Will Humble Vaccination, Wills Blog

Kennedy’s Not-So-Silent War On Vaccination

In what may be an early warning of a public health crisis, Secretary Kennedy is imposing new clinical trial requirements on the Novavax COVID-19 vaccine for each updated variant.

This marks a departure from the streamlined approval process that previously allowed updated vaccines tweaked to focus on new antigens.

According to a recent NBC News report, FDA appears to be slow-walking vaccine approvals this bureaucratic slowdown could be the tip of the iceberg. If these new hurdles become the standard, Pfizer and Moderna’s mRNA vaccines may soon face the same impossible demands: full-scale clinical trials for every tweaked version tailored to emerging variants.

Kennedy may even apply the same ‘logic’ to the seasonal flu vaccine, which is reformulated each year based on evolving strains.

It’s logistically impossible to conduct full clinical trials in time for each flu or COVID variant. If the FDA (Kennedy) insists on this standard, it could lead to the effective de-authorization of all COVID and flu vaccines.

As Politico reported,   RFK Jr. eyes reversing CDC’s Covid-19 vaccine recommendation for children  Kennedy is already planning to pull COVID vaccine recommendations for kids.

If he follows through, it’s a man-made disaster. Tens or even hundreds of thousands of preventable deaths annually, and a healthcare system overwhelmed by millions of unnecessary hospitalizations.

I know I keep writing gloom and doom stuff – and it is probably making you sad and overwhelmed – but it’s times like these when we need to use our collective professionalism, education, experience and ethics in motion to pushback however we can – even if it’s just writing this blog.

If we don’t act now, we may soon find ourselves unarmed in the fight against both seasonal and pandemic diseases—with devastating consequences.

Note: Next week I’ll cover the legal interventions to some of Kennedy’s decisions that have been taken by APHA. If you feel powerless and want to do something about all this damage to public health – one thing you can do is simply join APHA. 

Will Humble Medicaid, Wills Blog

AHCCCS Asks Permission to Implement Work Requirements & Five-Year Benefit Limit

​AHCCCS just turned in their waiver request to the CMS asking permission to implement work reporting requirements and establish a five-year lifetime limit on Medicaid benefits for certain adults.

The proposal aligns with Senate Bill 1092 (enacted in 2015) which requires AHCCCS to annually ask CMS permission to implement a work requirement & 5-year lifetime benefit cap for able bodied adults.

See the Final Submitted Waiver Request

As you might expect – the real key in the waiver is the definition of who is ‘able bodied.’

AHCCCS’ proposal has a long list of categories of adults that are exempted because they’re not considered ‘able bodied.’ More on that in a bit.

Once approved by CMS (which will happen unless they think AHCCCS was too generous with excluding populations), “able-bodied adults” aged 19 to 55 would need to engage in at least 20 hours per week of qualifying activities like a job, school attendance or participation in “Employment Support and Development” programs in order to keep their Medicaid coverage.

There will also be a 5-year lifetime limit for Medicaid enrollment in AZ for “able-bodied adults”. ​

Exempt Populations:

  • People who are at least 56 years old;
  • Those who qualify for services through the Indian Health Service or Tribally-Operated Health Facilities;
  • Native Americans;
  • Women up to the end of the 12-month postpartum;
  • Former Arizona foster youth up to age 26;
  • People determined to have a serious mental illness or who have have a qualifying SMI diagnosis;
  • Those in active treatment with respect to a substance use disorder;
  • People receiving temporary or permanent long-term disability benefits from a private insurer or the government;
  • Individuals who are receiving Supplemental Nutrition Assistance Program, Cash Assistance, or Unemployment Insurance income benefits;
  • People who are exempt from ADES’ SNAP Work Requirement programs;
  • Individuals who are determined to be medically frail; 
  • Individuals who have an acute medical condition (physical and/or behavioral) that would prevent them from following the requirements;
  • Full-time high school students who are older than 18 years old;
  • Full-time trade school, college, or graduate students;
  • Victims of domestic violence; 
  • People taking part in AHCCCS Works;
  • Individuals who are homeless or who were recently homeless for up to six months post-housing; 
  • Individuals who have recently been directly affected by a catastrophic event such as a natural disaster; 
  • Parents, caretaker relatives, foster parents, and legal guardians, and caregivers of individuals diagnosed with SMI;
  • Caregivers of a family member who is enrolled in the Arizona Long-Term Care System (ALTCS);
  • Individuals who were incarcerated within the last six months; or
  • Veterans regardless of the discharge status.

