Will Humble Vaccination, Wills Blog

Arizona Again Among the Worst States for Childhood Vaccination Rates

Each year, the CDC compiles and releases data on childhood immunization rates across the country by examining school-reported data on kindergarten vaccine coverage and exemption status.

Since there’s no national requirement for individual-level vaccine reporting, the best available proxy for estimating childhood vaccination rates is the percentage of kindergartners who are not exempted from school vaccine requirements. States compile and report this data to the CDC, which typically summarizes it in a Morbidity and Mortality Weekly Report (MMWR).

Instead of an MMWR summary with trend analysis and public health context, the CDC quietly released a spreadsheet (without commentary) this year listing each state’s kindergarten coverage rates for vaccines like MMR (measles, mumps, and rubella), DTaP, polio, and varicella. You can find that raw data here: CDC Kindergarten Vaccination Data 2025 (Excel Spreadsheet)

Arizona Ranks 40th of 51 in MMR Vaccine Coverage

This year’s numbers show that just 88.6% of Arizona kindergarteners are up to date on their MMR vaccines, placing Arizona 40th out of 51 (the 50 states plus D.C.). See that Chart Here.

That’s a drop of 0.6% from last year, consistent with a trend we’ve seen for more than a decade, where Arizona’s coverage falls by roughly half a percent every year.

The national picture isn’t much better, but Arizona’s continued slide is alarming—especially considering that the MMR vaccine is essential to preventing measles outbreaks, which have been on the rise globally and domestically.

AZ Childhood Vaccination Rates Declined During the Ducey Administration: Is it Bad Luck or Bad Policy & Management?

ADHS Announces Positive Changes to their Vaccines for Children Program!

An Unusual Pattern in Public Health Rankings

Most public health outcomes tend to follow a familiar regional pattern: Northeastern and West Coast states (typically those with stronger public health infrastructure and progressive policy environments) perform well, while Southern states (those in the “SEC Conference” region) have the worst outcomes.

But vaccination rates is an exception.

For example:

  • Mississippi, a state that usually performs poorly in health rankings, has among the highest childhood vaccination rates in the country.
  • Meanwhile, Minnesota, often considered a leader in health policy, has one of the lowest vaccination rates, even worse even than Arizona.
What Explains the Difference?

Policy.

States like Mississippi don’t allow personal or philosophical exemptions to school vaccine mandates. In other words, unless there’s a medical reason, their kids need to be vaccinated to attend school.

In contrast, states like Arizona have permissive exemption policies that allow parents to opt out of school vaccination requirements for personal or religious reasons. Unsurprisingly, those states consistently rank near the bottom in vaccine coverage.

Why It Matters

The decline in vaccination rates, especially for highly contagious diseases like measles, isn’t just a bureaucratic issue. It puts entire communities at risk. MMR vaccine coverage needs to be above 90–95% to have herd immunity and prevent outbreaks. Arizona, like many other states, is now falling below that threshold.

The Bottom Line

Arizona’s persistent decline in MMR vaccination rates should be setting off alarm bells. We now rank in the bottom 20% of the country, and our trendline shows no sign of reversal. Policy decisions, especially around whether states allow personal choice exemptions are a major reason.

Thankfully, Governor Hobbs has consistently been vetoing bills that would have thrown gas on the fire.

Public health stakeholders, lawmakers, and communities need to pay attention. We know what works, no personal exemptions for school attendance.

Note: For decades, CDC published this data in the form of an MMWR report. This year, it was released only as a raw spreadsheet with no accompanying analysis or context.

Will Humble Professional Development, Wills Blog

Free Professional Development Opportunity: The Satcher Health Leadership Institute

ASTHO and the Satcher Health Leadership Institute with support from CDC invites qualified professionals to apply to the next cohort of the Developing Executive Leaders in Public Health program.

Qualified public health professionals must be currently employed at a local, island/territory, tribal, or state public health department. Federal employees are not eligible to take part in the DELPH program.

