Public health

SACRAMENTO — Gov. Gavin Newsom signed a law giving California the power to set its own immunization schedules based on state health experts and independent medical groups — a sharp break from decades of reliance on guidance from the federal government.

The move came the same day that California and its West Coast allies issued joint recommendations for COVID-19, flu and RSV vaccines, part of a regional alliance formed to counter what they say is a politicized U.S. Centers for Disease Control.

“Our states are united in putting science, safety, and transparency first — and in protecting families with clear, credible vaccine guidance,” said the governors of California, Oregon, Washington and Hawaii, which make up the West Coast Health Alliance.

The flurry of vaccine actions came as lawmakers and the University of California proposed a $23-billion ballot measure to replace federal research dollars lost to Trump-era cuts, underscoring efforts by Democrats in the state to shield science and public health from shifting federal policies. The measure, if passed by the California Legislature when lawmakers return in January, would go before voters in November 2026.

“The loss of critical federal funding awarded to the University of California presents an unprecedented and perilous moment for the state and its communities,” Theresa Maldonado, UC vice president for research and innovation, said in a statement.

The healthcare clash comes following a wave of COVID cases and as the annual flu season nears. For decades, the CDC has been the nation’s trusted authority on vaccines — setting childhood immunization schedules, guiding which shots adults should receive and shaping state health policies across the country.

Now, at the direction of Health and Human Services Secretary Robert F. Kennedy Jr., a Trump ally, the CDC fired top leadership, lost senior scientific advisors and remade its vaccine advisory committee with members who the Associated Press found spread misinformation and conspiracy theories about immunizations.

Kennedy, a longtime vaccine skeptic, has defended the shakeup as necessary to create trust and “eliminate politics from science.”

“They deserve the truth and that’s what we’re going to give them for the first time in the history of the agency,” Kennedy told the Senate Finance Committee earlier this month during a contentious hearing.

The overhaul triggered a fierce backlash as more than 1,000 employees at the health agency and national health organizations have called on Kennedy to resign. Some states, however, have embraced the approach — Florida announced plans to become the first state to end all vaccines mandated, including for schoolchildren.

The polarization is taking a toll. A recent KFF poll found Americans are increasingly uncertain about public health guidance and whether new recommendations from the administration will make them more or less safe.

Public health experts say that not only are vaccines crucial for the health of individuals and the community but they also ultimately save money — preventing sickness and the rise in healthcare costs that would accompany widespread disease outbreaks.

The changes in federal vaccine recommendations have been sweeping. The Food and Drug Administration, which falls under Kennedy’s purview, now requires adults 65 and younger and otherwise healthy — who report no underlying health issues — to consult with a healthcare provider before getting the COVID vaccine. Similarly, the CDC requires parents of healthy children to talk to a healthcare provider before their child can receive the COVID vaccine, a barrier the American Academy of Pediatrics called “deeply troubling.”

The American Academy of Pediatrics issued its own COVID vaccine guidance, countering what the CDC recommended, that says all young children 6 months to 23 months should be vaccinated, as well as certain high-risk older children. The group has also said that older children should be offered the vaccine if their parents request it.

The CDC also changed its vaccine schedule from recommending the COVID vaccine to all pregnant women to offering “no guidance” as to whether healthy pregnant women should get the vaccine. In response, the American College of Obstetricians and Gynecologists recommended that people receive the updated COVID-19 vaccine at any point during their pregnancy.

California said it too will reject CDC guidance, starting with the recommendations released Wednesday from the West Coast Health Alliance. Those recommendations were developed by health officers and subject matter experts from each state, who considered guidelines from medical organizations such as the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.

The COVID-19 vaccine recommendations from the West Coast Health Alliance include vaccinating all children 6 months to 23 months and those 2 years old to 64 years old with risk factors. The alliance also recommended all pregnant and postpartum women or those planning to become pregnant to be vaccinated.

The alliance recommended children 6 months and older and all adults and pregnant women to receive the flu shot. For the RSV vaccine, the alliance recommends it for children younger than 8 months, as well as anyone 75 years or older. The alliance recommends the RSV vaccine for all other ages if a person has risk factors.

“We want the people who live and work in our states to know that there is a strong public health, healthcare and scientific community that will continue to stand together to provide and use the data and evidence needed for you to make healthy choices, and we are here to protect our communities,” said Dr. Erica Pan, director of the California Department of Public Health, in a statement.

Seniors in some parts of the country say they are being denied COVID-19 vaccinations amid an ongoing spike in cases, leading to rising frustration over new Trump administration policies that are making it harder to get the shots.

Matthew D’Amico, 67, of New York City, said a Walgreens declined to administer COVID-19 vaccines to him and his 75-year-old wife on Friday because they didn’t have a prescription. They’re trying to get vaccinated ahead of a trip.

