For the first time in nearly three decades, the Food and Drug Administration approved a new chemical UV filter for use in sunscreens sold in the U.S. And that has many dermatologists cheering.

"This is a very big deal," says Dr. Heather Rogers, a dermatologist in Seattle and a fellow of the American Academy of Dermatology.

The new ingredient is called bemotrizinol, and it has several advantages over the chemical sunscreen ingredients previously available in the U.S., Rogers says.

"It hits like really every box for us that we have been waiting for as dermatologists and consumers," Rogers says.

Here's what you need to know about this new ingredient and how it could lead to better sunscreens sold stateside.

1. It blocks both UVA and UVB rays

Rogers says in general, you want to use sunscreens that are broad spectrum, meaning they protect against both UVA rays – the longer wavelengths that cause premature aging and wrinkles – and UVB rays, which lead to sunburns. Both types of UV rays can cause skin cancer.

She says the sunscreens currently sold in the U.S. do an excellent job of protecting against UVB rays, but the chemical UV filters available in sunscreens in the U.S. until now aren't as good at blocking out UVA rays.

In general, chemical sunscreens sold in the U.S. rely on an ingredient called avobenzone to block out UVA rays, says Kelly Dobos, a cosmetic chemist who teaches at the University of Cincinnati.

But avobenzone by itself isn't photo stable, meaning its protection can start to break down rapidly when exposed to sunlight. And as avobenzone breaks down, it can release molecules that lead to skin irritation, says Alexa Friedman, a senior scientist with the nonprofit Environmental Working Group, or EWG.

By contrast, bemotrizinol offers protection against both UVA and UVB rays all on its own, and it is photo stable, so it breaks down more slowly, offering better protection, Rogers says.

"So if you go a little longer than two hours to reapply your sunscreen, there will be more protection left," Rogers says. However, she says you should still reapply sunscreen every two hours.

2. It's long been used in other countries 

Bemotrizinol has been widely used in European and Asian sunscreens for decades. But it has taken 20 years for the FDA to approve its use in this country.

That's because in the U.S., sunscreens are regulated as over-the-counter drugs rather than cosmetics, as they're classified in Europe. That means ingredients need to undergo rigorous testing for safety and efficacy before they can be approved for use in the U.S.

"It's really expensive and time consuming," Dobos says. The European company DSM-Firmenich spent at least $18 million over more than two decades in its push to gain FDA approval for bemotrizinol.

3. It has a well-documented safety profile

However, all that testing means bemotrizinol has more safety data to back it up than any other chemical sunscreen ingredient currently approved in the U.S., says Friedman of EWG.

"This ingredient is exciting because we have that data to support its safety," Friedman says.

Friedman says animal testing showed bemotrizinol doesn't lead to concerns like reproductive harm, while clinical testing on humans found that it does not irritate the skin, even after repeated application over time, "which is hopefully how people are using sunscreens."

And because bemotrizinol's molecules are larger, it's not readily absorbed by the skin and into the bloodstream, she says.

That's important, because studies have shown that some of the other chemical sunscreen UV filters sold in the U.S. can be absorbed in the bloodstream, prompting calls for more safety data and leading to a backlash against sunscreen on social media fueled by misinformation. Rogers says that trend is concerning because skin cancer is the most common form of cancer.

"We just need to have sunscreen that people will use, that they'll trust," Rogers says. "And this ingredient is going to allow that to happen. And that is very exciting."

And bemotrizinol is also considered to be non-irritating, Friedman says. That should be welcome news to people who've been put off by chemical sunscreens in the past.

4. It could lead to sunscreens that look better on you

Until now, Rogers says, the only sunscreen ingredient available in the U.S. that offered the aforementioned advantages of bemotrizinol – photo stable, non-irritating, minimally absorbed into the skin and with good broad spectrum protection against both UVA and UVB rays – was zinc oxide.

Both zinc oxide and titanium dioxide are mineral UV filters. Both chemical sunscreens and mineral sunscreens work by absorbing UV rays from the sun. Mineral sunscreens also reflect some UV rays. The bigger difference is that mineral sunscreens sit on the surface of the skin, while chemical sunscreens get absorbed into the skin, Rogers says.

The downside of mineral sunscreens is that they can leave an unattractive white cast on the skin – think of lifeguards with white paste on their noses. "Particularly if you're a person of color, zinc is going to make you look pale, white or ashy, which really makes it hard to use on a regular basis," Rogers says.

Bemotrizinol, on the other hand, is transparent on the skin, and because it protects against both UVA and UVB rays on its own, it doesn't have to be mixed with as many other chemical filters and stabilizers to achieve broad spectrum protection, Dobos adds. She says that should lead to more aesthetically pleasing, less greasy sunscreen formulations in the near future.

"I think it's a real win for public health," Dobos says. "If we can make a sunscreen that consumers like to use and want to use and apply in the proper amounts, I think that's something that's really going to be a win for consumers."

DSM-Firmenich has exclusive rights to market bemotrizinol in the U.S. for 18 months. It will be sold under the brand name Parsol Shield. The company says the first sunscreen products containing the ingredient should start hitting American store shelves around September.

Copyright 2026 NPR

Yacine Lo's twins were clearly not well.

Diarra and Khadim, her girl and boy, should have been busily toddling around like almost-2-year-olds they were. Instead "they were very, very weak," she says. "It's very sad to see your kids that way. When my kids aren't well, I can't be well, I can't even eat."

Lo lives outside of Keur Mbar, a small rural community in western Senegal with high levels of poverty. As a result, malnutrition is common here, she says, and she knew the signs. She also knew where to go for help. 

So she wrapped Diarra and Khadim on her back, and set off on foot to a clinic over 3 miles away. The route is flat but harsh. The vast, dusty landscape is only broken by the occasional acacia tree or the looming contortions of a baobab, which looks as though it grows by moonlight.

"It takes long," she says. "It's really very painful with your babies on your back under the hot sun."

Initially, the journey was worth it.