Effective implementation will depend on AHCCCS’s ability to cross-reference databases to find exempt individuals, collaborating with agencies like ADES, Social Security etc. for data sharing.

Additionally, it’ll be super important to set up user-friendly systems for “able-bodied” members to report their work, school attendance, or ESD program participation is crucial to prevent unnecessary loss of coverage due to documentation challenges.​

I expect the work program and the 5-year benefit limit for able bodied adults to begin October 1, 2025.

See the Final Submitted Waiver Request

AHCCCS Seeks Public Input on Proposed Medicaid Work Requirements & 5-Year Lifetime Limit on Benefits – AZ Public Health Association

Will Humble Medicaid, Wills Blog

Congressional Budget Office Scores Various Medicaid Cut Impacts

The Congressional Budget Office was established by congress in 1974 to give congress objective, nonpartisan information to help them make decisions about budget and economic policies.

The CBO is part of the Legislative Branch – and is supposed to provide nonpartisan alternatives to the information from the Office of Management and Budget – which is part of the Executive Branch.

This week the CBO scored the financial and health insurance impacts (loss of health insurance coverage) of various options for cutting Medicaid beging considered in congress right now.

Rather than give a breakdown I thought I’d just link to the CBO Letter to Wyden-Pallone Letter -Medicaid and you can read it for yourself. It’s only 8 pages long.

Jan Brewer: Scaling back AHCCCS hurts all of Arizona | Opinion

Will Humble Professional Development, Wills Blog

Public Health Journalism this Week

Jan Brewer: Scaling back AHCCCS hurts all of Arizona | Opinion

An Arizona measles outbreak is ‘inevitable.’ Are we ready? | Phoenix New Times

GOP proposals to cut Medicaid could leave millions without health insurance, budget office finds | Arizona Mirror

US measles cases surpass 1,000 in 2025: See cases by state

Rural Arizona understaffed, underfunded ahead of wildfire season | Arizona Capitol Times

Will Humble Professional Development, Wills Blog

Free Arizona Digital Health Symposium – Charting a Course for Advancing Digital Health

The Arizona Digital Health Symposium is bringing together health leaders across sectors this Friday to share insights and generate ideas that will accelerate the creation and adoption of innovative technologies that can improve the health of Arizonans this upcoming

Friday, May 16 from 9am to 4pm.

There’s no charge for pre-registrants.

Arizona Digital Health Symposium | College of Health Solutions

The event will serve as a catalyst for advancing digital health research, fostering cross-sector collaboration, and creating and translating groundbreaking innovations into practical applications that improve health outcomes for Arizonans.

Location: Health Futures Center, 6161 E Mayo Blvd, Phoenix, AZ 85054

Arizona Digital Health Symposium: Charting a Course for Advancing Digital Health Registration

Will Humble Climate Change, Social Determinants, Wills Blog

HB2679: A Reckless Bill Foisting Utility Debt On the Public

Arizona lawmakers are again pushing a bill that prioritizes utility profits to their shareholders over public interest, clean air and the social determinants of health.

HB2679  — titled “power; public utilities; UCC; securities” (sponsored by Rep. Griffin) — is headed for the Governor’s desk after being fast-tracked through the Senate Tuesday and the House Wednesday, with little transparency, minimal stakeholder engagement, and virtually no opportunity for public review.

What Is HB2679?

HB2679 is being pushed by APS to let them issue bonds to recover and imposes “non-bypassable” charges on ratepayer utility bills. It basically would let utilities like APS move debt from their balance sheet into mandatory ratepayer charges.

Non-bypassable means there’s a mandatory fee added to all utility customers’ bills which can’t be avoided even if they generate their own power (e.g., via rooftop solar) or reduce energy usage via energy efficiency measures etc.
If Governor Hobbs signs HB2679, utilities will be able to move debt into bonds to recoup funding from inefficient assets like coal-fired power plants. They’d then be able to pass on those unlimited costs directly to our bills, with no cap, little proper vetting and limited oversight from the Arizona Corporation Commission (ACC).
APS will pay anything to craft energy policies in its favor | Opinion
Because HB2679 doesn’t cap how much bad debt utilities can turn into ratepayer charges, there’s NO limit on what you could be forced to pay.
Even after the amendments this week, it would still shift financial liability away from the utilities and onto customers who would be on the hook.