“I can’t believe we can’t get” the vaccine, D’Amico said in an interview. “I’ve been inoculated a number of times and never had to get a prescription. And it’s just very frustrating that this is where we are.”

He’s not alone in his exasperation. Under the leadership of the vaccine skeptic Health and Human Services Secretary Robert F. Kennedy Jr., federal agencies have effectively made it more difficult to get vaccinated against COVID-19 this year. The Food and Drug Administration has only “approved” COVID-19 vaccines for those age 65 and up, as well as younger people with underlying health conditions.

That means across the country, people younger than 65 interested in getting the COVID-19 vaccine must now either consult with a healthcare provider or “attest” to a pharmacy that they have an underlying health condition. It’s a potential hurdle that can make getting the vaccine more difficult and, some health experts worry, prompt even more Americans to eschew getting vaccinated.

As D’Amico can attest, though, being part of a group for whom the COVID vaccine is “approved” doesn’t necessarily guarantee easy access.

“For me to go to my primary [healthcare provider] now and get a prescription, it’s just kind of ridiculous,” D’Amico said.

At least some people younger than 65 are encountering pharmacy staff asking probing questions about their medical conditions.

That happened Friday at a CVS in Orange County, according to 34-year-old Alex Benson, who takes medication that can suppress his immune system.

Besides just protecting himself, he wanted to get vaccinated as he has family members who are at high risk should they get COVID — his mother is immunocompromised, and his mother-in-law had open-heart surgery on Thursday night.

Benson said an employee asked why he thought he was eligible for the vaccine.

“They asked me for either a prescription or they wanted to know … why I felt I needed the vaccination,” Benson said. At one point, a staffer offered to call his doctor to get an authorization for the vaccine.

Benson said he was alarmed by the questions, and started to “feel kind of some desperation to plead my case to the pharmacist.” Another CVS staffer later came over and said further answers weren’t necessary and simply attesting he was eligible was good enough. He eventually got the vaccine.

Still, he felt the experience was dismaying.

“I think easy access should be the policy,” Benson said. “I tend not to get too political, but it seems just rather juxtaposed to me that an anti-regulation administration is using regulation in this way. They’re supposed to be removing barriers to healthcare.”

The vaccine chaos comes as COVID-19 is either increasing or starting to hit its late summer peak. According to data released Friday, there are now 14 states with “very high” levels of coronavirus detected in their wastewater — California, Texas, Florida, North Carolina, Indiana, South Carolina, Alabama, Louisiana, Connecticut, Utah, Nevada, Idaho, Hawaii and Alaska, as well as the District of Columbia.

Dr. Elizabeth Hudson, the regional physician chief of infectious diseases for Kaiser Permanente Southern California, said data continue to show an increase in coronavirus cases.

“Over this past week, we’ve seen an increase in the number of outpatient COVID cases, and even a smattering of inpatient cases,” Hudson said. “It appears that we may be nearing the top of the wave, but it may be another two weeks or so until we truly know if we’re there.”

The rate at which coronavirus lab tests are confirming infection also continues to rise statewide and in the Los Angeles area. For the week ending Aug. 30, California’s COVID test positivity rate was 12.83%, up from 7.05% for the week ending Aug. 2. In L.A. County, the positive test rate was 14.83%, up from 9.33%.

Other data, however, suggest some areas may have reached their summer COVID peak.

In Orange County, the COVID positive test rate was 13.1%. That’s below the prior week’s rate of 18%, but still higher than the rate for the week that ended Aug. 2, which was 10.8%.

In San Francisco, the test positivity rate has been hovering around 9% for the last week of reliable data available. It’s up from 7% a month earlier.

In addition, wastewater data in L.A. County show coronavirus levels declined slightly from the prior week.

“It’s too early to know if this decrease in wastewater viral concentrations is the first sign that COVID-19 activity is peaking or is regular variation typical of this data source,” the L.A. County Department of Public Health said.

COVID hospital admissions in California are increasing — with the latest rate of 3.93 admissions per 100,000 residents, up from 2.38.

But they remain relatively low statewide and in L.A. County. The number of L.A. County residents seeking care for COVID-related illness, or who have been hospitalized, “is quite a bit lower than during summer surges in 2023 and 2024,” the public health department said.

A relatively mild summer wave, however, could mean that the annual fall-and-winter COVID wave might be stronger. In July, the state Department of Public Health said that scientists anticipate California would see either a stronger summer COVID wave or a more significant winter wave.