At the clinic, community health workers confirmed her suspicion and gave her a week's supply of a near-miracle food — Plumpy'Nut, the brand name of what's called a ready-to-use therapeutic food, or RUTF. It's a nutrient-dense paste made up of peanut butter, powdered milk, oil and sugar, fortified with vitamins and minerals.

Typically, in Senegal and other countries, a parent from a remote area would have had to travel even further to find a hospital or doctor who could provide this life-saving food. But for the past few years, Senegal, with the help of U.S. funding and nonprofit organizations, has been trying to bring care closer to kids like Diarra and Khadim.

Once a week, she'd make the journey back to the clinic for more Plumpy'Nut. Over time, the twins started improving, and her mood lifted.

"When you see that your kids are in good health, you are happy and feel good, because this is something natural, this is something human," she says. "But whenever your child is suffering, you suffer with them."

That suffering has increased over the past year and a half, she says, in the aftermath of the Trump administration's massive cuts to foreign aid. While Lo's son has recovered, Diarra still suffers from malnutrition and needs treatment. But these days, when she comes to the clinic, there's often no Plumpy'Nut.

"It's so frustrating," says Lo. When that happens, she trudges home empty-handed, hoping the key to her child's recovery will be there next time. "It's a big problem."

A safety net frays

Such shortages are happening across Senegal, according to health officials.

The small rural clinic Lo relies on is one of over 500 across Senegal serving as a net that catches kids with malnutrition and offers this superfood.

U.S. foreign aid, through a variety of programs, supported those clinics and the food they delivered. The sudden cuts have sent a shockwave through the whole system, leading to staff and food shortages.

In a statement, the State Department did not address NPR's questions about the shortages. They did say that the State Department is currently programming $23 million in maternal, child health and nutrition resources in Senegal. But the shortages were evident during an April reporting trip by NPR, and the State Department did not respond to multiple requests for additional details on what that $23 million is funding.

"It's having a heavy impact," says Latsouk Faye, regional supervisor for food, nutrition and child survival in Diourbel. "Many people just abandon, they no longer come to the clinics. Malnutrition is coming back."

An innovative partnership

Roughly 1 in 10 children in Senegal are acutely malnourished, a condition that can lead to long-term health and cognitive deficits. If it becomes severe, it can be fatal.

"About half of the mortality of children under 5 is related to malnutrition," says Ndèye Astou Badiane, country director in Senegal for Helen Keller Intl, a nonprofit that addresses this issue. Identifying cases early and offering treatment is crucial to saving lives, she says. But historically, this kind of treatment was only available at hospitals or doctors' offices, which are often out of reach where malnutrition is highest.

So in 2022, Helen Keller and some other nonprofits partnered with the Senegal Ministry of Health to try something different — training and equipping community health workers to treat severe acute malnutrition.

Fatma Diouf is one such community health worker in Keur Mbar, where Lo's twins got treatment.

Walking around the village, Diouf seems to know everyone. She flashes a wide smile at kids playing soccer in the street and greets them by name. "I'm part of this community," she says, and got into this work to help it.

Her clinic is a squat, tan building with turquoise-painted doors and windows. Families with young kids come to her for screening, advice and treatment. She first brings them to the courtyard, where a large scale hangs from a small tree.

"We start by weighing the child, seeing whether he has a normal weight or not," she says. Then they run through a checklist of other signs of malnutrition. Swollen hands or feet can indicate severe protein deficiency. Lumpy skin, very thin arms and fever can be signs too.

If a child meets the criteria, and doesn't require more intensive care at the hospital, Diouf hands them packets of Plumpy'Nut. Three of these a day over the course of several weeks can bring a child back from the brink. Week after week as families come back, she watches as little ones regain their strength and become active, little kids again.

Since 2022, the program has grown to five regions across Senegal, screening hundreds of thousands of children. The Ministry of Health was behind the initiative, too.

"The impact has been very positive," says Mamadou Dieng, regional health director in Diourbel. "Many children who normally wouldn't be screened have been screened, and there has been a reduction in the mortality rate."

The Ministry of Health had plans to expand this model throughout the country. Aid cuts have thrown those plans into question.

USAID directly supported the program in its early days and helped fund nutrition program staff more generally across Senegal until 2025. The U.S. was also the biggest supporter of UNICEF, which buys and distributes the vast majority of RUTF in the country, contributing over $1 billion in 2024.

"So many activities that were supported by the American government have stopped all of a sudden," says Badiane, of Helen Keller. "It was really a severe shock."

"They think we are deceiving them"

It's been a shock at Fatma Diouf's clinic, too.

"We get way less than we used to," she says. That means she's turning many families home empty-handed. Often, those families blame Diouf. "They think we are deceiving them," she says. "That I choose who to give the Plumpy'Nut [to] and just leave them aside."

The situation has been hard on Diouf. She recalls one child who came to the clinic during a shortage and began searching where Diouf keeps the product. After finding nothing, "[the child] just screams and refuses to go home," she says. "It really hurts."

Some of the Plumpy'Nut that ends up at Diouf's clinic is typically stored in a warehouse over an hour away, in the town of Diourbel. The heavy metal doors creak as Faye, the regional health official, opens them.

"This place used to be full," he says, able to store about 4,000 boxes — enough to feed over 4,000 kids for several weeks of treatment. "But since USAID left, since the start of the problem with Trump, UNICEF has become weaker," he says, gesturing at the empty space.

Overall, his district is getting about half of the RUTF it used to, he says. There's also fewer staff to shuttle the life-saving product from central storage facilities to smaller clinics, like Diouf's. Faced with prolonged shortages, he says many families have just stopped making the trip to the clinics. 

That point is echoed by Dr. Arame Ndiaye, a pediatrician in Bambey, Senegal. "If families can no longer get RUTF, they are prone to abandoning" and not coming to clinics for care, she says.

Or even for screenings. From October thru December of 2024, more than 180,000 kids were screened for malnutrition in the area, according to data from the National Nutrition Development Council and Helen Keller. After the cuts, from July through September, fewer than 87,000 kids were screened. That represents just 30% of the region's population of children, far from the program's goal of reaching about 80% of kids.

