.

The lesser-known reason is that the surgeon general commands the Commissioned Corps of the U.S. Public Health Service, a uniformed branch of 6,000 officers deployed into national emergencies, like hurricaines and disease outbreaks. The corps requires its own officers to hold an active, unrestricted medical license and complete residency training. This means that if Casey Means is confirmed as surgeon general (a big if right now), she would be responsible for enforcing standards she doesn’t meet.

Figure from the U.S. Public Health Service website

In case you missed it

• CA YLE Matt’s colon cancer screening PSA.
• NY YLE Marisa on the blizzard and police response to mental health crises.
• And a measles brief for Christian communicators in an attempt to break echo chambers.

Bottom line

Stay healthy, neighborly, and safe out there.

Love, YLE

Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE reaches more than 425,000 people in over 132 countries with one goal: “Translate” the ever-evolving public health science so that people will be 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 belo