Applications | ASTHO

This is a 10-month program with two in-person events. A calendar of events for all virtual and in-person sessions with dates and locations will be shared during the program orientation. Participation in these events is a requirement for participation in the program.

Scholars will be expected to attend and be fully engage in DELPH programming and events.

  • Completing self-study modules and taking part in cohort discussions.
  • Actively engaging with an assigned mentor and executive coach.
  • Actively engaging as a volunteer through association leadership opportunities.
  • Serving as an ambassador to recruit and keep diverse leadership candidates for their agency.

Applications | ASTHO

Will Humble Behavioral Health, Wills Blog

New Executive Order on Homelessness: Big Talk, Small Leverage?

This week, the President issued an executive order directing a few federal agencies (DOJ, HHS, HUD, and DOT) to “crack down” on unsheltered homelessness, substance use, and untreated serious mental illness in ways that feel more like policing than public health.

Ending Crime and Disorder on America’s Streets – The White House

You can read the Executive Order here, but here’s the quick version: the EO tells cabinet agencies to: 1) Support court-ordered treatment and institutional care for people who are homeless and “unable to care for themselves”; 2) Give grant priority to cities that enforce laws against camping, drug use, and squatting; and 3) Withhold funding from harm reduction programs like safe consumption sites.

One line even encourages the collection and sharing of health data with law enforcement, “where allowed by law.”

Note: While Executive Orders give agencies formal direction from the executive, they don’t give them any additional statutory authority. They still need to act within the boundaries in federal law set by congress. If agencies use an EO in a way that exceeds their existing statutory authority it’s relatively straightforward for the judicial branch to overturn those actions.

Most of the Power Lies Closer to Home

From a public health perspective, the EO raises more questions than it answers. First, most of the real levers that impact homelessness and behavioral health lie at the state and local level.

State law determines what qualifies as grounds for court-ordered evaluation or court-ordered treatment. Local governments control zoning, affordable housing incentives, and most eviction policies. States decide whether or not to preempt city NIMBY-informed and unreasonable zoning restrictions that prevent more affordable housing. Substance use treatment systems vary widely from one state to the next.

The Federal Role: More About Funding Than Policy

Yes, the federal government plays an indirect and limited role, primarily through funding. HUD’s Continuum of Care grants, SAMHSA block grants, and DOJ reentry funding can shape what local programs are available and how they’re run.

But the biggest federal lever by far is Medicaid, specifically the 1115 waiver that allows AHCCCS (our state’s Medicaid agency) to experiment with coverage for services like behavioral health, supported housing, and community-based crisis care, including their new H2O initiative.

Striking Absence: No Mention of CMS or Medicaid

And that’s where this EO gets oddly silent. There’s no mention of CMS, 1115 waivers, or how Medicaid policy might be aligned with this new federal posture.

That’s surprising, since Medicaid pays for a huge portion of behavioral health care in Arizona, including treatment mandated by the courts for members with a Serious Mental Illness.

If the President truly wanted to change how states approach serious mental illness, substance use, and homelessness, Medicaid waivers and Medicaid agency oversight would be the place to start.

Instead, the EO is silent on Medicaid and in my opinion reads more like a political message dressed up as policy (at least so far)… except for nebulous expectations for changes in HUD’s Continuum of Care and SAMHSA block grants (which are relatively small).

What HUD and DOJ Might Do (Eventually)

The National Association of Counties issued an objective summary, noting that the EO reflects a shift in federal posture toward institutional treatment and “public safety” requirements, but with few details and unclear implications for how it’ll be implemented.

White House Executive Order Shifts Federal Approach to Homelessness, Mental Illness and Public Safety | National Association of Counties

Agencies like HUD and DOJ are instructed to prioritize enforcement-focused jurisdictions when awarding grants… but again, no specifics yet.

So, What Does This Mean for Arizona?

