Will Humble Public Health, Wills Blog

Who Did More Harm to Public Health in 2025  Kennedy or Rubio?

For much of 2025, public-health debates in the United States have focused on the damage being caused by Health Secretary Robert F. Kennedy Jr. with his reckless vaccine policy decisions, deep funding cuts, the wholesale firing of experienced public-health professionals across HHS agencies, and the loss of trust in public health institutions like the CDC.

His actions weakened domestic health protections and further eroded trust in science, evidence-based decision-making, and the scientific method itself.

But even accounting for all of Kennedy’s harm, the most destructive public-health decision of 2025 didn’t come from his agency. It came from the Secretary of State Rubio via elimination of the U.S. Agency for International Development.

That decision will cost more lives, undermine more health systems, and increase global health risk more than any other public health policy choice made this year. It also delivered a severe blow to America’s ability to lead through diplomacy.

USAID Provided Key Global Public Health Infrastructure

For decades, USAID was one of the most important public-health institutions on the planet, arguably more consequential than the World Health Organization or the Gates Foundation. It served as a core pillar of global disease prevention and health-system stability. Today, it’s gone.

USAID funded (and held partners accountable for) infectious-disease surveillance, HIV treatment, tuberculosis, malaria prevention, maternal and child health services, clean water and sanitation systems, nutrition programs for mothers and infants, vaccine delivery infrastructure, and health workforce training in developing nations.

USAID’s work stopped outbreaks before they became pandemics. It reduced mass displacement. It stabilized regions where collapsing health systems fuel hunger, conflict, and migration. It improved women’s health, helped families plan their futures, and helped entire populations escape poverty.

USAID focused on upstream prevention on a global scale. It was also one of our most effective tools for building diplomatic influence.

Hard Power, Soft Power & Why USAID Mattered

In international affairs, countries project power in two ways. Hard power relies on forces like military strength, sanctions and the threat of punishment. Soft power relies on trust, humanitarian aid, scientific cooperation, and being seen as a reliable partner acting in good faith.

USAID was a key to U.S. soft power. When we helped countries prevent disease, strengthen health systems and keep children alive and families out of poverty, it built credibility. We earned cooperation and trust. It made our leadership legitimate.

Rubio’s elimination of USAID dismantled global public health infrastructure and dramatically weakened our soft power… broadcasting that the U.S. is transactional, unreliable, and disinterested in shared global responsibility.

That erosion of trust will obviously make cooperation during future emergencies more difficult. It will even make collaboration more difficult when a future administration wants to restore the U.S.’ role as an international force for good.

The Damage Is Underway

Thanks to Secretary Rubio disease surveillance is collapsing, meaning outbreaks are detected later or not at all. Interruptions in HIV and tuberculosis treatment are fueling drug resistance, which will inevitably reach us as well.

Gaps in maternal and child health services are translating into preventable deaths. Weakening vaccine infrastructure invites the return of diseases that were on the decline.

Who Owns This Decision

Responsibility for the decision is clear. As Secretary of State, Rubio presided over, defended, and even trumpeted the dismantling of USAID. President Trump supported it. Elon Musk helped drive the ideological thrust that made it possible.

Together, they reframed global public health as expendable “foreign aid” rather than what it is: a frontline defense against disease, instability, humanitarian catastrophe… and a key source of U.S. soft power.

What History Will Remember

Kennedy has done plenty of damage to public health in 2025. But history will judge the elimination of USAID as something worse: an abdication of public health responsibility trading several decades of disease prevention and diplomacy in exchange for personal ambition and professional survival.

History will remember Rubio’s decision as an abandonment of global public health and soft power, not dollars “saved.”

Will Humble Health Insurance, Healthcare, Wills Blog

Congress Fails to Extend Enhanced Health Insurance Tax Credits

The clock has run out for folks hoping Congress will help make their Marketplace health insurance more affordable.

Even though a small number of Republicans in the US House recently joined Democrats to support a discharge petition to force a vote on extending the enhanced premium tax credits (none from AZ including Ciscomani), it came too late to matter for next year.

Speaker Mike Johnson has refused to bring the bill to the floor, and under House rules, any vote wouldn’t happen until January.

Health plans that start January 1, 2026 are already priced and no longer include the former enhanced advance premium tax credits. 

