SEATTLE. ‘Heartless, punitive’: Health officials, immigrant advocates decry Trump proposal to limit access to green cards if using public benefits (The Seattle Times)

By 

Seattle Times staff and  Los Angeles Times

Health officials and advocacy groups are strongly condemning the Trump administration’s proposal to limit legal immigrants’ access to green cards if they use an array of public benefits, including Medicaid, food stamps and federal housing subsidies.

“This is not only bad for the health and well-being of the people most directly affected, it is bad for all of us,” said Dr. Georges Benjamin, head of the American Public Health Association, one of scores of health-care groups to criticize the administration’s proposal.

“We hope that this heartless, punitive public policy will be reversed,” Benjamin said.Among the major groups nationally calling on the Trump administration to withdraw the so-called public charge proposal – posted Wednesday in the Federal Register – are the American Medical Association, the March of Dimes and the American Hospital Association.

Read more.

NATIONAL. FDA hunts for more details on e-cig marketing (STAT)

By Megan Thielking

The FDA is expanding its investigation into how e-cigarette businesses might be illegally marketing their products. The FDA fired off letters to 21 e-cigarette companies — both manufacturers and importers — seeking information about about whether their products were on sale before August 8, 2016. That's the date when the FDA started requiring new or modified products to receive clearance before hitting the market. Meanwhile, leaders of more than two dozen urban health departments — from Austin to Boston — just sent a letter to FDA Commissioner Scott Gottlieb urging him to ban flavors in e-cigs and vapes.

NATIONAL. Big Tobacco is marketing vapes to our kids, so our city took them on and won — it’s the FDA’s turn now (The Hill)


By Tomas Aragon and Derek Smith

The FDA recently announced that it considers a new surge in teen e-cigarette use to be an epidemic, and will give e-cigarette manufacturers 60 days to prove that they are not marketing to kids. This is a very welcome move for those of us who have been pushing to prevent teen tobacco use. Our city recently took on the makers of e-cigarettes and won. The FDA should take San Francisco's lead and do everything it can to protect kids from Big Tobacco. Read the full article

NATIONAL: San Francisco Voters Uphold Ban on Flavored Vaping Products (The New York Times)

By Jan Hoffman

Despite a $12 million ad blizzard by a giant tobacco company, voters in San Francisco resoundingly supported a new ban on the selling of flavored tobacco products, including vaping liquids packaged as candies and juice boxes, and menthol cigarettes.

The measure, known as Proposition E, is said to be the most restrictive in the country, and health groups predicted it could serve as a model for other communities.

The vote had been expected to be close, but the final tally was 68 percent to 32 percent in support of the ban. Those results reflected a big miscalculation by R. J. Reynolds Tobacco Company, which had saturated the city with multimedia ads in four languages, likening the ban to Prohibition and invoking a black market crime wave.

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NATIONAL: Chicago health commissioner: Big Tobacco is targeting our youth and we must stop them (The Hill)

By Dr. Julie Morita, Commissioner, Chicago Department of Public Health

The U.S. Food and Drug Administration recently announced a crackdown on e-cigarette sales to minors, but before then, the city of Chicago had already taken matters into its own hands. The City Council passed an ordinance to require tobacco dealers to post warning signs at their doors about the health risks of e-cigarettes and other tobacco products. These signs, once designed and distributed, will also contain quit-line numbers to help our residents beat a nicotine addiction. 

The ordinance, introduced by Mayor Rahm Emanuel, reflects the nation’s growing understanding that e-cigarettes, also known as vaping products, are the latest effort by Big Tobacco to get our kids hooked on a risky and potentially deadly habit.

To be sure, our country has made strides fighting tobacco use, with declining rates of smoking and lung cancer deaths. In Chicago, we have reduced cigarette smoking rates by high school students from 13.6 percent in 2011 to 6.0 percent today, a record low. 

Yet, according to the Centers for Disease Control and Prevention Youth Risk Behaviors Survey the rate of cigar smoking (7.2 percent) and e-cigarette use (6.6 percent) is now higher than cigarettes among Chicago high school students. Even more concerning, 14.5 percent of students report tobacco use of any kind. Tobacco remains the leading cause of preventable disease, disability and death in the United States.