For now, probably not much. Unless CMS starts using its 1115 waiver authority to reshape Medicaid in ways that align with this EO (which the order doesn’t mention), the direct impacts will be limited in at least the near future. AHCCCS isn’t required to change how it funds COT or behavioral health services. Our housing programs that depend on HUD grants may face new strings attached, but we won’t know until those grant criteria are formally updated.

Public Health Needs the Right Tools, Not Just Tough Talking EO’s

Bottom line: this Executive Order may generate headlines, but it’s not likely to change much in Arizona, at least not yet.

For real progress, we need policy that’s informed by evidence, not just ideology, and that uses the right tools to support people living with serious mental illness, substance use disorder, and housing instability. These tools include Medicaid flexibility, community-based treatment capacity, and housing-first strategies, not just law enforcement crackdowns and institutional beds.

We’ll be watching to see how (or if) the cabinet agencies translate this order into actual policy… or whether a new EO extends this into the Medicaid world. In the meantime, local and state action remain the primary drivers of outcomes.

Will Humble Public Health, Public Health Law, Wills Blog

One Stop Shop for HR1 Public Health Impacts

The National Health Law Program recently published a one stop shop for finding what portions of HR1 will kick in when – things like changes to Medicaid, Marketplace Insurance and SNAP in a report called Budget Reconciliation Act Implementation Dates for Select Medicaid and Health Provisions

More relevant dates and information are found in the third column (for example, sunset dates for temporary provisions, deadlines for federal agency rulemaking or guidance, overlapping rulemaking deadlines, or areas where administrative discretion may affect implementation).

A single provision may have multiple entries to reflect multi-stage implementation across more than one deadline.

Color coding is used to distinguish between the different programs addressed Medicaid (no color), Medicare and Marketplace.

Seems like a pretty important thing to save in your favorites.

Will Humble Healthcare, Public Health, Vaccination, Wills Blog

Three Ways to Reduce the Burden of Cancer and Why NIH & NCI Funding Matters

There are several effective strategies to reduce the burden of cancer, each playing a unique but complementary role in the fight against one of the world’s leading causes of death.

From high-profile breakthroughs in treatment like immunotherapy and precision medicine to prevention and early detection, research funded by the NIH and the National Cancer Institute have been reducing the burden of cancer through prevention and treatment.

Public funding for biomedical and public health research—especially through the NIH and its daughter agency, the National Cancer Institute (NCI)—has been a cornerstone of this progress.

Kennedy’s Defunding of Public Cancer Research Threatens Lives & Future Cancer Treatment & Prevention
Advancing Cancer Treatment Through Foundational Research

The most visible progress in cancer treatment are treatment breakthroughs like new immunotherapies, targeted drugs, and precision medicine.

While the companies that take the drugs the final miles attract the headlines, they’re only possible because of the foundational, long-term research funded by the NIH and NCI.

Comprehensive Cancer Information – NCI

NIH & NCI support the “bottom of the pyramid” work that industry rarely invests in like the core biology, mechanisms of disease, and early-phase research that lays the groundwork for later clinical innovation, clinical trials and finally licensing of new therapies.

Preventing Cancer Through Behavior & the Environment

In public health, our greatest wins come from prevention. Perhaps the most striking example is the decades-long campaign to reduce tobacco use.

Thanks to tobacco taxes, smoke-free laws, education, and cessation programs, smoking rates have dropped dramatically and so have lung cancer rates.

Similarly, public health improvements like food safety regulations and widespread refrigeration have led to declines in stomach cancer, once one of the most common cancers globally. Prevention through behavior change and environmental improvement saves lives before a diagnosis is even on the table.

Catching Cancer Early: Better Screening

Early cancer detection saves lives. Public health programs like Medicaid, Medicare and Marketplace health insurance (the Affordable care Act) increase access to screening like mammograms, Pap smears, and PSA tests which help find cancers when they are most treatable.

Guidelines developed through research ensure screening is both effective and safe, while programs that expand access (especially in underserved populations) ensure equity in outcomes.