The current confusion over federal COVID vaccine policy has been exacerbated by the chaos at the U.S. Centers for Disease Control and Prevention, where Kennedy earlier this year fired everyone on the influential Advisory Committee on Immunization Practices, and orchestrated the firing of CDC Director Susan Monarez just 29 days after she was confirmed to the post by the Senate.

Some of Kennedy’s handpicked replacements on the ACIP have criticized vaccines and spread misinformation, according to the Associated Press. And the new interim CDC director — Jim O’Neill, a Kennedy deputy — is a critic of health regulations and has no training in medicine or healthcare, the AP reported.

The CDC hasn’t issued its own recommendations on who should get vaccinated, and that inaction has resulted in residents of a number of states needing to get prescriptions from a healthcare provider for at least the next couple of weeks. In some cases, that’s true even for seniors, as D’Amico found out.

As of Friday, CVS said people need a prescription to get a COVID-19 vaccine, sometimes depending on their age, in Arizona, Florida, Georgia, Louisiana, Maine, North Carolina, New Mexico, New York, Pennsylvania, Utah, Virginia and West Virginia, as well as the District of Columbia.

CVS couldn’t even offer the COVID-19 at its pharmacies in Nevada as of Friday; they were only available at the company’s MinuteClinic sites, according to spokesperson Amy Thibault.

CVS said it expects to offer COVID-19 vaccines without prescriptions at its pharmacies in New Mexico, Nevada, New York and Pennsylvania “soon,” due to recent regulatory changes in each state.

“Right now, all patients in all states need to attest to being eligible for the vaccine in order to schedule an appointment online,” Thibault said. If an adult says they have no underlying health conditions, but do have a prescription from a healthcare provider for “off-label” use of the vaccine, they can get the shot, Thibault confirmed.

On Thursday, Hawaii joined California, Washington and Oregon in launching the West Coast Health Alliance: an interstate compact meant to provide science-based immunization guidance as an alternative to the CDC.

“Together, these states will provide evidence-based immunization guidance rooted in safety, efficacy, and transparency — ensuring residents receive credible information free from political interference,” according to a statement from Gov. Gavin Newsom’s office.

The statement suggested that the Trump administration was essentially “dismantling” the CDC.

“The absence of consistent, science-based federal leadership poses a direct threat to our nation’s health security,” the statement said. “To protect the health of our communities, the West Coast Health Alliance will continue to ensure that our public health strategies are based on best available science.”

It was not immediately clear, however, whether the formation of the West Coast Health Alliance would make it easier for people to get COVID-19 vaccines at the nation’s largest pharmacy retailers, where many people get their shots.

Mainstream medical groups, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, are also offering their own recommendations to advise individuals and families on what vaccines they should get.

This is the story of two Republican doctor-senators named Bill.

One of them, as majority leader from 2003 to 2007, helped a self-described “compassionate conservative” Republican president pass a Medicare prescription drug plan and the President’s Emergency Plan for AIDS Relief (PEPFAR), “the largest commitment by any nation to address a single disease in history.”

The other, as a member of the Senate Finance Committee, voted to send Robert F. Kennedy Jr.’s nomination as secretary of Health and Human Services to the Senate floor. It was a 14-13 vote, so his was a crucial “aye” that allowed a conspiracy theorist, disinformation spreader and anti-vaxxer to become the top public health official in America. He already has defunded world-changing mRNA vaccine research, imposed major restrictions on access to COVID vaccines amid a surging variant of the virus and triggered a crisis at the Centers for Disease Control and Prevention.

“The firewall between science and ideology is completely broken down,” Dr. Demetre Daskalakis, former director of the CDC’s National Center for Immunization and Respiratory Diseases, said Sunday on ABC’s “This Week.” He was part of the shocking CDC leadership exodus last week after the Trump administration forced out CDC Director Susan Monarez.

The trajectory from heart and lung transplant surgeon Bill Frist of Tennessee to gastroenterologist Bill Cassidy of Louisiana is emblematic of the dark Republican Party journey on science and health — from the Bush family to the Trump family, from American greatness to self-defeating denialism on everything from vaccines to cancer research.

There are four doctors in the Senate: Cassidy, orthopedic surgeon John Barrasso of Wyoming, obstetrician-gynecologist Roger Marshall of Kansas and ophthalmologist Rand Paul of Kentucky. All are Republicans and all voted in February to confirm Kennedy.

Eleven of the 17 medical doctors in the House are Republicans, and all of them voted for the nearly $1 trillion in Medicaid cuts in the vast tax-and-spending law that Trump signed on July 4. So did the four dentists in the House, all of them Republicans. The American Dental Assn. endorsed three of them. The fourth is Arizona’s Paul Gosar, a top competitor with Kennedy in the medical disinformation space whose siblings have made ads urging voters to reject him.