E-cigarettes hit the market in 2004 and since then we’ve seen their use rise dramatically. Nearly all e-cigarettes use flavored liquids that attract young people with names like Gummy Bear, Cherry Crush and Crème Brulee. Most e-cigarettes contain nicotine and harmful toxins, making them addictive and dangerous to youth, whose developing brains are more susceptible to addiction. Other tobacco products such as cigarillos and dip, which are known to cause cancer, also come in flavors that entice youth. 

Big Tobacco knows that marketing that focuses on flavors is effective at getting youth to start using. Such marketing, as well as tactics like cheap prices, coupons and a barrage of misleading messages, have led the public, especially young people, to vastly underestimate the health and addiction risks of these products. 

This misconception must be taken seriously, as tobacco use almost always begins in adolescence and young adulthood. The problem is worsened by the fact that some of today’s most popular vaping products, like JUUL, are designed to look like USB flash drives, making them easy for youth to conceal.

Unfortunately, the research is now clear that the use of e-cigarettes by youth is associated with an increased likelihood of progressing to cigarettes. For young people, tobacco use begets more tobacco use. 

In Chicago, knowing that prevention will save lives for generations, we have confronted Big Tobacco’s ever-evolving tactics through a robust suite of policies. Prior to our recent warning sign ordinance, we raised the purchasing age from 18 to 21, made cigarette prices among the highest in the nation, banned tobacco discounts and required that clerks ringing up tobacco sales be at least 21. 

We have targeted vaping by banning the use of e-cigarettes in public facilities, prohibiting the sale of flavored tobacco (including menthol) within 500 feet of high schools and becoming the first big city to impose our own e-cigarette tax.

Cities and states across the country should follow suit. And, the FDA should act immediately to ban youth-attracting flavors in all tobacco products, prohibit e-cigarette marketing to youth and reverse its 2017 decision to delay vaping regulation and allow risky products to remain on the market without undergoing agency review.

The fight against Big Tobacco isn’t over, despite our nation’s gains. Every level of government must enact bold, transformative solutions to meet the emerging threats to public health and equip young people to reject tobacco, once and for all.

NEW YORK CITY. Gag rule is a direct attack from Washington on women's health care (New York Daily News)

By Dr. Mary T. Bassett, Laura McQuade, Lisa David and Dr. Mitchell Katz 

MAY 21, 2018

Any day now, the Trump administration is expected to propose a new rule designed to make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood and organizations that provide complete, high quality, medically appropriate sexual and reproductive health care services.

This is an attack on all women, and especially on communities of color and those with low incomes. All people deserve the right to access quality, compassionate, affordable health care.

The federal Title X family planning program serves 4 million people annually and exists to help ensure that every person — regardless of where they live, their income, their background and whether or not they have health insurance — has access to basic preventive and reproductive health care, like birth control, cancer screenings, testing and treatment for sexually transmitted infections, and annual health exams.

As public health leaders committed to ensuring access to quality, compassionate health care in New York City and beyond, we condemn this outrageous attack on the health and safety of our communities. Undermining the basic health care relied on by millions of people is wrong, and it is a threat to our city's public health.

Under this anticipated rule, doctors, nurses, hospitals, and community health centers across the United States would be forced to choose between receiving federal family planning funding, or freely providing the full range of options that patients deserve, including abortion services, referrals to safe, legal abortion providers, and complete and accurate information about care options.

For nearly two decades, Title X law has been clear: health care providers cannot withhold information from patients about pregnancy options, including abortion. This proposed new rule ends that protection.

Major medical associations, including the American College of Obstetricians and Gynecologists, the American College of Physicians, oppose this rule. In fact, when a similar version of this rule was introduced in the 1980s, it was met with tremendous outcry and opposition from the medical community, and was ultimately, and rightly, shelved.

In New York State, more than 300,000 people receive care annually at Title X-funded health centers. In New York City alone, 150,000 people rely on Title X for their sexual and reproductive health care. More than half of the people who rely on the Title X program nationwide are people of color: 21 percent of all Title X clients identify as Black or African American, and 32 percent identify as Hispanic or Latino. Twenty-two New York City health care providers receive Title X funding, including Planned Parenthood of New York City, 10 NYC Health + Hospital sites, and other community-based providers.