The impact is evident. Tening Ngom is the primary caregiver for her baby nephew, Aliou, who has been getting Plumpy'Nut at Diouf's clinic.

"When he started getting the treatment, he recovered very well," she says outside her home, over the occasional bleating of her goats. But with this shortage, she says he often misses treatment.

"If they don't have [the product], he starts crying and he doesn't stop crying. He never stops crying," she says. In recent weeks, she says Aliou's health has deteriorated, and he's very weak again.

Health officials in Senegal interviewed for this story worry that this kind of relapse is happening more broadly.

Still, there are some glimmers of hope. Through a variety of sources, including philanthropic funds and some foreign aid dollars, the flow of RUTF is improving. But the supply is still unstable. And that net of community health workers who serve as links between families and this lifesaving treatment is fraying.

"Since the aid cuts, many [community health workers] are no longer getting paid," says Diouf. "For some areas, the number of workers have halved, but for others, there's no one."

Despite these challenges, Diouf keeps trying to reach out to families. Instead of offering RUTF, she and her colleagues make a home-grown substitute with local ingredients, like millet, maize and ground nuts. It's not as effective as the real deal, she says, but it's something.

Helen Keller is scrambling to fill the gaps too, says Senegal country director Badiane. They've had some success with the help of the Eleanor Crook Foundation, an American nonprofit. But she says neither the nonprofit nor the Senegalese government has the resources to easily sustain what's been lost.

"Senegal is a poor country," she says, and the government has many competing priorities for spending.

In March, Senegal signed a new, five-year, $90 million health aid deal with the U.S. government. In 2024 alone, the U.S. sent more than $230 million in foreign assistance to Senegal. While the details of the new deal are still being worked out, Badiane says that money for nutrition programs was left out. In a statement, the State Department said that the deal reflects Senegal's own strategic objectives.

In the face of these challenges, Badiane says her team is pushing hard to keep this community-based model of malnutrition care going. "It's an approach that's working," she says, for kids like Diarra, Khadim and Aliou and thousands of others. "We need to treat these children, and they cannot wait. They need RUTF."

Copyright 2026 NPR

It's the first scene in a new documentary. A group of women are being taught how to use phone cameras so they can make a documentary about their lives as domestic workers, community health workers, toilet operators and home caregivers. The voice of their instructor is heard talking about the things they need to think about: composing a frame, lighting, holding the camera still.

One woman raises her hand and asks: "Where is the record button?"

The room erupts in laughter.

Inexperience didn't keep them from fulfilling their dream. These 10 working class women from Mumbai are the co-directors of the new movie Mast Mahila Mandali –- that's Hindi for Cool Ladies Club –- which had its premiere this spring in Mumbai's iconic, 1930s art-deco style Regal theater for an audience of 1,200 that included families and neighbors of the novice directors as well as cinephiles and media professionals.

The title came from Shilpi Gulati, the filmmaker they worked with and who taught them filmmaking basics. She suggested it at a meeting of the ten women. They deliberated over it and thought it fit the spirit of the film, pushing back against the idea that they are helpless women from the slums.

"For me, a 'cool lady' is someone who is bindaas — relaxed, fearless and does whatever comes to her heart," says Rehana Shaikh, 32, a home caregiver and one of the ten selected to take part in this project.

The idea was to show what their lives are like — and also to show how cool they are by giving them a chance to express their creativity and just goof around on camera and have fun.

The idea for the film took root in 2024 and came from Supriya Jan of CORO India, a nonprofit group that teaches leadership skills to marginalized women. Her initial idea was to focus on the group's Right to Pee campaign, which advocates for safe, clean and free public toilets. And she wanted women from the impoverished M-east ward to make the film rather than hiring an outsider.

Jan, the executive producer of the film, reached out to Shilpi Gulati, a filmmaker who teaches at the School of Media and Cultural Studies at the Tata Institute of Social Sciences in Mumbai, to work on the project.

At first, Gulati was puzzled by the idea. The women did not know anything about filmmaking, so how could they co-direct a film? She sprang into action: "It was a wild experiment. I put together a lesson plan so the women could learn the basics of filmmaking, from lighting to composition. We met every Saturday from about 1:30 to 6:30 p.m.," says Gulati. With only five smartphones available, the ten women worked in pairs.

"I would give them a production exercise for the week — like shooting the Mumbai monsoon or interviewing each other about who you were in the past and who you are today?"

As the women talked and filmed, the scope of the documentary expanded. Instead of making a five-minute film about sanitation, they wanted to document the unseen lives of ordinary women like themselves, sharing intimate moments, telling their stories. It became a 70-minute documentary that took six months to film and a year-and-a-half to edit.

The driving theme, says Gulati, is that even in their busy lives, these women could take time for themselves, build friendships and show that "having fun is not frivolous. That being mast [carefree] and claiming joy is cool. It is a radical act of resistance against oppressive structures."

Darshana Mayekar, a toilet operator and a slum sanitation program leader, says the experience made her feel young again. "For 20 years, I have been busy raising a family and working. While making the film, I was able to live a little for myself. I am 50, but I feel 20," she says.

Vaishali Mane, 35, a community worker who helps women access property rights, says being in front of the camera gave her the confidence to speak up — for herself and other women.

Then there's the exhilarating story of Rehana Shaikh.During the months of filming, Shaikh was between jobs so instead earned money by doing tailoring – gluing tiny round mirrors to a dazzling yellow, silver and white colored sharara set of wide-legged pants, a tunic and stole.

When it was time to take a break, Sheetal Navle, a community health worker, filmed Shaikh going up a narrow set of stairs in her two-story home to her kitchenette, where she would prepare dinner for her husband and three children.

In the scene filmed, as she cooks, she plays a rambunctious Bollywood number on her phone and begins to dance.

"I had always dreamed of being a dancer on screen or on stage," she says. "Growing up, I was not allowed to step out of the house even for dance classes.

"When the opportunity to learn filmmaking came, I said yes because I wanted to learn something new. My husband said no. He didn't want me on screen." She says he was uncomfortable about women speaking openly on camera.