Even if the House acts in January, it’s doubtful the Senate would follow. The practical result is straightforward: the enhanced premium tax credits are almost certainly gone.

As a result, Marketplace premiums will rise a lot for most of the 350,000 or so Arizonans who buy Marketplace health insurance.

Those former enhanced subsidies mainly helped people earning between 138% and 400% of the federal poverty level, working adults who don’t qualify for Medicaid and don’t get insurance through a job.

The impact will be different depending on how much the person or family makes.

  • People closer to 138% of poverty will see the largest percentage increases in premiums.
  • People between 300% and 400% of poverty will face large dollar increases — often hundreds of dollars more per month.

Folks will now be making various choices depending on their values and family circumstances. I can think of 4 different ways this will affect Marketplace customers:

  • They’ll drop coverage altogether, gambling that they won’t get sick or injured. Healthier and younger people will disproportionately choose this option – further damaging the risk pool and making premiums go up in the long run.
  • They’ll downgrade plans, moving from Gold or Silver to Bronze plans with lower premiums but sky-high deductibles.
  • They’ll pay more and cut back elsewhere, staying in the same plan category but sacrificing other household needs.
  • They’ll change jobs for insurance, giving up freelance work or small businesses to find employer-sponsored coverage.

ACA Premiums Set to Increase in 2026 as Enhanced Marketplace Premium Tax Credits Expire – AZ Public Health Association

The former enhanced premium tax credits have worked exactly as intended. KFF data show they helped drive record marketplace enrollment and made coverage affordable for middle-income families who were previously priced out.

This was a policy choice. Congress has chosen higher premiums, fewer insured people, a weakening of the risk pool leading to higher long term premiums, more medical debt and uncompensated emergency department care.

Remember that in November.    

How to handle Obamacare uncertainty 

Will Humble Maternal Health, Public Health, Wills Blog

Evidence-Based Advocacy Comes at a Price: Kennedy Punishes the American Academy of Pediatrics for Disagreeing with the New Hepatitis B Vaccine Guidance

Last week Kennedy canceled numerous federal grants previously awarded to the American Academy of Pediatrics. The decision came right after the Academy publicly criticized a new Advisory Committee on Immunization Practices recommendation to delay the Hepatitis B vaccine for some newborns.

Kennedy’s message: Criticize my agency policies and you’ll lose your funding.

The grants that were cut supported work the AAP has done for years like educating pediatricians & parents about vaccines, improving maternal & child health care, preventing injuries, strengthening clinical guidance, and helping doctors reach families with evidence-based health information.

Kennedy’s action highlights a fact that many nonprofits face (including AZPHA): Advocacy that stays true to your mission caries a financial risk.

It happens at the state and local level too. AzPHA learned this years ago, when we lost our largest organizational member and sponsor over our support for evidence-based firearm safety legislation. A couple of years ago we lost a county health department organizational membership for the same reason. 

Every nonprofit receiving government funding faces this same calculation. Do we speak authentically and vocally when policies supported (or opposed) by an organizational member or sponsor threaten public health, or do we stay quiet to protect revenue?

That’s why diversified funding matters so much. Nonprofits that rely too heavily on a single government agency whether federal, state, or local are more exposed when their priorities differ from those of their funder.

A broad mix of funding sources provides a buffer. It allows organizations (like us) to tell the truth, even when it makes politicians and appointees mad.

That’s what we’ve been striving for at AZPHA over the last few years…  a broader base of member organizations to diversify our funding and provide a financial buffer so we’re able to do evidence-based advocacy and buffering revenue risk.

Advocacy grounded in evidence and mission will sometimes upset funders. But if nonprofits stop advocating for what they believe in they’ll stop being who they are.

Public health depends on organizations willing to speak up like the American Academy of Pediatrics and AZPHA even when it costs them.

Will Humble Public Health, Wills Blog

Phoenix Imposes Criminal Penalties for Providing ‘Street Medicine’ in Parks without the Parks Director’s Permission

Last week the Phoenix City Council voted 8–1 to pass a sweeping new ordinance banning volunteer street-medicine services in city parks unless providers first get a permit from the city’s Parks and Recreation Department Cynthia Aguilar (who wrote the ordinance).