Since day one, the Trump administration has pushed policy after policy to take away our basic health care, rights and freedoms. In addition to trying to eliminate the Teen Pregnancy Prevention Program, it has already sabotaged protections for survivors of sexual assault on campus; attempted to kick millions of people off their health insurance; implemented a rule that would allow employers to decide whether or not their employees' birth control is covered by insurance; and tried time and time again to prevent patients from coming to Planned Parenthood and other health care providers that offer evidence-based sexual and reproductive health care.

New Yorkers — and Americans — won't stop until every woman, person of color, immigrant, LGBTQ person, and others being targeted by the Trump-Pence administration can control our bodies and our lives. We stand with you, we will fight for you, and we are more committed than ever to ensuring that health care is never a victim of political warfare.

Bassett is New York City Health Commissioner. McQuade is president and CEO of Planned Parenthood of New York City. David is president and CEO of Public Health Solutions. Katz is the president and CEO of NYC Health + Hospitals.

SAN FRANCISCO. San Francisco will bring anti-addiction medication to users on the streets (Washington Post)

By Lenny Bernstein

San Francisco will begin supplying anti-addiction medication to long-term drug users and homeless people on city streets, an attempt to overcome a formidable obstacle to treatment that has complicated efforts to address the opioid crisis.

The city announced Thursday that its medical providers will offer buprenorphine and naltrexone prescriptions at needle exchanges, in parks and in other places where people with opioid disorders congregate. Users will be able to pick up the medications, which block the craving for opioids and the painful symptoms of withdrawal, at a centrally located city-run pharmacy.

The city is billing the plan as the first of its kind in the United States, though a few other communities have tried similar programs over the years.

“If we’re going to save people’s lives, we can’t wait for addicts to come to us. We have to go to them and engage. And offer. And give support,” said Barbara Garcia, director of health for the city and county of San Francisco.

The United States faces a shortage of drug treatment options of all kinds. Medication-assisted treatment with buprenorphine, methadone and naltrexone is widely considered the most effective way to wean users off opioids, but it is still in short supply and relapses are common, especially among people with the most severe form of opioid use disorder.

Buprenorphine, taken as a film placed on the tongue or in pill form, is generally dispensed by doctors or other providers who must receive eight hours of special training. Typically they give it to users daily or supply them with a few doses at a time. Naltrexone is offered as an injection that lasts a month, but users must be clean for seven to 10 days before it can be administered, which makes it difficult to use on the street.

Buprenorphine also is sold illegally on the street by users seeking to stave off withdrawal symptoms or wean themselves from heroin. Several experts said even intermittent, self-administered use is preferable to the risk of heroin laced with powerful fentanyl that many users now encounter.

Users who live on the street, many of whom also have mental illness, often cannot keep scheduled medical appointments or lack the means to get to them. Others feel reluctant to use the formal medical system. So some cities bring medical and other services to them on the street.

“I think it’s a great idea,” Joshua Sharfstein, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, said of San Francisco’s drug treatment plan. Bringing users into treatment depends on being in the right spot at the right time, when someone feels ready to try, said Sharfstein, an expert in medication-assisted treatment.

Heroin users “will go into withdrawal every eight to 12 hours, so when they’re ready for buprenorphine, you should give it to them right then and there,” said Sharfstein, who is not involved with the San Francisco effort.

The San Francisco program is expensive and labor-intensive. In a year-long pilot program, the city treated 95 people, 22 percent of whom stayed with the program. Twenty-two percent also were still taking buprenorphine at the end of 12 months. More than half the people had chronic medical conditions, two-thirds had psychiatric conditions and 61 percent used methamphetamine as well as heroin, according to the city. There are 7,000 homeless people in the city.

The new program is slated to start in the fall. By next spring, the city hopes to have 250 more people in treatment at an overall cost of $3 million annually.

In Contra Costa County, east of San Francisco, the government runs a less formal attempt to reach hardcore users on the street. There, street medicine teams hand out prescriptions twice a week that users can fill at any local pharmacy. Because some people may not be able to walk to a drugstore, outreach workers sometimes bring buprenorphine to users on the street, said Joe Mega, medical director of the county’s health care for the homeless program.

Mega said he has issued 21 prescriptions and that 11 recipients were continuing to receive buprenorphine after six months.

San Francisco is among a handful of U.S. cities making plans to open supervised drug consumption sites, where users are watched while they smoke or inject drugs by monitors who are ready to administer the overdose antidote naloxone. Such programs are widespread in Canada but against federal law in the United States.