"I convinced him by saying I will only be behind the camera," she says, deciding to hold back on the details and negotiate with him over time.

Shaikh went back and forth on keeping the dance scene in the film, given her husband's concerns. "The other women encouraged me, saying 'don't hide your passion.' It became a way to inspire others to relieve their stress and dance." 

At the premiere, her husband and three children cheered and hooted.

She was thrilled. "They were telling others in the audience, 'She is my wife, that's my mother!"

Note: In addition to Shaikh, Navle, Mane and Mayekar, the Mumbai women who served as co-directors are Kavita Ghuge, Rohini Kadam, Kavita Khomne, Gauri Rane, Anjum Shaikh and Nazneen Siddiqui. They were paid $262 each for their work on the film as co-directors; potential income from distribution deals and ticket sales will be shared as they own joint copyright of the film with Shilpi Gulati, who was also a co-director, and CORO India. Since the premiere, there have been additional community screenings of Cool Ladies Club, and the documentary will be submitted to film festivals this summer.

Neha Bhatt is an award-winning journalist and author based in Delhi, India, reporting on public health, development and culture. Her work has appeared in The Guardian, The British Medical Journal, Stanford Social Innovation Review, The Globe and Mail, Devex and National Geographic. Connect with her on linkedin.com/in/nehabhattwrites

Copyright 2026 NPR

But how exactly does heat kill? Here's the science behind what happens to the body in extreme temperatures, including the three main ways heat can shut down vital systems, as well as tips to stay safe, cool down and fend off heatstroke.

This comic was written and illustrated by Connie Hanzhang Jin, based on reporting by Maria Godoy. It was edited by Carmel Wroth and Alyson Hurt.

Copyright 2026 NPR

Seven years ago, the state Department of Transportation added four-inch-long bird spikes to the San Diego-Coronado Bay Bridge as a deterrent to suicides.

But the bridge has remained the second most frequently used bridge for suicide in California. According to Caltrans, about 400 suicides have occurred since the bridge opened in 1969.

Now, a more permanent solution is coming.

State Coastal Commissioners approved on Wednesday Caltrans’ proposal to build a better system. It consists of an 8-foot-tall steel wire mesh barrier on top of the bridge’s guardrails. The steel mesh will have one-inch openings designed to prevent climbing over the concrete guardrails.

“Installing the barriers, at its core, is going to save lives,” said Coastal Commissioner and San Diego City Councilmember Vivian Moreno. “Supporting first responders who have the difficult job of leading rescues and also ensuring ongoing access to the coast.”

One of those first responders was Wayne Strickland, a retired Coronado firefighter who responded to numerous suicide calls on the Coronado Bridge.

For years, he has urged Caltrans to build a barrier. He said survivors and the families who lost loved ones worked alongside him, sharing their stories with Caltrans commissioners at public meetings.

“The Caltrans commissioners listened and, one was so upset, he kind of had to leave the room for a minute,” said Strickland. “It made a difference with them talking and their stories.”

Caltrans expects to begin construction on the $145 million project this fall and have it ready by 2028.

For Strickland, a permanent barrier gives him hope.

“This will save lives,” he said. “It'll keep the bridge open, and everything will be good. And I'm ecstatic that it's getting done. I'm very happy.”

If you or someone you know needs help, contact the 988 Suicide & Crisis Lifeline by calling or texting the number 9-8-8.

"I was running around hospitals trying to get blood. By the time I got back she was gone."

Dr. Olufemi Oladapo is haunted by the memory of the excited mother-to-be whom he couldn't save in Nigeria in his early career. After waiting six years to become pregnant, she died of postpartum hemorrhage. That's the leading cause of maternal death, responsible for 43,000 deaths a year.

To fight this tragedy, Dr. Oladapo, who's now a physician with the World Health Organization's Special Programme on human reproduction, co-authored a sweeping three-part series published today in the Lancet. characterizing the crisis and laying out how to solve it.

The condition impacts some 27 million women each year. Some bleeding is normal after childbirth. But excessive bleeding — a postpartum hemorrhage — is incredibly dangerous.

"It can become a medical emergency very quickly," says Adam Devall, a professor of maternal health at the University of Oxford. A woman who has had an otherwise uncomplicated labor can deteriorate within minutes if the bleeding is not recognized and treated promptly.

And the women themselves are aware of how severe it is.

"Typically, the women say, 'I feel like I'm dying.' They actually sense it when they are bleeding too much," says Ioannis Gallos, who's with the World Health Organization's Maternal and Perinatal Health Unit. "If no one was to act on it, within 10 to 20 minutes, easily a woman can die."

That's why postpartum hemorrhage is considered, in Devall's words, "a race against time."

Calling the series a comprehensive compilation of all the evidence, former Jhpiego Chief Medical Officer Dr. Harshad Sanghvi praised the authors for "this tremendous effort" and considers the series "a significant call to action." Jhpiego is a nonprofit organization with a focus on women's and children's health.

Starting with a special drape

To treat these bleeds promptly, say the co-authors, it's essential to measure the blood loss rather than merely eyeballing it — which can miss the hemorrhages about half the time. Devall says a simple plastic drape placed beneath the woman can work wonders.

"The blood then collects into this specially designed drape, which has calibrated lines on it," says Devall. "These lines allow midwives and doctors to easily see the amount of blood loss after the birth."

There are multiple interventions: uterine massage to encourage contractions, medication, IV fluids.

The researchers conducted a massive trial across Nigeria, Kenya, Tanzania and South Africa involving more than 200,000 women. They tested this approach — of early detection with a drape, clear criteria for treatment and the subsequent set of simultaneous interventions … and the results were unmistakable.

"We saw a massive decrease in severe bleeding," says Devall.

A survival gap

The study also points up a tremendous difference between survival rates in wealthy and lower resource countries.

"The rate of postpartum hemorrhage is not any different between high-income countries and low-income countries," says Oladapo. "What is different is what is given when these conditions are identified."

The report finds the mortality rate from postpartum hemorrhage can be more than 200 times less in well-resourced countries like the United States compared to under-resourced countries such as Afghanistan, Vietnam or Nigeria, where Oladapo treated that patient years ago.