Frist was the only doctor in the Senate when he served. After leaving the Senate in early 2007, he joined the Bipartisan Policy Center, where he is a senior fellow and co-chair of its Health Project. He has been on the board of directors of the Nature Conservancy since 2015, and was elected to a three-year term as global board chair in 2022.

Frist has sharply criticized the Medicaid cuts passed into law this year, saying they threaten rural hospitals and public health. Last spring, accepting a 2025 Earth Award from Time Magazine, he said climate health is crucial to human health, and he urged a personal approach to raise American awareness. He often describes his environmental and health missions as inseparable. “Planetary health is human health. Let’s lead with science, unity, and urgency,” he posted on X on Earth Day.

Good luck with that, at least in the short term. The same new law that cuts Medicaid also cuts funds for renewable energy projects and incentives, with conservationists predicting more pollution, fewer jobs and higher energy costs as a result. Only three Republican senators bucked the party tide on that bill, and Paul was the only doctor among them. His breaking point was a provision raising the U.S. debt limit to $5 trillion — not Medicaid or clean energy cuts affecting health.

Cassidy, of course, voted for it. And when Monarez found herself in Kennedy’s crosshairs over vaccines, Cassidy privately intervened for her, which backfired. Now, having failed to spare America this nightmare when he could have, the senator is threatening “oversight” by the health committee he chairs and trying to get a Sept. 18 meeting of unqualified Kennedy-appointed vaccine “advisors” postponed.

This is thin gruel, especially from a doctor once committed to public health and science writ large. Cassidy co-founded a clinic that gave free dental and medical care to the working uninsured, his website says, and created a public-private partnership that vaccinated 36,000 children for hepatitis at no cost to their families. During the Biden presidency, he voted for bipartisan gun safety and infrastructure bills and the bipartisan CHIPS and Science Act to bolster the U.S. semiconductor industry. He was also one of five Republicans voting for a small-business COVID relief bill.

Even more notably, in the Senate impeachment trial after the Jan. 6, 2021, Capitol riot, Cassidy voted to convict Trump of “incitement of insurrection.” “Our Constitution and our country is more important than any one person. I voted to convict President Trump because he is guilty,” he said then. The Louisiana Republican Party censured him the same day.

Now running for his third term, Cassidy is already facing primary challengers who don’t have that baggage. They include state Treasurer John Fleming, a former congressman who worked for Trump in the White House, and public service commissioner Eric Skrmetta, who chaired all three of Trump’s presidential campaigns in Louisiana.

Fleming has said Cassidy’s vote to convict Trump failed the people of Louisiana. And that’s the problem with today’s Republican Party. The truth is that since that brave vote, Cassidy has failed all Americans. He has also assured that his legacy will be the wreckage of our once world-class public health and medical research programs.

On the other side, there is the 314 Action group that is recruiting and funding Democratic doctors and other Democratic scientists to run for office. It’s an openly partisan operation, right up to a snarky-ish all-caps X post about its $1-million commitment to California’s fight to neutralize the five new House seats Texas is trying to add. What else can you do when the other major party, even its medical professionals, is leading, aiding and abetting in the GOP war on science?

“If @SenBillCassidy had a spine, a known anti-vax conspiracy theorist wouldn’t be destroying our public health,” the group posted last Wednesday on X. “He had an opportunity to thwart the confirmation of RFK Jr.,” 314 Action president and founder Shaughnessy Naughton told me in a recent interview. “Instead he chose to go down a different path and go against what his life experience and professional training told him was a dangerous nominee to lead our health services. And he did it anyway. … That is shameful.”

In February, before Kennedy was confirmed, the conservative New York Times columnist Bret Stephens rated him “worst nominee in U.S. Cabinet history.” And then Stephens suggested the person he preferred for the job: Bill Frist.

Jill Lawrence is an opinion writer and author of “The Art of the Political Deal: How Congress Beat the Odds and Broke Through Gridlock.” @jilldlawrence.bsky.social

NEW YORK — For the first time in 30 years, the American Academy of Pediatrics is substantially diverging from U.S. government vaccine recommendations.

The group’s new COVID-19 recommendations — released Tuesday — come amid a tumultuous year for public health, as vaccine skeptics have come into power in the new Trump administration and government guidance has become increasingly confusing.

This isn’t going to help, acknowledged Dr. James Campbell, vice chair of the AAP infectious diseases committee.

“It is going to be somewhat confusing. But our opinion is we need to make the right choices for children to protect them,” he added.

The AAP is strongly recommending COVID-19 shots for children ages 6 months to 2 years. Shots also are advised for older children if parents want their kids vaccinated, the AAP said.