Phoenix bans syringe access, limits medical events in city parks

Beginning in April it will be a criminal Class 1 misdemeanor for volunteers to provide medical services in parks without a permit from Aguilar. Disobey by providing health related humanitarian aid without a permit & you’ll face 6 months in jail, big fines and a permanent criminal record. 

View Aguilar’s Ordinance

The new ordinance squarely targets the services provided by Phoenix Street Medicine to persons experiencing homelessness. Phoenix Street Medicine is a program coordinated by the UA Mel & Enid Zuckerman College of Public Health with collaboration from UA College of Medicine, ASU, NAU, Midwestern University, and Creighton University.  One of the co-founders is AZPHA Board Member Jeffery Hanna.

Their mission is simple and evidence based: meet people where they are, rather than expecting them to navigate a system that often shuts them out. The program hosts about 12 outreach events each month, mostly at Hance Park in downtown Phoenix.

The humanitarian services they provided were wide-ranging and practical, including:

  • Blood pressure, blood sugar, cholesterol, and A1c screening
  • Physical exams, wound care, foot care, and other urgent needs
  • Flu, COVID-19, and Hepatitis A vaccines
  • Mental health screening and education
  • Narcan distribution to prevent overdose deaths
  • Vision screening and prescription glasses
  • Help with medications, daily living needs, and referrals to clinics and community resources

The program was also an important professional-development resource. Medical, nursing, and public-health students gain real-world experience working with high-need populations under the supervision of licensed clinicians.

That training helped build a workforce that understands trauma-informed care, harm reduction, and the realities of homelessness in Arizona.

The 8-1 council vote came despite hours of public testimony from dozens of physicians, nurses, public-health professionals, service providers, students, and community members.

Many of them (including Arizona Public Health Association members) urged the council to slow down, reconsider, or narrow the ordinance. They warned that criminalizing basic medical care would make people sicker, not safer. The council approved it anyway.

The authority to issue or deny Phoenix Street Medicine permits rests Aguilar, who will have unilateral power to approve or deny permits.

Judicial review may not matter because there are no clear standards, timelines, or appeals process laid out in the ordinance. Or maybe judicial review will work because of the lack of those criteria?

My biggest concern is that Aguilar will simply refuse to issue permits to Phoenix Street Medicine, effectively shutting down the services. If (when) that happens people experiencing homelessness will lose access to basic care, and the city will see more preventable crises spill into emergency rooms and jails.

Phoenix has chosen enforcement over compassion and people experiencing homelessness will pay the price if (when) permits become a tool to block care rather than enable it.

Time will tell.

Will Humble Professional Development, Wills Blog

Public Health Upcoming Events

 

AZPHA Member Breakfast & Learn

American Indian Health Education Center (AHEC) Workforce Development

Friday, January 9, 2026

9am – 10am


Our Speakers: Brooke Rector & Angel Sanchez

Brooke Rector
Brooke Rector is the Youth Program Coordinator for AIH-AHEC, where she works to expand health career opportunities for Native students, address the underrepresentation of Native professionals in healthcare, and help alleviate workforce shortages. She leads the Youth Career Pathways Program, collaborating with tribal leaders, elders, and healthcare institutions to ensure that training is grounded in traditional knowledge while incorporating modern medical practices.

Brooke also coordinates summer programs, health clubs, and student resources that provide youth with hands-on exposure to careers in medicine, nursing, public health, and allied health fields. She is passionate about promoting health across Arizona, particularly among youth and underserved communities.

Angel Sanchez
Angel Sanchez is the Academic Pathways Coordinator for AIH-AHEC. He holds a Bachelor of Public Health from Arizona State University and a Master of Public Health from the University of Arizona. Angel previously worked as a Student Support Specialist at ASU’s College of Health Solutions.

In his current role, he supports high school and college students pursuing careers in healthcare and public health, applying his knowledge of healthcare policy and administration to strengthen Tribal communities and address workforce needs across Arizona.

Register Here

The Hertel Report Winter State of the State Conference

Join The Hertel Report’s Winter State of the State on Friday, February 13, 2026, featuring our bi-annual Arizona healthcare market update hosted and moderated by Publisher Jim Hammond.

  • $15 Discount for AZPHA Members: Use Code AZPHA2026

WINTER STATE OF THE STATE

Friday, February 13, 2026

Networking & Breakfast Begins 7am

Program: 8am to 10:30 am

Orange Tree Golf Resort, Scottsdale

Virtual Attendees Welcome!