The drug oxytocin can stem the bleeding but it does require refrigeration – a challenge in lower resource countries.

The report also calls for pit-crew-like simulation-based training for the whole care team.

The research team says the goal now is to get medical professionals and health workers to adopt their recommendations.

It's an idea that appeals to Doreen Kainyu Kaura. She's a professor of midwifery at the University of the Western Cape in South Africa who wasn't involved in the research effort. She says the conclusions align with what she's experienced in the delivery room.

"It will be a fantastic approach to ensure that we have these lifesaving interventions that reach women at the right place, at the right time," says Kaura.

"Women should not be dying from PPH [postpartum hemorrhage] in this day and age, given what we know," says Oladapo. "If we use what we have now, we will reduce more than 95% of the deaths."

And the economics favors interventions: "Postpartum hemorrhage as it is now is costing us more money than what we would have used to prevent it."

"If you invest even 5% of the cost of postpartum hemorrhage in preventing it," Dr. Oladapo concludes, "you're going to not just save lives but also save money."

Dr. Sanghvi shares his optimism, "This is the decade in which we can probably reach the goal of eliminating postpartum hemorrhage as the leading cause of maternal death. I think it is within our reach."

Copyright 2026 NPR

Gov. Gavin Newsom announced Thursday he is making available $46 million in voter-approved funding to help clean up cross-border pollution in the chronically contaminated Tijuana River and the New River at the California-Mexico border.

Since 2018, more than 100 billion gallons (378 billion liters) of raw sewage filled with industrial chemicals and trash have poured into the Tijuana River, according to the International Boundary and Water Commission. The United States and Mexico signed an agreement last year to clean up the longstanding problem by upgrading wastewater plants to keep up with Tijuana’s population growth and industrial waste from factories, many owned by U.S. companies.

For years, tens of thousands of people have and continue to be exposed to the sewage. During a February visit to San Diego, Environmental Protection Agency Administrator Lee Zeldin said it will take a couple of years to fix one of the nation’s worst and longest-running environmental crises that affects largely low-income Latino communities.

“People in San Diego County shouldn’t have to worry about getting sick, losing access to their beaches, and living with polluted air,” Newsom, a Democrat, said in a news release.

The New River flows north across the border through the city of Calexico to the Salton Sea about 60 miles away (about 97 kilometers). The water that enters the U.S. contains raw sewage and other pollution from industrial, domestic and agricultural sources.

The funding will come from Proposition 4, a $10 billion bond measure approved in 2024 to fund water, climate, wildfire and natural resource projects across the state. At least 40% of the money is supposed to be spent on communities hardest hit by climate change and environmental pollution.

The funding will be made available as competitive grants for projects that reduce bacteria and trash, address public health issues related to the cross-border pollution and support mitigation and restoration.

The raw, foul-smelling sewage from the Tijuana River that empties into the Pacific Ocean also emits hydrogen sulfide, a toxic gas that can erode neurons in the nose and trigger asthma attacks, and cause symptoms such as headaches, nausea, cough, shortness of breath, skin and eye irritation, according to the U.S. Centers for Disease Control and Prevention. Its long-term health problems are only starting to be understood.

“This funding is desperately needed. Certainly every dollar we can secure to address the Tijuana River crisis is a big help,” said Phillip Musegaas, executive director of the San Diego Coastkeeper, an environmental nonprofit in Southern California. “Unfortunately, this funding is really just a small portion of what’s needed to fully address the crisis."

He added: “We need more federal funding to fix and expand the wastewater infrastructure that is now under stress and is often failing or inadequate to treat all the sewage that’s being generated.”

In Thursday's announcement, Newsom called on the Trump administration again to find a permanent fix.

“California has stepped up repeatedly, but we can’t solve a decades-long federal failure on our own," Newsom said in the release. “The Trump administration must do its part, honor its commitments, and finally deliver the lasting solutions this community deserves, and they have a moral obligation to provide.”

An update to this story clarifies that some of the money from California is also available for cleanup of the New River.

The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment

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Families of transgender youth in California learned this week that their private medical records will not be sent to the Trump administration, for now. That's after a federal judge temporarily blocked hospitals in California from producing any documents responding to criminal subpoenas from the Department of Justice.

For nearly a year, the DOJ has served hospitals with subpoenas, seeking detailed patient files of transgender youth, personnel files for clinicians, and other documents related to transgender healthcare. Attorneys for the government haven't articulated exactly what's being investigated, but they have pointed to the stated goal of President Trump to end gender-affirming care for youth.

Criminal subpoenas to hospitals

At first, the DOJ issued administrative subpoenas, and many of those were quashed in court. Now they've moved to criminal subpoenas using a grand jury in a federal court in Texas.

One was posted publicly by NYU Langone Medical Center last month. It is not known how many hospitals across the country have received the criminal subpoenas, but the notice from NYU says that it was "one of several institutions" to receive them. The Trump administration refers to transgender healthcare as "sex-rejecting procedures" in the subpoena.

The administrative and criminal subpoenas are practically identical, says Shannon Minter, legal director of the National Center for LGBTQ Rights, which has brought many of the lawsuits fighting these subpoenas. "Nothing has changed — they haven't uncovered some new reason or basis to be seeking these records," he says.

"It is pure harassment. It's just an effort to frighten people, to intimidate doctors out of providing the care and to frighten parents and make them afraid that the federal government is going to seek them out, identify them and harm their families in some way," he adds.

Stanford case brought by families

The win in California this week is significant, Minter says. A group of six families who received care at Lucile Packard Children's Hospital Stanford sued to block the hospital from sending any of their medical files to the Justice Department.

Right before a deadline for the hospital to send those files, a federal judge in the Northern District of California granted a request for a temporary restraining order that applies to the whole state.

A Justice Department spokesperson in a statement said "it will use every legal and law enforcement tool available to ‌protect innocent ⁠children from being mutilated under the guise of 'care.'"