That differs from guidance established under U.S. Health Secretary Robert F. Kennedy Jr., which doesn’t recommend the shots for healthy children of any age but says kids may get the shots in consultation with physicians.

Children ages 6 months to 2 years are at high risk for severe illness from COVID-19, and it was important that recommendations continue to emphasize the need for them to get vaccinated, said Campbell, a University of Maryland infectious diseases expert.

Vaccinations also are recommended for older children who have chronic lung diseases or other conditions that put them at higher risk for severe disease, the AAP said.

In a statement, Department of Health and Human Services spokesperson Andrew Nixon said “the AAP is undermining national immunization policymaking with baseless political attacks.”

He accused the group of putting commercial interests ahead of public health, noting that vaccine manufacturers have been donors to the AAP’s Friends of Children Fund. The fund is currently paying for projects on a range of topics, including health equity and prevention of injuries and deaths from firearms.

The 95-year-old Itasca, Illinois-based organization has issued vaccination recommendations for children since the 1930s. In 1995, it synced its advice with recommendations made by the federal government’s Centers for Disease Control and Prevention.

There have been a few small differences between AAP and CDC recommendations since then. For example, the AAP has advised that children get HPV vaccinations starting at age 9; the CDC says that’s OK but has emphasized vaccinations at ages 11 and 12.

But in 30 years, this is the first time the recommendations have differed “in a significant or substantial way,” Campbell said.

Until recently, the CDC — following recommendations by infectious disease experts — has been urging annual COVID-19 boosters for all Americans ages 6 months and older.

But in May, U.S. Health Secretary Robert F. Kennedy Jr. announced that COVID-19 vaccines are no longer recommended for healthy children and pregnant women. A few days later, the CDC issued language that healthy children may get the shots, but that there was no longer a “should” recommendation.

The idea that healthy older kids may be able to skip COVID-19 boosters has been brewing for some time among public health experts. As the COVID-19 pandemic has waned, experts have increasingly discussed the possibility of focusing vaccination efforts on people 65 and older — who are among those most as risk for death and hospitalization.

A CDC expert panel in June was set to make recommendations about the fall shots. Among the options the panel was considering was whether suggest shots for high-risk groups but still giving lower-risk people the choice to get vaccinated.

But Kennedy bypassed the group, and also decided to dismiss the 17-member panel and appoint his own, smaller panel, that included vaccine skeptics. Kennedy also later excluded the AAP, the American Medical Association and other top medical organizations from working with the advisers to establish vaccination recommendations.

Kennedy’s new vaccine panel has yet to vote on COVID-19 shot recommendations.

The panel did endorse continuing to recommend fall flu vaccinations, but also made a decision that led to another notable difference with the AAP.

The new advisory panel voted that people should only get flu vaccines that are packaged as single doses and do not contain the preservative thimerosal.

The AAP said there is no evidence of harm from the preservative, and recommended doctors use any licensed flu vaccine product that’s appropriate for the patient.

Stobbe writes for the Associated Press.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

I took a week of vacation to relax, clear my head and stop obsessing over depressing news.

I hear frequently from people who say that, for their peace of mind, they’re tuning out the news altogether, so I tried it for a couple of days. Opened a book. Walked the dog.

Steve Lopez

Steve Lopez is a California native who has been a Los Angeles Times columnist since 2001. He has won more than a dozen national journalism awards and is a four-time Pulitzer finalist.

But I’m in the news business, and I felt like a hypocrite, so I kept sneaking peeks. As it turns out, that wasn’t healthy.

You can’t follow a single 24-hour news cycle without questioning your own sanity.

Do we really live in a country in which the president posts fake videos of a predecessor being arrested?

In which a dead man’s sex trafficking crimes dominate White House news for days on end?

In which the federal government has made it a priority to arrest tamale vendors and fire meteorologists?

President Trump holds a gavel after signing the “One Big Beautiful Bill Act” at the White House in Washington, D.C., on July 4.

(Brendan Smialowski / Pool / AFP via Getty Images)

In which the Social Security Administration sends us emails fawning over the president and making false claims, the White House jokes and memes about immigration raids and the Department of Homeland Security triggers a trolling war with social media posts about its version of national heritage?

I have a weekly goal of avoiding alcoholic beverages on Mondays, Tuesdays and Thursdays, but in this political culture, what chance do I have?

With lots of time to practice, I picked up my guitar, but events of the last few weeks continued to haunt me.

The “Big Beautiful Bill” that Trump signed into law on July 4 will add trillions to the national debt, heap tax breaks on those who need them least and rip healthcare coverage away from the neediest. As a result, L.A. County’s health services are anticipating federal cutbacks in the hundreds of millions of dollars.