A Case Study in Prevention: The HPV Vaccine

One of the most powerful cancer prevention tools is the HPV vaccine. It prevents infections with human papillomavirus, a major cause of cervical and other cancers.

The science that led to the vaccine including the discovery of HPV’s role in cancer, the development of virus-like particle technology, and the conduct of early trials was heavily funded by NIH and NCI… a textbook example of how sustained public investment in basic and translational research can produce life-saving tools.

The fight against cancer depends on a multifaceted approach and it only works when backed by robust public funding. Whether through new treatments, behavioral prevention, early detection, or vaccines like HPV, the contributions of NIH and NCI are foundational to our progress.

Sadly, all of that is now at risk because of Secretary Kennedy’s enthusiasm for dramatically cutting back on cancer prevention, screening and treatment research.

Will Humble Healthcare, Prevention, Public Health, Wills Blog

Kennedy’s Defunding of Public Cancer Research Threatens Lives & Future Cancer Treatment & Prevention

For more than 50 years, the National Institutes of Health & the National Cancer Institute have been sparking major advances in cancer prevention, diagnosis, and treatment. Sadly, those days are coming to an end.

From early chemotherapy trials to new immunotherapies and CAR T-cell treatments, public funding has driven the basic science and clinical research that private industry uses to develop new cancer therapies, prevention strategies and tools.

Without NIH and NCI, many if not most, of the lifesaving cancer therapies we rely on today wouldn’t exist.

NIH and NCI-funded research has led to thousands of patents, laying the scientific groundwork for the private sector to develop therapies with market potential. Achievements like monoclonal antibody therapies, targeted treatments for leukemia, and CAR T-cell therapy for refractory cancers all began in federally funded labs.

Three Ways to Reduce the Burden of Cancer and Why NIH & NCI Funding Matters – AZ Public Health Association

The ROI from NIH and especially NCI funding is huge (6x). For every $100M invested by NIH and their NCI, an estimated $598M in downstream product development is generated.

Private industry and equity plays an important role in therapy development too (especially in late-stage development and commercialization) BUT their focus is mostly on ‘top of the pyramid’ projects with clear market potential… not the core research that provides the foundation for those new therapies.

Without publicly funded early-stage research investment, the pipeline for future breakthroughs will atrophy. Unfortunately, that’s exactly the path the U.S. has been on for the last 6 months.

Kennedy has already slashed NIH & NCI research by an astonishing 35%, and he’s just getting started with his cuts. He has executed mass cancellations of numerous contracts & ended hundreds of research projects (over 800) and layed off ~2,500 NIH researchers.

Note: The canceled NCI research grants were arbitrary and capricious. He didn’t look at the merits of the research or its potential when he the canceled the grants…  he simply used ‘keyword-based filtering’ to find words like ‘disparity’, ‘equity’, ‘gender’, and ‘mRNA’ & summarily canceled the research because a key word was used (without any scientific peer review).

His cuts are doing both short-term damage to cancer research and long-term.

By disrupting and ending the careers of young investigators and ending early-stage research programs, his cuts will kill the careers of the next generation of cancer scientists.

Even if (when) a future, more thoughtful administration and congress restores some of the funding, the loss of research talent, abandoned trials, and broken partnerships will impair progress for decades.

Given Kennedy’s aversion to research, it’ll likely take a profound change in the makeup of Congress before we can reverse the tide… unless there’s success in the courts to stem the tide of bad decisions.

Colorado et al. v. DHHS, RFK Jr.
Arizona Attorney General’s Federal Action Lawsuits

If we’re unable to turn the decision-making tables in the 2026 mid-term election the damage will be profound and probably irreversible. In the meantime, our only backstop are the legal actions being filed in federal courts to stop some of these dangerous actions by Kennedy.

Additional Note:

In federal fiscal year 2025 Congress appropriated $7.22 billion to the National Cancer Institute, the same level as FY 2024.