'Long journey to survive'

Arne Johnson is the parent of a trans teen in the Bay Area and a volunteer with the group Rainbow Families Action. He says even if the win is temporary, it's still a relief for parents like him. "This is like being in a stormy ocean right now — like you're floating on a raft and each individual wave is terrifying, but we also know we have a really long journey to survive," says Johnson, who is not a plaintiff in the case.

He says he's grateful to the families who brought the case and the attorneys representing them. "It's impressive and very noble in a time when people are compromising and turning their backs on our families," he says, fighting tears. "It just really means a lot to folks to see how hard people are working to fight for our kids."

So far, the many legal challenges to the Trump administration's attempt to get the medical files of transgender youth have been quite effective, Minter says. "We don't have any reason to believe that any hospitals have turned over records yet, but there would be no way to know that for certain," he adds.

At the same time, many hospitals and clinics that had been providing gender affirming care for young people all over the country have ended their programs, citing legal and financial pressure from the Trump administration. And this week, a federal judge in Maryland rejected a bid to certify a class of families of transgender youth nationwide to fight the administrative subpoenas.

Craig Konnoth is a professor specializing in health law and LGBTQ rights at the University of Virginia School of Law. He notes that the federal government's moves to get private medical records are unprecedented and could have effects far beyond transgender youth.

"It's not just search and seizure of medical records," he says. "It's the ability of the government to come after you, hoping that they'll be able to catch you out in something, that they will attach a label to afterwards, because they don't like the group that you belong to or the group that you're trying to assist."

That's why, he says, if the government succeeds in these efforts, the implications are vast.

Copyright 2026 NPR

I own at least 10 skin care products. Of those, I use four regularly, and one or two I apply occasionally. And the others? Honestly, they're just gathering dust.

Today, many of us have a veritable beauty counter in our bathrooms. It's easy to feel that if you don't use the right serums, acids, creams and masks, you're doomed to wrinkled, splotchy and prematurely aged skin.

Do we really need all this stuff to achieve healthy, attractive skin?

That's the topic of Life Kit's Guide to Skin Care. In this newsletter series, you'll learn how to create a routine and find products that work for your goals right now and in the years to come.

We hope our guide helps you make more-informed choices about your skin, instead of using a throw-everything-at-it approach that can irritate your complexion — and strain your budget.

How to sign up 

To sign up for this newsletter series, click here and enter your email address. Over the course of a week, you'll get guidance from half a dozen skin care experts — including dermatologists, researchers and cosmetic chemists. Some of them also do consulting work for companies that make skin care products.

Sign up at any time to begin your journey.

Expert advice on skin care, straight to your inbox 

In this weeklong series, we'll send you four emails that dive into different facets of skin care. Here's what to expect:

• Email 1: The three products your skin really needs. Also: Can topical products slow down skin aging?
• Email 2: What works to move the needle in skin health and appearance? Decoding active ingredients in over-the-counter products. Plus: Are expensive products better? 
• Email 3: Botox, fillers and more: How to address common skin issues that are beyond the scope of topical products. Plus: 4 skin-boosting lifestyle habits.
• Email 4: All about the routine: How do you layer products? Is there a difference between daytime vs. nighttime products? How do you know whether your routine is working? 

After this newsletter series ends, you'll receive weekly emails from Life Kit on lifestyle topics like health, money, relationships and more.

Why a simple skin care routine matters 

The world of skin care is overwhelming. You can spend a lot of time and money on products that you don't even need. Knowing what will keep your skin healthy and looking good is the best strategy. The rest? It's just noise.

At its most basic level, skin care is about keeping our outermost layer healthy so it can function as intended, says dermatologist and dermatologic surgeon Michelle Henry.

But skin also needs topical support to help keep that protective barrier intact.

In this series, you'll learn which products are essential and whether your skin concerns — wrinkles, hyperpigmentation, loose skin — may require more than a cream or serum.

But manage your expectations, say experts. Supporting your skin through the years doesn't mean it will look forever young — and it shouldn't, says Henry. 

"Just because you don't have wrinkle-free, rosy skin does not mean it's not healthy," Henry says. "Healthy skin is comfortable, functional skin. And the good thing is that for the most part, healthy skin does look beautiful." 

Sign up for Life Kit's Guide to Skin Care here.

Kelle Walsh is a health and wellness journalist based in Colorado.

This story was edited by Malaka Gharib. The visual editor is CJ Riculan. We'd love to hear from you. Email us at LifeKit@npr.org. Listen to Life Kit on Apple Podcasts or Spotify, and sign up for our newsletter.

Copyright 2026 NPR

Health officials in the Democratic Republic of Congo began worrying about possible Ebola cases in mid-April. Deaths in the northeastern part of the country that seemed like they may have been caused by the deadly virus prompted officials to take samples. They then sent them to the lab in Bunia.

"The first samples were tested on April 30th," says Jean-Jaques Muyembe, general director of INRB, DRC's national biomedical research center. The lab ran the samples on GeneXpert, a machine that automates the process of detecting specific bits of viral DNA. The results came back negative for Ebola. So did more samples a couple of weeks later.

Eventually, officials sent samples hundreds of miles away to Kinshasa for more specialized testing.

Those turned up positive for Ebola.

The problem was that GeneXpert, the machine that forms the backbone of DRC's Ebola surveillance, couldn't detect the rare species that was circulating, says Muyembe. So it was mid-May before officials rang the alarm bell and declared an outbreak of Ebola Bundibugyo.

That month-long delay allowed the outbreak to grow into one of the largest Ebola outbreaks ever. Suspected cases ballooned to over 1,100 as labs struggled to keep up with incoming samples.

"The initial response has been pretty significantly hampered by the lack of appropriate diagnostics on the ground," says Caia Dominicus, senior technical adviser for the independent non-profit International Pandemic Preparedness Secretariat. If officials can't test in a timely manner, they can't get patients to isolate and prevent the virus from spreading, she says.

The response has caught up since then, at least somewhat.