The Hertel Report’s 2026 Winter State of the State Conference features a morning of networking, a full breakfast, and timely insights on Arizona’s healthcare market. Get the latest updates on Medicaid, Medicare Advantage, Marketplace, ACOs, and commercial market trends, and explore how the Trump administration’s priorities are shaping health policy, public health, and the strategies Arizona’s healthcare leaders are using to navigate the evolving landscape.

Register for the Hertel Report Winter State of the State Conference Here
Will Humble Professional Development, Wills Blog

Public Health Journalism this Week

Who’s Who in Arizona Healthcare for 2026 – AZ Big Media

Arizona advises providers continue giving Hep B vaccine

Arizona lawmaker wants to ban fluoride from drinking water

Will Humble fears RFK Jr.’s vaccine policies will make them unavailable for everyone. Here’s how

Phoenix bans syringe access, limits medical events in city parks

Arizona group tracks untreated mental illness in violent crimes

Will Humble Medicaid, Social Determinants, Wills Blog

UPDATED: Where Does Arizona’s Medicaid Work Requirement Planning Stand? A Summary

Arizona has been working on Medicaid work requirements for several years. AHCCCS (our state Medicaid agency) even received federal approval for a waiver to start work requirements in 2024 due to a law signed by Ducey in 2015.

AHCCCS Asks Permission to Implement Work Requirements & Five-Year Benefit Limit – AZ Public Health Association

But before the program could launch Congress passed HR1, which set new, national work requirements for every state.

Because of that change, Arizona will now begin work requirements on the same timeline as the rest of the country. Right now, that start date is expected to be January 2027.

AHCCCS says they don’t plan to start work requirements early using the old waiver. Instead, they’ll move forward under the new rules in HR1.

What HR1 Means for Arizona

HR1 makes work requirements part of federal law. It also limits the federal government’s ability to change or weaken those rules. Even though Mehmet Oz is in charge of CMS, HR1 doesn’t give him the power to create new, nationwide policy. Congress wrote HR1 so states (not CMS) decide the details of who’s exempt, as long as states stay within the boundaries of the law.

But- if a state proposes exemptions that Oz thinks are too broad he can argue that the state is outside the HR1 guardrails and can decide not to approve their state plan.

This means Arizona should have the flexibility to define things like:

  • Who’s “medically frail” (e.g. able bodied)
  • Who counts as a caregiver
  • What counts as a temporary illness
  • What hardship or “good cause” exemptions look like
  • What documentation people need to show
  • How work hours will be checked

Oz can review a state’s choices, but he can’t rewrite the rules or add new exempt groups. His job (via HR1) is to make sure Arizona’s following HR1, not to micromanage the program.

UPDATE: View CMS Guidance for Work & Community Engagement Requirements
UPDATE: View the American Hospital Association’s Take on the Work/Community Engagement Requirements

What AHCCCS Has Done So Far

Think of what AHCCCS is doing right now as grading a road before construction begins. They know the path they need to take, but they’re still waiting for instructions about the exact “route and materials” required. CMS says more guidance will come by June 2026.

Much of the planning AHCCCS has already completed for its earlier waiver can now be reused. I expect them to use many of the same definitions and processes they developed last year. This helps keep the work moving while they wait for more federal direction.

See: AHCCCS Asks Permission to Implement Work Requirements & Five-Year Benefit Limit – AZ Public Health Association

AHCCCS is also looking at how people will report their work activities. They haven’t yet decided whether this tool will be inside Health-e-Arizona Plus or linked to it, but the goal is to make the process as simple as possible for members.

CMS has also encouraged states to reuse systems they already have, such as the work-verification tools used for SNAP. This could make it easier for members who already report work information for other programs.

Costs and Planning

AHCCCS has estimated the costs of getting ready for the 2027 start date. You can find these on pages 7 and 195 of their FY 2027 budget request: : FY2027 AHCCCS Budget.

These numbers may change as Arizona learns more from CMS and moves further down the implementation road.

Editorial Note: In my experience rewriting code on a legacy computer program to bolt on a new set of circumstances is fraught with challenges. Usually, the person that wrote the initial code is long gone and often the code documentation is lost or never existed – making it super hard for the programmers.  