Extending the Life of Dirty Coal Plants

Besides the fact that customers rather than shareholders would be on the financial hook, HB2679 would likely extend the operational life of the Four Corners Power Plant. This comes at a direct cost to:

  • Ratepayers, who will be stuck footing the bill for electricity they buy from outdated inefficient infrastructure.
  • Public health, especially for communities already disproportionately affected and because low-income people will be stuck with unavoidable electricity fees.
  • The Environment, as the continued burning of coal harms air and water quality.
While HB2679 claims to empower the Arizona Corporation Commission to approve or deny utility bond applications, it has contradictory language. Even if the ACC rejects a bond application, the “non-bypassable” consumer fee —would still added to your bill.
The real beneficiaries are APS shareholders — not everyday Arizonans.
Unlike similar utility securitization policies adopted in Colorado and New Mexico, HB2679 doesn’t include meaningful guardrails. In those states, the retirement of coal plants was part of broader, thoughtful energy transition plans. Arizona’s version lacks:
  • A requirement to retire polluting plants.
  • Any obligation to replace coal with renewable energy.
  • A robust oversight process through the ACC or SRP Board.
  • Cost-effectiveness protections that prioritize clean energy.

There’s Still Time to Get It Right

The Four Corners Plant isn’t slated for retirement until 2031. That means there’s no rush to pass this flawed legislation (making ratepayers pay for the retirement of the plant is one of the excuses APS uses for pushing the bill) …. so there’s still time to draft responsible legislation next session that protects consumers, ensures proper oversight, and advances a cleaner, more sustainable energy path for Arizona.

Send a message to Governor Hobbs and ask her to veto HB2679. Use this form here.

Let’s not make a rushed mistake that foists extra costs onto people who buy electricity in order to help wealthy people who have stock in utilities. Instead, let’s take a more thoughtful approach over the next year to truly examine the impacts.

APS will pay anything to craft energy policies in its favor | Opinion
Will Humble Disease Control, Wills Blog

How Do Influenza Pandemics Usually Start?

Last week I wrote about Secretary Kennedy’s actions to gut infectious disease research and public health practice funding are the man-made risk that will greatly impair our ability to detect and respond to future outbreaks and pandemics.

The Real H5N1 Threat: Kennedy’s Assault on Our Public Health System

This week I thought I’d give a short summary of how influenza pandemics typically get started.

See: Bird flu’s dangerous leap – Arizona PBS

Influenza pandemics usually begin when a new strain of the influenza virus emerges that can infect humans and spread easily from person to person. It usually starts with an antigenic shift when there’s a significant change in the virus’s genetic makeup creates a novel subtype that most people have little or no immunity to.

  • The natural reservoir for influenza A viruses is wild aquatic birds, like ducks, geese, and swans. These birds often carry the virus in their intestines and shed it in feces (usually without showing symptoms).
  • Poultry farms can also become infected, and when kept in close quarters with pigs, can serve as intermediate hosts.
  • Pigs are usually the lynchpin species because they can be infected by both bird and human influenza viruses. This makes pigs effective “mixing vessels” where genetic material from different influenza viruses can reassort to create new combinations when they have a concurrent infection.
  • Influenza viruses have an RNA genome. If a pig is infected simultaneously with an avian and a human strain, the RNA can reassort, leading to a new virus that has a mixture of genes from both sources. If this reassorted virus gains the ability to infect humans and transmit efficiently between them, it can spark a human pandemic.
  • The first human infections often occur in regions where humans live in close proximity to livestock and wild birds—especially in parts of Asia with informal & traditional farming practices where birds, pigs and humans live in close proximity to each other.
  • Once human-to-human transmission becomes efficient (via respiratory droplets), the virus can spread rapidly across the globe, leading to a pandemic.