“We can’t survive this big a cut,” Barbara Ferrer, L.A. County’s head of public health, told the Times for a story by Rebecca Ellis and Niamh Ordner. She added: “I’ve been around a long time. I’ve never actually seen this much disdain for public health.”

Dr. Jonathan LoPresti, who worked at County/USC for decades and is an associate professor of clinical medicine at the Keck School of Medicine at USC, is alarmed. He sent me an a copy of an opinion piece he’s writing, which includes a warning that county hospitals could “again be overrun with the poor … and homeless, leading to further hospital and ER overcrowding, delayed discharges and reduction in routine health maintenance … That could lead to an increase in community TB cases and more serious complications of treatable disease, as well as deaths.”

He added this:

“How many public deaths are people willing to accept?”

There is no limit, judging by crystal clear signals from Washington.

I think we can all agree that historic rainstorms, hurricanes and wildfires in the United States and the rest of the world will continue to kill thousands.

Here’s a synopsis of the Trump response:

The U.S. climate change website has been shut down.

Protesters gather on the National Mall for the “Hands Off” protest against the administration of President Trump on April 5.

(Dominic Gwinn / Middle East Images / AFP via Getty Images)

The administration says the Federal Emergency Management Agency should be eliminated, and the urban search and rescue chief has resigned, citing chaos and dangerous disaster response delays.

Layoffs and buyouts have reduced National Weather Service ranks by 14% despite warnings of dire consequences.

So I swam laps, thinking that having my head under might help, but it only made me feeling like I was drowning.

Hundreds of probationary workers at the National Oceanographic and Atmospheric Administration have been fired, and the fulltime staff will be trimmed by 2,000.

These cuts, and the elimination of federal support for scientific research, are damaging in obvious ways. But when I asked UCLA professor Alex Hall what’s most disturbing, here’s what the director of the Center for Climate Science had to say:

“I feel like the thing that’s most chilling is the way the word ‘climate’ has become a dirty word.”

In other words, the politicization of the subject — Trump and supporters insist human-caused climate change is either exaggerated or a hoax — has created a form of censorship.

“That’s where we really start to face dangers — when people can’t talk about something,” said Hall, who has been studying the link between climate change and California wildfires.

I may be a little biased on this topic. My daughter just graduated from college with a degree in earth science. What she and thousands like her are being told, essentially, is, “Good for you, but the planet’s health is neither a concern nor a priority. If you’re looking for work, the Border Patrol is hiring, and cryptocurrency might be a good career path.”

So there you have it. That’s how I spent my summer vacation, failing miserably in my attempt to look the other way.

But all was not lost.

I played pickleball a couple of times, in Glendale and Los Feliz, and suffered no major injuries. I took my beagle Philly to Rosie’s Dog Beach in Long Beach and watched him race around like the happiest hound in the world. And, borrowing from Trump’s penchant for cutbacks, I’ve trimmed my list of no-alcohol days from three to two.

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Los Angeles County’s health system, which is responsible for the care of the region’s poorest, is careening toward a financial crisis because of cuts from a presidential administration and Republican-led Congress looking to drastically slash the size of government.

President Trump’s “Big Beautiful Bill,” which passed earlier this month, is expected to soon claw $750 million per year from the county Department of Health Services, which oversees four public hospitals and roughly two dozen clinics. In an all-staff email Friday, the agency called the bill a “big, devastating blow to our health system” and said a hiring freeze had gone into effect, immediately.

And the Trump administration’s budget for the next fiscal year will likely result in a $200-million cut to the county Department of Public Health, whose responsibilities include monitoring disease outbreaks, inspecting food and providing substance use treatment.

“I’m not going to sugarcoat it. I’m not going to say we survive this,” said Barbara Ferrer, head of the public health department, in an interview. “We can’t survive this big a cut.”

Both Ferrer and Department of Health Services head Christina Ghaly warned that the federal cuts will devastate their agencies — and the patients they serve — for years to come. Employee layoffs are likely.

In April, the White House announced it was ending infectious disease grants worth billions of dollars, including $45 million that L.A. County was supposed to use to combat the spread of measles and bird flu. California has joined other states in a lawsuit fighting the cuts, and the court has issued a preliminary injunction suspending the cuts.

A protest earlier this month in Anaheim, co-led by the California Nurses Assn., called on Rep. Young Kim (R-Anaheim Hills) to vote against President Trump’s spending bill.

(Allen J. Schaben/Los Angeles Times)

This month, the county public health department lost another $16 million after Trump’s bill cut funding for a program educating food stamp recipients about how to buy healthy meals.

And there’s more to come. The Trump administration’s proposed budget for 2026 will be the biggest blow yet, Ferrer warned, yanking $200 million from her department — a 12% cut.