Add to that government agencies often don’t have the funds to get started writing the code and or don’t have the parameters they need to make the changes in time. This often leads to the deployment of untested programs that have all kinds of glitches. In this case – the glitches will end up with persons who meet the work requirements being unable to prove it to the agency that they do and then losing all health insurance.

Time is a critical factor. Let’s hope AHCCCS has things sufficiently lined up to be able to execute this effectively in 13 months.

Will Humble Prevention, Professional Development, Wills Blog

Action Alert: Phoenix Considers Outlawing ‘Phoenix Street Medicine’ Tomorrow

A proposal from City of Phoenix Parks and Recreation Director Cynthia Aguilar would make it a crime to provide basic medical screenings to people experiencing homelessness in city parks unless her department gives special permission — permission that is unlikely to be granted.

Proposed Phoenix ban may end medical aid to homeless in parks

If approved by the Phoenix City Council tomorrow (Thursday December 17 at 2:30pm at the Phoenix City Council Chambers, 200 W. Jefferson St., Phoenix, AZ), the measure would basically outlaw the Phoenix Street Medicine program and put volunteer health workers at risk of arrest by Phoenix Police and prosecution for a Class 1 misdemeanor by the County Attorney with punishments of 6 months in jail and $2,500 in fines if they continue to do this important work.

Request to Speak Virtually Against the Motion (Item 46)

Sign the Petition · Oppose Phoenix Park Ordinance Prohibiting Medical Care and Harm Reduction

Aguilar’s target is clear: Street Medicine Phoenix, a volunteer health program organized by the University of Arizona, which provides care to people who otherwise have little or no access to the health system.

Street Medicine Phoenix | Zuckerman College of Public Health

Street Medicine Phoenix began in 2017, founded by University of Arizona medical students who wanted to bring health care directly to people living on the streets, in encampments, and in public spaces. One of the co-founders is AZPHA Board Member Jeffery Hanna.

The Street Medicine Phoenix mission is simple and evidence based: meet people where they are, rather than expecting them to navigate a system that often shuts them out.

The program hosts about 12 outreach events each month, mostly at Margaret T. Hance Park in downtown Phoenix and in areas once known as “The Zone”. The services they provide are wide-ranging and practical, including:

  • Blood pressure, blood sugar, cholesterol, and A1c screening
  • Physical exams, wound care, foot care, and other urgent needs
  • Flu, COVID-19, and Hepatitis A vaccines
  • Mental health screening and education
  • Narcan distribution to prevent overdose deaths
  • Vision screening and prescription glasses
  • Help with medications, daily living needs, and referrals to clinics and community resources

This care is free, voluntary, and evidence based. No one is forced to take part. No one is charged.

People experiencing homelessness face much higher rates of chronic disease, mental illness, and early death. In the summer they are at a 500 times higher risk of dying from excessive heat.

Many avoid hospitals or clinics because of cost, fear, transportation barriers, or past trauma. Street Medicine Phoenix and similar programs have been shown to improve health outcomes, reduce emergency room visits, and build trust between vulnerable people and the health system.

Street Medicine Phoenix is doing exactly what public health should do, prevent illness, reduce suffering, and connect people to care before small problems become emergencies.

Sadly, someone on the council or the leadership of Phoenix Parks and Recreation wants to end the program and even criminalize their humanitarian aid.

The compassionate and logical response from city staff would be to support, partner with, or expand the program, not criminalize it.

There’s another major benefit to this program that the proposal would trash. Street Medicine Phoenix provides important early-career training for students and professionals from the UA College of Public Health and College of Medicine, along with partners from ASU, NAU, Midwestern University, and Creighton University.

Future doctors, nurses and public health professionals gain real-world experience working with vulnerable populations. They learn empathy, cultural humility, and how social conditions shape health. The experience comes at an important early-career time… valuable experience which will carry through to the rest of their career.

By the way… the proposal wasn’t vetted through City Council subcommittees or village planning committees, which is the normal process for major policy changes proposed by city department leaders or a council member.

It’s been radio-silence from Aguilar and the elected council members about their motivation. Nobody has yet explained why blood pressure checks, wound care, or vaccines and referral to services in a park should be a crime punishable by jail time.

In my opinion, Aguilar’s proposal to criminalize volunteer medical care isn’t how you “build healthy communities” (straight from the Parks and Rec website).