BALTIMORE. Baltimore Asks Trump to Expand Use of Drug for Opioid Overdoses (CQ News)

By Sandhya Raman

Baltimore is making a first-of-its-kind request that the Trump administration use its existing authority to lower the cost of opioid overdose reversal drug naloxone in order to provide it to health care workers and law enforcement.

In a letter sent Thursday to Kellyanne Conway, counselor to the president, the Baltimore City Health Department and Public Citizen outline ways to make the drug more affordable. Other cities may follow suit. 

“Specifically, we ask that the Administration procure naloxone treatments and supply them to local health and law enforcement programs or authorize such programs to procure generic versions of patented naloxone treatments,” the letter reads.

Additionally, the authors ask the administration to “authorize use of any and all patents necessary to allow for the production of generic naloxone treatments and delivery systems to respond to the opioid epidemic.”

Government use authority, according to the groups, would allow the federal government to purchase generic versions of on-patent medicines. While naloxone is generic, Narcan, an easy-to-use form of naloxone that is often available as a nose spray, is under a patent until 2035.

Leana Wen, health commissioner for the Baltimore City Health Department, said at a press conference that the city is currently forced to ration naloxone because it doesn't have the resources to purchase enough of this drug.

“The problem that we have in Baltimore is not the policy. It’s the price,” said Wen.

Currently the Baltimore City Health Department pays $75 per kit for Narcan, Wen said. The cost for the city to provide a kit to every resident would be $46.5 million, or about one-third of the department’s entire budget.

Wen issued a blanket prescription to the city in October of 2015 for individuals to purchase naloxone using their own insurance, but she doesn’t see that as the ultimate solution.

“You are carrying naloxone to save someone else’s life,” she said, drawing a comparison to asking a fireman to buy his own firehose.

The city’s representative in Congress supports the request to the government.

“I commend the Baltimore Health Department and Public Citizen for working to combat the skyrocketing price of naloxone,” said Rep. Elijah E. Cummings, D-Md., in a statement. “The President’s own Opioid Commission recommended that the Trump Administration negotiate directly with drug companies to lower these prices, but President Trump has ignored this recommendation for the better part of a year while communities like Baltimore are forced to ration their supplies."

NATIONAL. Black Mothers Respond to Story on Maternal Mortality (The New York Times)

By Joneigh S. Khaldun, MD, MPH, FACEP
Director and Health Officer, Detroit Health Department


I am a black woman, an emergency-department physician, and the director of the Detroit Health Department. I am also the survivor of a life-threatening postpartum complication — a brain bleed (bilateral subdural hematomas) that was delayed in diagnosis, three weeks after I delivered my first child 11 years ago.

I originally had planned a natural labor and enlisted a doula, but after a day and a half of labor, I failed to progress and ended up having a C-section. After the delivery, I had excruciating headaches and told both my OB and my anesthesiologist several times. I felt brushed off and did not know what to do. It was not until I told one of my fellow residents about the pain I was experiencing that I went into my own ER where I worked and received a CT scan that diagnosed my life-threatening brain bleed.

I ended up having an urgent surgery on a Sunday afternoon to save my life. This experience has made me a better physician, and it is why I have committed myself to improving the lives of mothers and babies in my work in Detroit.

Read the full article

SAN ANTONIO. After ‘Tobacco 21,’ Metro Health Director Seeks ‘Culture of Health’ for SA (Rivard Report)

By Roseanna Garza

March 28, 2018 (Rivard Report) -- Photographs and awards line the walls and shelves in Colleen Bridger’s office at the San Antonio Metropolitan Health District, mementos from her last job, in Orange County, North Carolina.

“[Before,] a big day for me would be one press conference and two meetings,” Bridger said of her job in Orange County, which has a population of just 135,000. When she took over as San Antonio’s Metro Health Director just over one year ago, she knew she would have to adjust to a much faster pace.

Bridger moved fast and aimed high during her first big push for change, successfully spearheading San Antonio’s effort to become the first city in Texas to raise the age for purchasing tobacco products from 18 to 21. She introduced the idea to City Council in November 2017, and it was passed just three months later.

She called the legislation, known as Tobacco 21, the “most significant public health policy that I will ever be involved with.”