Secretary Kennedy effectively cut a large portion of that cancer research funding with a freeze on NIH grant-making, delaying NCI awards to the tune of $1.5B. He ended over 240 NIH cancer-related grants, affecting approximately $355 million of NCI‑related research funds. He canceled more than $180M in NCI-specific grants during the first three months of 2025 alone.

Combined, these executive actions resulted in an NCI loss of about $2B (so far) in the current fiscal year.

Kennedy is now proposing a formal cut for next fiscal year to reduce the NCI budget from $7.2B to $4.5B (a 37% cut).

Will Humble Uncategorized

Public Health Journalism this Week

AI data centers are using more power. Regular customers are footing the bill | Arizona Mirror

Indigenous men support each other in pursuing better health care

‘True public servant’: Phoenix health leader Suzanne Pfister dies

Ciscomani voted to defund Planned Parenthood and gut Medicaid, let’s hold him accountable | Arizona Capitol Times

1st West Nile virus-related death of the season occurs in Maricopa County

Session Wrap: Gov. Hobbs on 2025’s victories and ongoing battles | Arizona Capitol Times

Phoenix Elementary School District boosting student health with clincs

Sedona affordable housing development could help city’s rental crisis
Will Humble Assurance & Licensure, Public Health Law, Wills Blog

ADHS Stepping on the Rulemaking Gas

The ADHS has really stepped up the pace of their rulemakings in the last several months. For a long time, stakeholders have been frustrated at the pace of agency rulemakings at the agency. Someone recognized the need for more rule writers in the Operations side of the house.

Among the most important of those rulemakings is one to finally increase the Health Care Institution Fees needed to run the assurance and licensure side of the house. Fees to regulate things like assisted living, skilled nursing, outpatient treatment, hospitals and surgery centers and behavioral health facilities haven’t been adjusted since 2009 when I set them – meaning in real dollars the department only has about ½ the money they did 15 years ago to do that important work.

Among the other important rulemakings underway, the department also finally posted draft rules for Secure Behavioral Health Residential Facilities that will be providing 24-hour on-site supportive treatment and supervision for individuals who are seriously mentally ill and chronically resistant to treatment.

A draft of the proposed rule changes has been posted on the Department’s rulemaking webpage and is available for public comment through July 27, 2025. 

Here’s a listing of the active rulemakings… shows us that someone in leadership over there knows of the need and has finally resourced that critical part of the agency mission.

Rulemakings In Progress – Home

Will Humble Professional Development, Public Health Law, Wills Blog

What the Latest U.S. Supreme Court Term Means for Public Health

As Arizona’s public health community contends with growing needs and strained systems, recent decisions from the U.S. Supreme Court have reshaped the legal landscape in ways that will affect health access, equity, and administration—not just nationally, but here at home.

During President Trump’s second term, SCOTUS weighed in on several major cases that touch the core of public health: access to evidence-based care, health equity, regulatory authority, and protections for vulnerable populations.

The ASU Center for Public Health Law and Policy just completed their annual assessment of key public health law and policy cases before the U.S. Supreme Court for the Journal of Law, Medicine, and Ethics is now available online ahead of print via SSRN at the following link: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5328006.

Here’s a brief overview of the most impactful decisions this term and what they could mean for our work in Arizona:

Where the Court Upheld Public Health Interests

Several rulings affirmed protections that help preserve public health infrastructure and individual rights:

  • USPSTF Authority Preserved
    The Court upheld the legitimacy of the U.S. Preventive Services Task Force, ensuring continued coverage for vital services like cancer screenings and vaccines under the Affordable Care Act.
  • Upholding the Right to Challenge Denials of Public Benefits
    In a COVID-related case, SCOTUS expanded individuals’ ability to bring federal constitutional claims when denied public benefits… critical in safeguarding due process for people relying on health, disability, or food aid.
  • Stronger Protections for Students with Disabilities
    The Court affirmed the right of families to seek federal relief when public schools do not provide adequate plans for children with disabilities, helping ensure long-term health and educational outcomes.
  • Regulatory Power Affirmed for FDA and ATF
    The Court backed the FDA’s authority to regulate flavored vaping products that disproportionately attract youth and affirmed the ATF’s power to classify ghost gun kits as firearms—important wins for harm reduction and violence prevention.
  • Attempt to Regulate Online Pornography to Protect Minors
    In a complex free speech case, the Court acknowledged states’ interests in protecting children from harmful content online.
Key Setbacks
  • Limits on Gender-Affirming Care for Minors
    The Court allowed state bans on medical treatment for transgender youth to stand, even when such care is prescribed by physicians. This decision elevates legislative authority over clinical judgment, raising concerns for Arizona providers and health systems trying to meet the needs of transgender patients within the bounds of evolving state law.
  • Weakened DEI Protections in Employment
    In a ruling that undercuts workplace equity efforts, the Court narrowed the interpretation of Title VII, ending distinctions between systemic discrimination against minority and majority groups. This will make it harder to defend targeted DEI initiatives, including those within public health agencies and nonprofit organizations.
  • Reduced Legal Recourse for Patients Excluded from Medicaid Networks
    The Court ruled that patients cannot sue states for excluding providers who also offer abortion services from Medicaid networks. In Arizona, this limits judicial recourse for marginalized patients whose options may already be severely constrained.
  • Rural Hospitals Denied Reimbursement Relief
    A case brought by rural hospitals seeking better Medicare reimbursement was denied, a decision that may worsen access in Arizona’s already under-resourced rural regions, where provider shortages and uncompensated care burdens are significant challenges.

These rulings remind us that the courts are the most significant force defending against unlawful and unconstitutional policy decisions that have been and will continue to be pressed by the Trump administration and their harmful cabinet secretaries. Keep in mind that the above analysis is just for the US Supreme Court analysis and doesn’t include cases or rulings at the District or Appellate Court levels.

Will Humble Opioids, Public Health, Wills Blog

Kennedy’s Delay of Opioid Surveillance Funds Undermining Arizona’s Opioid Response

As Arizona continues to struggle with overdose deaths driven by fentanyl and other synthetic opioids, state and county health departments are being forced to hit the brakes on one of their most powerful tools in the fight: the surveillance data that informs their opioid settlement fund interventions.

The CDC’s Overdose Data to Action (OD2A) program has been a cornerstone of Arizona’s overdose prevention strategy for the last 6 years. OD2A equips state, county health departments, cities and other jurisdictions with detailed surveillance data on both fatal and nonfatal overdoses, info that’s essential for designing, evaluating and testing public health interventions.

Without OD2A data, overdose prevention becomes guesswork.

This week Secretary Kennedy decided to delay (and likely cancel) $140M in OD2A federal grants. Public health departments are now bracing for a major data blackout.

Addiction funding withheld by Kennedy : NPR

The Arizona OD2A grant expires on September 1. The delay in renewing the grant has already forced jurisdictions to pause or shelve new surveillance activities just as opioid settlement funds, intended to mitigate this very crisis, begin flowing into local communities.

A Historic Billion Opioid Settlement: What It Means for Arizona’s Public Health

Arizona is slated to receive more than $1.1B from national opioid settlements over the next 18 years, with planning underway in counties and cities. But using those funds effectively requires knowing what to fund, where, and for whom.

That’s exactly what OD2A delivered and what Kennedy has delayed and will likely delete.

Cities, counties, and the state now face spending their limited settlement dollars without the evidence needed to guide them, a counterproductive move that impairs effective intervention development.

By pulling back OD2A funding, the federal government is telling states to fly blind.

Secretary Kennedy’s pattern of sidelining evidence-based public health tools has already done tons of harm. If this one is left uncorrected, it’ll weaken overdose response efforts across Arizona and the nation resulting in unnecessary and avoidable deaths.

Making America Healthy Again indeed.

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