“I’m old. I’ve been around for a long time,” said Ferrer, whose work in public health dates back to the Reagan administration. “I’ve never actually seen this much disdain for public health.”

Ferrer said the cuts mean she no longer has enough money for the county’s bioterrorism watch program, which monitors for outbreaks that might signal a biological attack. Soon, she said, county officials may have to stop testing ocean water for toxins year round, cutting back to just half the year.

“Like, you want to swim? You want to know that the water is safe where you swim, then oppose these kinds of cuts,” she said. “That affects everybody who goes to the beach.”

L.A. County Public Health Director Barbara Ferrer said she is bracing for $200 million in cuts to her budget.

(Al Seib/Los Angeles Times)

Layoffs are likely, said Ferrer. About 1,500 public health staffers are supported through federal grants. More than half the federal money the department receives is funneled to outside organizations, which would likely need to make cuts to stay afloat.

A similarly grim cost analysis is underway at the county Department of Health Services, where executives said they expect to lose $280 million this fiscal year because of the bill.

“I can’t make a promise that we will be able to avoid layoffs because of the magnitude of the challenges,” said Ghaly.

Ghaly said the bill slashed the extra Medicaid money the county typically gets to cover care for low-income patients. They expect many patients might be kicked off Medicaid because of new eligibility and work requirements. The federal government is pulling back on payments for emergency services for undocumented people, meaning the county will have to foot more of the bill.

The White House did not respond to a request for comment.

Department of Health Services officials said they expect to lose $750 million per year by 2028. By then, the agency’s budget deficit is projected to have ballooned to $1.85 billion.

In an attempt to pump more cash into the system, L.A. County supervisors voted on Tuesday to increase a parcel tax first approved by voters in 2002, which is expected to raise an additional $87 million for the county’s trauma care network.

After a long debate Tuesday, Supervisors Holly Mitchell and Lindsey Horvath worked to direct $9 million of the parcel tax money to Martin Luther King Jr. Community Hospital, a private hospital that serves as a critical safety net for South Los Angeles residents who would otherwise find themselves in a medical desert.

Without that cash infusion from the county, the cuts in Trump’s bill would have put the hospital at risk of closing, since the majority of patients in its emergency room are on Medicaid, said Elaine Batchlor, Martin Luther King’s chief executive officer.

“If they’ve lost their Medicaid coverage, we simply won’t get paid for those patients,” she said.

Dr. Elaine Batchlor, chief executive of MLK Community Healthcare, said her hospital was hanging by a thread financially. Then came more cuts.

(Francine Orr/Los Angeles Times)

Martin Luther King replaced a county hospital that closed after losing national accreditation in 2005 because of serious medical malpractice, landing it the nickname “Killer King.”

“The fact that that hospital closed in the first place I think is criminal, and I intend to do all I can to protect the integrity of the services,” said Mitchell, whose district includes the hospital and who pushed for it to get a cut of money from the parcel tax increase.

Local health providers said that changes at the state level have created additional uncertainty. The state budget for this fiscal year freezes enrollment in Medi-Cal, California’s version of Medicaid, for undocumented immigrants ages 19 and older starting in January. Medi-Cal recipients ages 19 to 59 will have to pay a $30 monthly premium beginning July 1, 2027.

“Most families [we serve] are making about $2,400 to $2,600 a month. They’re going to have to choose between paying their Medi-Cal fees for a family of four — that’s $120 a month — or paying rent or paying for food,” said Jim Mangia, head of St. John’s Community Health, who said the cuts will disrupt care for tens of thousands of low-income residents.

The St. John’s clinic, which gets most of its revenue from Medi-Cal reimbursements, serves more than 120,000 patients a year, most of whom live below the federal poverty line.

If the clinic doesn’t find a way to replace the lost revenue, Mangia warned, services will have to be reduced. The clinic recently started treating immigrant patients in their homes after realizing they had been skipping appointments because they feared being arrested by federal immigration agents.

“Then what we’re looking at is closing several health centers,” said Mangia. “We’re looking at laying off hundreds of staff.”

At Venice Family Clinic, a community health center that serves nearly 45,000 patients annually, 80% of patients rely on Medi-Cal. Roughly half the clinic’s revenue comes from Medi-Cal reimbursements.

Dr. Mitesh Popat, a family physician and head of the clinic, said that federal policy changes — especially more frequent paperwork and added work requirements — will likely push eligible patients off of Medi-Cal. He said the clinic is exploring ways to expand support for patients to navigate the paperwork and keep their coverage.

“This puts a bunch of barriers in the way of people who already have enough challenges in life,” Popat said. “They’re trying to make it, trying to survive, trying to put food on the table.”