"Diagnostic capacity has improved significantly from where we were three and a half weeks ago," says Abdirahman Mahamud, who directs health emergency alert and response operations at the World Health Organization. The backlog of cases has mostly disappeared, but he warns current testing capacity is not enough to keep up with an outbreak that the U.S. Centers for Disease Control and Prevention projects could reach 20,000 cases by August.

"We are very much aware we are still behind the curve," says Mahamud. "If transmission continues, both geographically, or the case load increases, we will require additional surge."

A difficult diagnostics situation

One big reason testing capacity has improved to date is a machine called RADI-One.

It's a device that can detect Bundibugyo in patient samples, and requires less training and equipment than typical lab-based testing. That ease of use allows it to be deployed in smaller clinics that are closer to the outbreak, including Mongbwalu, the mining town that's been heavily affected.

Currently, seven labs — and one mobile lab — are able to process tests across northeastern DRC. Larger labs, like the one in Bunia, can currently process over 100 samples per day, according to a laboratory technician. The technician requested that NPR not use their name due to fears of losing the job for speaking to the media without authorization.

"Right now, we really don't have a backlog and the samples that arrive are analyzed right away and the turnaround time is basically one to twelve hours," says the technician.

Yap Boum, a senior official at Africa CDC, said on a press call Wednesday that Africa CDC is working with WHO and DRC health officials to have 50 RADI-One testing machines by the end of June.

More will likely be needed, says Dominicus, and "there just aren't that many machines available." WHO and Africa CDC are in talks with the small South Korean manufacturer, KH Medical, to get more, but that'll take time. There are other tests that could be deployed, but they would need to be validated first, she says, and "they're not the traditional systems that have been used, so there's a necessity to train staff."

Lab-based testing has another inherent limitation — the space between the patient and the lab.

"Sample transport is a major bottleneck. It can take days, some areas are almost completely inaccessible," says Dominicus. Add in ongoing conflict, population displacement and community mistrust make for "a much more difficult diagnostics situation," she says.

The faster the test, the faster the response

One tool that could improve that situation is rapid tests, akin to the kind that became widely used during COVID. A pinprick of blood placed on a thin strip of paper could give results in minutes as opposed to hours or days.

"The faster you detect someone's positive, the faster you can actually isolate them and stop them from spreading it onwards," says Abraar Karan, an infectious disease physician at Stanford University.

Rapid tests are less sensitive than lab-based tests, meaning they're more likely to miss positive cases. But they could still play a key role in better understanding the true scope of the outbreak and reining it in.

"We need to have a rapid test for the community," says Muyembe. In addition to testing the living, Muyembe says rapid tests could screen the dead, too. Burials in DRC often involve community members touching the deceased, which can spread the virus. Testing bodies beforehand could guide whether burial practices need safety precautions.

Despite that need, there are no rapid tests approved for Bundibugyo. There are several designed for more common species of Ebola which may work, according to lab-based research, though it's unclear how well they'd work in the field.

Developing a new Bundibugyo-specific test could take a couple of months, says Robert Garry, a microbiologist at Tulane University. "I think they could be scaled up fairly quickly. It's not a complicated technology."

Ranu Dhillon, a global health physician who advised Guinea on the 2014 Ebola outbreak thinks it's worth it, as developing therapeutics or vaccines would take even longer.

"Validating [existing tests] or having some sense of its performance characteristics could be done relatively quickly," he says. Patient samples coming into labs for traditional testing could be simultaneously evaluated on these rapid tests, he says, to see how they compare.

Scaling up both lab-based and rapid tests will take significant investment. Often diagnostics are overlooked, compared with vaccines or therapeutics, says Dominicus, of IPPS. "It's underfunded, but they give us the information we need to make key decisions," she says. "Without them we're flying blind."

Bundibugyo is rare, but not unheard of. If appropriate diagnostics had been in place before this outbreak, Dominicus says it may not have gotten so bad. "That delay in diagnostic ability set the response back."

Copyright 2026 NPR

The most powerful factors affecting a child's brain development involve socioeconomic opportunities, according to a study in the journal Science.

The analysis of more than 2,300 9- and 10-year-olds found that environmental factors ranging from household income to education to neighborhood quality are associated with brain differences that can clearly be seen in MRI scans.

The researchers also found that preteens who'd grown up in neighborhoods with lower incomes and limited social support had brain differences associated with less sleep and more stress.

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"Something is going on in these neighborhoods," says Scott Marek, the study's first author and an assistant professor of radiology at WashU School of Medicine. "We need to find out how socioeconomics is becoming biologically embedded."

The research "highlights the fact that the environment in which we grow up and live has powerful impacts on our brain," says Russell Poldrack, a psychology professor at Stanford University who was not involved in the study.

It also challenges earlier research that focused on links between brain development and factors like IQ and mental health.

Those factors do appear to have a small influence on brain development, says Dr. Nico Dosenbach, an author of the new study and a professor at WashU Medicine in St. Louis.

"But socioeconomics was, by a wide margin, absolutely the dominant variable," Dosenbach says.

As a result, some earlier studies linking cognitive performance to brain differences "may require reevaluation," says Dr. Theodore D. Satterthwaite, an associate professor at the University of Pennsylvania Perelman School of Medicine.

Those studies focused on factors like IQ or mental health without accounting for socioeconomics, says Satterthwaite, who co-authored a perspective piece that accompanied the new study. So a reevaluation including that variable could weaken or even negate the findings.

In fact, the new study adds to what Satterthwaite calls a "rising tide of research" over the past few years, suggesting that childhood environment has a powerful influence on brain development.

Lots of brains, lots of variables

The goal of the new research was to take an unbiased look at brain development and consider every factor that might have an influence.

Data came from the federally funded Adolescent Brain Cognitive Development (ABCD) Study, which is tracking thousands of children starting at ages 9 and 10.

The researchers used brain scans from ABCD to identify differences in the organ's structure and communication networks. Then they looked to see whether those differences were associated with factors like a child's environment, cognitive abilities and mental health.

Finally, the team ranked each factor by how strongly it was associated with brain differences.

"The pattern that emerged was, at first, very confusing to us," Marek says.