Counterparts from the Big Cities Health Coalition, which comprises leaders of America’s largest metropolitan health departments, called the policy success “remarkable” given that little progress implementing Tobacco 21 has been made in other Texas cities despite overwhelming evidence of the positive health impact.

Read more

BALTIMORE. COMMENTARY: Baltimore city is suing Trump administration over cuts to teen pregnancy prevention education (The Hill)

Baltimore City joined a lawsuit brought by Healthy Teen Network against President Trump, challenging a decision by the U.S. Department of Health and Human Services (HHS) to cut funding from evidence-based teen pregnancy prevention education.

In June 2015, the Baltimore City Health Department (BCHD) was awarded an $8.6 million grant to implement comprehensive, evidence-based teen pregnancy prevention education in all of the City’s more than 120 middle schools and high schools.

 

In July 2017, BCHD received notice from HHS that the grant period would be terminated two years early. This termination amounts to a reduction in overall grant funding to $5.1 million — a funding cut of $3.5 million. Despite multiple phone and written requests for explanation, Baltimore City has not received a response from HHS as to why our program is being terminated.

 

NATIONAL. Local Officials Urge Congress to Restore Teen Pregnancy Prevention Program Abruptly Cancelled by HHS

The Big Cities Health Coalition (BCHC) held a webinar - you can listen to a recording here - today featuring Patty Hayes, the Director of Public Health – Seattle & King County to discuss how Teen Pregnancy Prevention programs contributed to a dramatic decrease in teen pregnancy rates in her county, why Congress must act to fund them and why her county is suing HHS to protect them. 

Last summer, the U. S. Department of Health and Human Services (HHS) announced it would abruptly end grants totaling $200 million to 81 adolescent health projects across the country, which collectively serve 1.2 million young Americans. These projects are funded through the Teen Pregnancy Prevention Program (TPPP), a federal grant program grounded in evidence-based research, which provides important funding to diverse organizations working to prevent teen pregnancy in the U.S.

Officials in Seattle & King County in Washington State are challenging this decision in court and have filed a lawsuit to block HHS from ending these programs.  The programs are slated to be cancelled at the end of June 2018, rather than the original date, June 2020. Congressional action by March 23 is necessary to preserve the progress that the program has made in improving adolescent health.

NATIONAL. Tough Gun Laws Keep More Hands Off the Trigger: Study (HealthDay News)

By Dennis Thompson

MONDAY, March 5, 2018 (HealthDay News) -- Debate over the value of tough state gun control laws has reached a fever pitch following last month's deadly shooting of 17 people at a Florida high school.

Now, results from a new study indicate that such laws are potentially so effective they can prevent firearm-related murders on a regional basis, with the benefits extending into other nearby states that have more lax laws on the books.

States with strong firearm laws have overall lower rates of gun-related murder and suicide, according to the county-by-county analysis.

But counties in states with weak gun laws also appear to gain some protection from gun violence if they are located next to states with stronger laws, researchers reported.

Read more.

MIAMI. Guns kill about 90 people a day. Is that a public health threat? (Miami Herald)

BY DANIEL CHANG

dchang@miamiherald.com

February 23, 2018 05:55 PM

On the same day that a troubled former student walked onto the campus of Marjory Stoneman Douglas High School in Parkland and murdered 17 people with an assault-style rifle, at least 28 more people died from gunshots elsewhere in the United States.

Some of those gun deaths were matters of self defense or public safety. Some were suicides, which account for nearly two-thirds of all firearm deaths in America, according to the Centers for Disease Control and Prevention.

But even though doctors and public health officials have long considered gun deaths a public health threat — firearms kill as many Americans each year as die in car accidents — the CDC and state agencies responsible for reducing preventable deaths can do little when it comes to guns.

Read more. 

SAN JOSE. Federal budget cuts put Californians’ health at risk (The Mercury News)

By the Mercury News & East Bay Times Editorial Boards

Congress does have a doctor in the House. Fifteen of them, to be exact. And another physician in the Senate. So there’s no excuse for the appalling attack on health care in the budget deal passed by Congress on Friday and signed by President Trump.

Congress did fund the Children’s Health Insurance Program for 10 years. That’s the good news for 200,000 kids in the Bay Area who rely on it to meet their basic health care needs. But Congress came up with the funding for CHIP by grabbing $1.35 billion from the Centers for Disease Control’s Prevention and Public Health Fund.