Historical Examples

  • 1918 “Spanish Flu“: Likely originated from birds, potentially with swine involvement. It caused the deadliest pandemic in recorded history.
  • 1957 “Asian Flu” and 1968 “Hong Kong Flu”: Resulted from reassortment involving avian influenza viruses and existing human strains likely in pigs.
  • 2009 “Swine Flu” (H1N1): Originated from pigs, involving a complex reassortment of avian, swine, and human influenza viruses.
Will Humble Public Health, Wills Blog

The Most Important Staffer in Congress You’ve Probably Never Heard Of

The Senate Parliamentarian plays an important but mostly overlooked role in the legislative process of the United States Senate. This ‘nonpartisan’ official acts as the chief interpreter of the Senate’s complex rules and procedures, advising the presiding officer on how to apply them during debates, votes, and other proceedings.

The current Senate Parliamentarian is Elizabeth MacDonough, who has been in the job since 2012. She’s not affiliated with any political party as neutrality is supposed to be a requirement of the role. Like a referee.

The Parliamentarian is appointed by the Senate Majority Leader (John Thune of SD).  The person’s main job is to provide guidance on the Senate’s complex procedural rules. Things like advising the presiding officer during debates, deciding the proper referral of legislation to committees, and making sure legislative actions follow established Senate procedures.

While MacDonough is appointed by the Senate Majority Leader (Thune) they don’t “report” to any one Senator or party. Instead, they serve the institution of the Senate itself.

One of the Parliamentarian’s most important jobs has to do with the development of the federal budget – which is underway right now. The Parliamentarian decides what legislative provisions qualify for inclusion in budget reconciliation bills. Essentially, she decides what policy measures get to bypass the standard 60-vote filibuster threshold and instead pass with a simple majority (51 votes).

According to Senate rules budget reconciliations just need 51 votes vs. the 60 votes needed for other measures.

To make the determinations, the Parliamentarian is supposed to apply something called the Byrd Rule, which limits budget reconciliation to things that directly affect federal revenues or expenditures.

The Parliamentarian is supposed to assess whether each part of a bill adheres to this rule. If a provision is believed not related to the budget, it’s supposed to be removed unless 60 Senators vote to override the ruling—effectively reinstating the filibuster barrier for that section.

For example, in 2021, MacDonough ruled that a proposed minimum wage increase could not be included in a COVID-19 relief package passed via reconciliation, saying it did not have a direct budgetary impact. In 2017, she advised that several provisions in a Republican-backed healthcare bill (the ‘skinny repeal’) didn’t meet reconciliation rules, forcing their removal or requiring 60 votes for passage.

While the Parliamentarian’s decisions are advisory, they historically have carried weight. Senate Majority Leaders have historically followed the Parliamentarian’s guidance. Deviations have been rare and politically sensitive.

But – as you know – these aren’t normal times.

Parliamentarian of the United States Senate – Wikipedia

Will Humble Public Health, Wills Blog

President Releases Budget Proposal – It’s Not Good for Public health

Last Friday the White House released the President’s ‘discretionary’ budget proposal for next federal fiscal year. The proposal presents top-level requests for each federal agency and doesn’t include funding tables that are usually part of the executive’s proposal.

Congress can approve, reject, or modify the Administration’s budget recommendations. A complete budget request with additional details such as congressional justifications and mandatory funding proposals is expected to be released by the White House in the coming weeks.

Here are some of the key federal agency proposals:

CDC

  • Decreases CDC’s budget by 48% going from $7.6B to just $4B.
  • Eliminates the:
    • National Center for Chronic Disease Prevention & Health Promotion
    • National Center for Environmental Health
    • National Center for Injury Prevention and Control
    • Global Health Center
    • Public Health Preparedness and Response
    • Preventive Health and Human Services Block Grant

HRSA

  • The budget decreases HRSA from $7.6B to just $6B. 
  • The budget includes a:
    • $74M decrease in funding for Ryan White HIV/AIDS program activities that do not focus on core health care and support services directly to patients, such as education and training.
    • $274M decrease in funding for MCH.
    • $1B decrease in funding for health workforce programs that provide scholarships and support for individuals to enter “high-paying medical careers.”
    • $286M decrease in funding for Title X Family Planning programs.

ASPR

  • Decreases funding by $240 million for ASPR.
  • Eliminates funding for ASPR’s Hospital Preparedness Program.

Other HHS Programs

  • Eliminates the Sexual Risk Avoidance Program.
  • Eliminates the Teen Pregnancy Prevention program.
  • Reduces funding levels for the HHS Office of Minority Health and Office on Women’s Health. 

For more information view the FY26 budget proposal.

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