The Phoenix City Council should reject the proposal and instead stand with Street Medicine Phoenix, a program that reflects the best of public health, compassion, and common sense. We urge AZPHA members to contact their city Council members and urge them to shoot down this cruel policy and if possible, attend the meeting and ask to speak to the Council.

Request to Speak Virtually Against the Motion (Item 46)

Sign the Petition · Oppose Phoenix Park Ordinance Prohibiting Medical Care & Harm Reduction
Thursday December 17 at 2:30pm
Phoenix City Council Chambers, 200 W. Jefferson St., Phoenix, AZ
Contact Your Councilperson

Mayor Kate Gallego

District 1 – Vice Mayor Ann O’Brien

  • Email: council.district.1@phoenix.gov
  • Phone: 602-262-7444

District 2 – Jim Waring

  • Email: council.district.2@phoenix.gov
  • Phone: 602-262-7445

District 3 – Debra Stark

  • Email: council.district.3@phoenix.gov
  • Phone: 602-262-7441

District 4 – Laura Pastor

District 5 – Betty Guardado

District 6 – Kevin Robinson

  • Email: council.district.6@phoenix.gov
  • Phone: 602-262-7491

District 7 – Anna Hernandez

  • Email: council.district.7@phoenix.gov
  • Phone: 602-262-7492

District 8 – Kesha Hodge Washington

  • Email: council.district.8@phoenix.gov
  • Phone: 602-262-7493
Will Humble State Legislature, Wills Blog

Legislative Session Begins January 12: Our Advocacy Approach

January 12 marks the beginning of the 2024 legislative session. The kickoff will be the Governor’s address to the legislature where she’ll outline what she sees as priorities.

Our Advocacy Approach

AzPHA will follow the session closely and express our support or opposition to bills based on a simple core principle…  we support bills that will have a positive impact on public health especially when they are evidence-based or evidence-informed.  We oppose bills that are likely to have a negative impact on public health. 

Our support or opposition to bills is located on the https://www.azleg.gov/ site under RTS Current Bill Positions. We have a host of Resolutions that also guide our advocacy which are posted on our website.

The fact that we have Resolutions on so many core public health priorities make it easy for us to be swift with our support or opposition. Our Resolutions go all the way back to the 1930s. They are started by either the Board or our members and all resolutions have been voted on and approved by our members.

Our Public Health Policy Committee has a discussion board on Basecamp and that’s also where we post information, research and documents related to public health policy.  Let me know if you’d like to sign up for that Basecamp site at willhumble@azpha.org.

Our policy committee also has conference calls every Friday at 2pm starting on January 9 and usually lasting through the last Friday in February. The calendar in the policy committee basecamp has the URL for the zoom meetings.

More details as the session actually approaches – but those are the basics.

PS: So far we’ve signed up against bills that would ban community water fluoridation, make ivermectin over the counter, and we signed up for a bill that would limit the speed limit for e-bikes (the kinds that don’t require a license – the ones the kids use) to 15mph.

Will Humble Disease Control, Prevention, Wills Blog

Arizona State Fair E-coli Outbreak: Petting Zoos Need Basic Safety Rules

Petting zoos can be a lot of fun for kids. They’re a teaching tool as well, helping kids have experiential learning opportunities about farm animals & agricultural life.

But they also come with real risks. Germs like E. coli, which live in the gut of many farm animals, can spread easily in these settings. These infections can cause severe stomach illness, kidney damage, long hospital stays, and in some cases can even be deadly.

CDC has written many reports over the years showing outbreaks linked to petting zoos.

Enteric Disease Outbreaks Associated with Animal Contact — Animal Contact Outbreak Surveillance System, United States, 2009–2021 | MMWR
Outbreaks of Escherichia coli O157:H7 Associated with Petting Zoos — North Carolina and Florida, 2004 and 2005

When I worked at the ADHS in jobs ranging from disease control epidemiologist to agency director we took this risk seriously. For years, we made it standard practice to send our vector-control staff to the State Fair before opening day. Our goal was simple: make sure the petting zoo area had the basic protections needed to keep kids safe.