“Pitting prevention against care and treatment is really a false choice,” said Dr. Sara Cody, Santa Clara County’s public health officer. “Nobody knows for sure how much the CDC will cut from California and Bay Area county budgets. But once again the importance of prevention is being short-changed.”

Public health keeps people, not surprisingly, healthier and out of the hospital. It’s as simple as that. Controlling outbreaks before they become widespread is an essential component of basic health care strategy. The CDC’s prevention budget supports vaccine coverage, enables states and counties to respond to infectious outbreaks, such as Ebola or Zika, and fights chronic problems, including diabetes, cancer, stroke and heart disease.

This winter’s flu outbreak demonstrates the importance of  public health funding. About 40 percent of Californians fail to get flu shots every year, and more than 160 under the age of 65 have died during the current flu season.

The value of the CDC funding became obvious in January 2016, after Santa Clara University student Bradley Sheffield contracted meningitis from an unknown source. The outbreak put the entire campus at risk.

The university’s quick action and the support of local public health officials stopped the disease in its tracks by providing thousands of students with emergency vaccinations. Sheffield recovered and was able to return to classes in the spring.

“The only reason we were able to be so nimble in response was because of the federally funded vaccines allowing the state to keep an emergency supply on hand,” said Cody. “It was 48 hours from the time we heard about the outbreak to the first shot in the arm.”

It’s an open question with the reduction in funding whether the state will be able to maintain a supply of emergency vaccinations for various outbreaks.

The CDC prevention and public health funding also provides crucial support in the East Bay. In 2016, Alameda County received a $500,000 grant to fight chronic disease, another $204,000 for smoking prevention programs and $65,000 to support its immunization program.

Benjamin Franklin was actually talking about fire safety when he said an ounce of prevention is worth a pound of cure. It shouldn’t be too much to ask Congress to be smart enough to know how foolish it is to stop protecting Americans from devastating outbreaks and diseases.

NATIONAL. 4 Health Programs (Other Than CHIP) That Congress Has Left in Limbo. (Governing)

By Mattie Quinn

It’s been more than 100 days since Congress missed its deadline to pass a long-term spending bill for the federal government. That has left the fate of many federally-funded, state-administered programs up in the air.

Most of the uproar around Capitol Hill gridlock is aimed at the Children’s Health Insurance Program (CHIP). It has historically had bipartisan support and covers 9 million children and pregnant women who don’t have employer-based insurance but make too much money to qualify for Medicaid.

In the meantime, the federal government has repeatedly released unspent funds to help states keep CHIP running. The most recent money is supposed to keep the programs afloat through March, but federal health officials warned last week that some states could run out this month.

Read more.

DETROIT. Detroit targets hepatitis A outreach: "What we're trying to do is reach people where they are". (MichiganRadio)

By Sarah Cweik

etroit is trying to fight a hepatitis A outbreak in the face of limited resources and low national vaccine supplies.

Detroit health department director Dr. Joneigh Khaldun talked about the city’s efforts to fight an outbreak of the viral liver disease on a conference call with other local and national health leaders Tuesday.

Michigan is one of a handful of states experiencing hepatitis A outbreaks right now. Michigan’s is one of the largest, with 610 cases and 20 deaths reported since August 2016.

Some of the highest-risk populations, including drug users and people experiencing homelessness, are also some of the hardest to reach. Khaldun says that’s especially true in Detroit, where the homeless population often means people living in transient housing spread out across the city.

So to fight the outbreak, “What we’re doing is trying to reach people where they are,” Khaldun said. That includes working with shelters, health clinics and other partners to screen and vaccinate people. In recent weeks, the health department has also brought on emergency rooms at the city’s four major hospitals to do that work.

The city is also following up with people in close contact with known hepatitis A cases. They can be protected if they receive a vaccine or immunoglobulin within two weeks of exposure.

“For every case that comes through and is associated with a city of Detroit resident, my team immediately responds to identify who those contacts can be, so that we can quickly get that person that post-exposure prophylaxis,” Khaldun sasid.

But that kind of follow-up is a challenge for a department with just three epidemiologists and limited resources. Another challenge: limited national vaccine supplies.

Khaldun says the city is relying on other health agencies to help supplement its efforts. The department is also purchasing more doses from private vendors, but can only get so much at a time. “So we’ve literally been every day purchasing 400 [doses], our max,” she said.

Read more.