The Trump administration has lifted a freeze on federal funds for HIV prevention and surveillance programs, officials said, following an outcry from HIV prevention organizations, health experts and Democrats in Congress.

The Los Angeles County Department of Public Health received notice from the U.S. Centers for Disease Control and Prevention on Thursday that it had been awarded nearly $20 million for HIV prevention for the 12-month period that began June 1 — an increase of $338,019 from the previous year.

“Let’s be clear — the Trump administration’s move to freeze HIV prevention funding was reckless, illegal and put lives at risk,” said Rep. Laura Friedman (D-Glendale) in a statement. “I’m relieved the CDC finally did the right thing — but this never should have happened.”

The CDC didn’t immediately respond to a request for comment.

Friedman and other advocates for HIV prevention funding sent a letter to Health and Human Services Secretary Robert F. Kennedy Jr. last month, warning that proposed cuts to these programs would reverse years of progress combating the disease and cause spikes in new cases — especially in California and among the LGBTQ+ community.

The letter cited estimates from the Foundation for AIDS Research, known as amfAR, suggesting the cuts could lead to 143,000 additional HIV infections nationwide and 127,000 additional deaths from AIDS-related causes within five years.

Los Angeles County, which stood to lose nearly $20 million in annual federal HIV prevention funding, was looking at terminating contracts with 39 providers. Experts said the dissolution of that network could result in as many as 650 new cases per year — pushing the total number of new infections per year in the county to roughly 2,000.

“Public Health is grateful for the support and advocacy from the Board of Supervisors, the Los Angeles County Congressional delegation, and all of our community based providers in pushing CDC to restore this Congressionally approved funding,” a spokeswoman for the county’s health department said.

“Looking forward, it is important to note that the President’s FY26 budget proposes to eliminate this funding entirely, and we urge our federal partners to support this critical lifesaving funding,” she said.

NEW YORK — All 17 experts recently dismissed from a government vaccine advisory panel published an essay Monday decrying “destabilizing decisions” made by U.S. Health Secretary Robert F. Kennedy Jr. that could lead to more preventable disease spread.

Kennedy last week announced he would “retire” the entire panel that guides U.S. vaccine policy. He also quietly removed Dr. Melinda Wharton — the veteran Centers for Disease Control and Prevention official who coordinated the committee’s meetings.

Two days later, he named eight new people to the influential panel. The list included a scientist who criticized COVID-19 vaccines, a leading critic of pandemic-era lockdowns and someone who worked with a group widely considered to be a leading source of vaccine misinformation.

“We are deeply concerned that these destabilizing decisions, made without clear rationale, may roll back the achievements of U.S. immunization policy, impact people’s access to lifesaving vaccines, and ultimately put U.S. families at risk of dangerous and preventable illnesses,” the 17 panelists wrote in the Journal of the American Medical Assn.

The new committee is scheduled to meet next week. The agenda for that meeting has not yet been posted, but a recent federal notice said votes are expected on vaccinations against flu, COVID-19, HPV, RSV and meningococcal bacteria.

In addition to Wharton’s removal, CDC immunization staff have been cut and agency experts who gather or present data to committee members have resigned.

One, Dr. Lakshmi Panagiotakopoulos, resigned after 12 years at CDC, disclosing her decision early this month in a note to members of a COVID-19 vaccines work group. Her decision came after Kennedy decided — without consulting the vaccine advisers — to pull back COVID-19 vaccination recommendations for healthy children and pregnant women.

“My career in public health and vaccinology started with a deep-seated desire to help the most vulnerable members of our population, and that is not something I am able to continue doing in this role,” she wrote in a message viewed by the Associated Press.

Those CDC personnel losses will make it hard for a group of new outside advisers to quickly come up to speed and make fact-based decisions about which vaccines to recommend to the public, the former committee members said.

“The termination of all members and its leadership in a single action undermines the committee’s capacity to operate effectively and efficiently, aside from raising questions about competence,” they wrote.

A spokesperson for the U.S. Department of Health and Human Services did not respond to the JAMA commentary, but instead pointed to Kennedy’s previous comments on the committee.

Kennedy, a leading voice in the anti-vaccine movement before becoming the U.S. government’s top health official, has accused the committee of being too closely aligned with vaccine manufacturers and of rubber-stamping vaccines.

The Advisory Committee on Immunization Practices, created in 1964, makes recommendations to the CDC director on how vaccines that have been approved by the Food and Drug Administration should be used. CDC directors almost always approve those recommendations, which are widely heeded by doctors and guide vaccination programs.

ACIP policies require members to state past collaborations with vaccine companies and to recuse themselves from votes in which they had a conflict of interest, but Kennedy has dismissed those safeguards as weak.

Stobbe writes for the Associated Press.