We didn’t license petting zoos, and we didn’t have enforcement power. But the State Fair always welcomed our help, and they followed our recommendations. Those steps were not complicated. They included:

  • Barriers to guide visitors in and out safely.
  • Limits on how many kids could be inside the animal area at one time.
  • Hand-washing sinks with running water, soap, and paper towels at both the entrance and exit.
  • A staff monitor on-site to watch behavior and make sure kids wash their hands on the way out.

These simple steps helped prevent outbreaks. Unfortunately, the department appears to have dropped this best practice. This year Arizona kids paid the price.

During the 2025 Arizona State Fair, a major E. coli outbreak occurred among children who visited the petting zoo. According to news reports there have been many cases linked to the exhibit, and several kids were hospitalized with serious complications. Some were diagnosed with hemolytic uremic syndrome, a kind of kidney injury that can be life-threatening.

Parents reported long delays in learning about exposures, and public warnings went out only after many children were already sick.

coli outbreak at Arizona State Fair may have started with pig
coli cases tied to Arizona State Fair didn’t trigger public warning

This outbreak was preventable. Nothing about it was new or surprising. CDC research, state outbreak investigations from around the country, and decades of experience all say the same thing: petting zoos need basic controls in place to reduce risk — especially when little kids (and pigs) are involved.

The 2025 outbreak demonstrates that Arizona can’t rely on safety practices that disappear when health department leadership changes. The State Fair runs for weeks and attracts hundreds of thousands of visitors. Any high-contact animal exhibit of that size should meet a minimum set of health and safety rules.

It’s time for Arizona to put simple, proven standards into law for long-standing exhibits like those at the state fair. Kids deserve protection, parents deserve transparency, and vendors deserve clear expectations.

I did a bit of research about what other states have in place and wrote a short model law (with some help from Chat GPT) and sent it to a state senator for consideration this session.

Perhaps you’ll hear about the bill in an upcoming policy update during the legislative session.

State Laws Requiring Hand Sanitation Stations at Animal Contact Exhibits—United States, March–April 2016 | MMWR
Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2009 – National Association of State Public Health Veterinarians

____________________

TITLE 36. PUBLIC HEALTH AND SAFETY
CHAPTER 6. ANIMAL CONTACT EXHIBITS
ARTICLE 16. LONG-TERM PETTING ZOOS

36-799. Definitions

  1. “Long-term petting zoo” means any animal-contact exhibit or activity open to the public for a continuous period of more than seven (7) days.
  2. “Operator” means any person, partnership, corporation, fair, or other entity that owns or manages a long-term petting zoo.
  3. “Animal-contact area” means any enclosure, pen, stall, walkway, or other space where the public may touch or otherwise have direct contact with live animals.

36-799.01. Minimum sanitation and safety requirements

  1. No operator shall open or maintain a long-term petting zoo for public use in this state unless the following minimum conditions are continuously maintained while the exhibit is open:
  2. Controlled access and egress: sturdy barriers or fencing shall be installed to create a unidirectional visitor flow with one entrance and one exit to the animal-contact area.
  3. Occupancy limit: the operator shall limit the number of children (persons under eighteen years of age) inside the animal-contact area at any one time to a maximum number determined by the operator in writing and posted at the entrance; in no case shall more than twenty (20) children occupy the area simultaneously, unless a lower limit is posted.
  4. Hand-washing facilities: hand-washing stations with potable running water, liquid soap, and single-use disposable towels shall be provided at both the entrance and the exit of the animal-contact area. These stations must be maintained in functional, sanitary conditions throughout operating hours.
  5. On-site monitoring: at least one staff monitor per twenty (20) children (or fraction thereof) shall be present in or adjacent to the animal-contact area during all hours of public access; the monitor’s duties shall include enforcing proper handwashing of all visitors upon exit and supervising animal-contact behavior to prevent unsanitary or unsafe conduct.
  6. The operator shall keep a written record of the posted occupancy limit and of the dates and times during which each monitor is on duty; such records shall be retained for a period of at least twelve (12) months and made available for inspection by authorized personnel upon request.

36-799.02. Enforcement and penalty

  1. The Arizona Department of Health Services Director shall have authority and responsibility to inspect long-term petting zoos for compliance with this article.
    B. Any operator found to be in violation of one or more provisions of this Article shall be subject to a civil penalty of up to five hundred dollars ($500) per day per exhibit until the violation is corrected.
    C. The Director may adopt rules necessary to implement and enforce this article, consistent with the minimum requirements set forth here.
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