Nearly all of the top-ranked factors were in some way related to socioeconomic opportunity. And these factors were associated primarily with brain differences in areas involved in sensory processing and motor control, not higher functions like attention or memory.

So the team worked to figure out how factors like income, preschool enrollment, healthcare access and neighborhood quality might be affecting brain development.

The apparent answer involves brain circuits involved in keeping someone awake and alert. These circuits are altered when children get less sleep, experience more stress, or spend a lot of time using social media.

The team found that all of those environmental factors are more prevalent in neighborhoods where children lack economic, educational and social opportunities.

The finding doesn't prove that these factors are actually causing the brain differences, Marek says, "But the data are screaming that we should be looking at sleep, stress and screens if we want to get somewhere."

Copyright 2026 NPR

For the latest news on the Ebola outbreak — along with stories about life in our changing world — subscribe to NPR's Global Health Newsletter.

The Trump administration has imposed some very tough measures in response to the hantavirus and Ebola outbreaks, despite the president's past history of criticizing COVID-19 restrictions during the pandemic.

The administration imposed mandatory federal quarantine orders on two American passengers from the cruise ship hit by the hantavirus, wants round-the-clock guards for some U.S. passengers quarantining at home, banned people from countries where Ebola is spreading from entering the U.S, and blocked Americans who catch Ebola from returning to the country for treatment.

"They have spent so much time talking about not having the government impose on peoples individual decisions and individual movement, touted individual choice over public health, and argued that individual freedom trumps public health guidance," says Dr. Ashish Jha, a senior fellow at Harvard University who served as President Biden's COVID-19 Response Coordinator. "And yet, in response to the hantavirus and Ebola, this administration has chosen to impose very draconian and extreme public health measures."

Stringent restrictions criticized as an overreaction

The administration, and some outside experts, defend the steps as necessary to protect the American public. Critics say the aggressive measures are uncalled for and counterproductive, and worry that similar tactics would be imposed more widely if any kind of outbreak actually occurs in the U.S.

"It's very concerning about what overreaction we may see," says James Hodge, a public health law professor at Arizona State University. "How far will this government go to contain an outbreak?"

The actions are surprising to some because of the administration's criticisms of lockdowns, mask mandates, vaccine requirements and other measures imposed during the pandemic. In addition, federal health officials frequently cite "health freedom" or "medical freedom" in announcing new policies, such as questioning vaccines and making unproven remedies such as peptides more easily available. The health freedom movement calls for leaving more medical decisions up to individuals.

"Health freedom is about giving people more choices," Jha says. "That's certainly not been consistent with the actions they've been taking."

The first controversial measure involved some of the passengers aboard the Dutch cruise ship hit by the hantavirus that claimed three lives. Federal officials initially said passengers flown from the ship to a federally funded quarantine unit in Omaha, Neb., were being kept there voluntarily. But the administration then took a very rare step: imposing mandatory federal quarantine orders on two of the passengers who wanted to quarantine at home like some other passengers.

"That's heavy-handed. And really quite unnecessary," Hodge says.

Given the virus doesn't appear to spread very easily from one person to another, the passengers could quarantine at home without posing a danger to the community, Hodge and others say. Passengers who left the ship early on were allowed to do that.

Next, the federal government said passengers leaving the federal quarantine unit in Nebraska could finish their quarantines at home only if they were subject to round-the-clock monitoring by their local health departments.

"They're taking a lot of steps that many would view as very authoritarian, very over-the-top," Hodge says.

Travel bans could undermine care

In the meantime, the Ebola crisis erupted in Africa— triggering two controversial reactions by the Trump administration. First, the administration banned anyone from countries with Ebola outbreaks from entering the U.S. even though the World Health Organization opposes such bans.

But even more surprising to many public health and infectious disease experts, federal officials also barred U.S. citizens helping fight Ebola from coming home to get treated if necessary. Instead, the administration has been sending Americans to Europe for treatment and wants to open a facility for exposed people in Kenya.

"It's completely stunning that we would not allow Americans to return to the United States," says Jennifer Nuzzo, who runs Brown University's Pandemic Center. "We have specialized, taxpayer-built units that exist solely for this purpose: to provide life-saving care to people who may be exposed to deadly diseases while they are doing important public health work."

Tough immigration stance echoed in public health response

In some ways, the tactics mirror the administration's immigration crackdown, says Lawrence Gostin, a public health law professor at Georgetown.

"The administration is conflating its immigration policy with public health guidance and expertise," Gostin says. "We're seeing a real overkill that's trampling the civil liberties of American citizens."

Similarly, the Trump administration invoked a public health regulation during the pandemic to quickly expel migrants and asylum-seekers at the U.S.-Mexico border to prevent the spread of the virus.

Gostin calls the administration's actions "political theater."

"The administration is trying to look tough," Gostin says. "And that's just no way to deal with an infectious disease that really doesn't know borders. We need to use science and public health rather than political theater and overkill."

The tactics could backfire by discouraging other countries from reporting outbreaks early, undermining public trust, and driving exposed and infected people into hiding instead of cooperating with public health authorities, Gostin and others say. That increases the chances people will bring dangerous infections into the country and spread the pathogens, experts say. The best way to protect Americans is to stop outbreaks at the source, according to Gostin and other public health experts.

"A lot of times there's unintended consequences that work against you when you set up travel bans like this," says Dr. Martin Cetron, former director of the division of global migration and quarantine at the Centers for Disease Control and Prevention. "The restrictions can drive people underground."

Department of Health and Human Services spokesman Andrew Nixon said in an email that the administration was mounting an "aggressive" response. But said the restrictions were "targeted" and aimed at "protecting the health and safety of the American people."

But the aggressive tactics are raising fears about how the administration will respond if an outbreak of hantavirus, Ebola or some other pathogen erupts in the U.S.

"Should we start having some outbreaks in the United States, it could be deeply problematic," says Wendy Parmet, a public health law professor at Northeastern University.

Other public health experts, however, defend the administration's response to the hantavirus, given the strain of the virus involved in the cruise ship outbreak can spread from person to person and can be deadly.

"These are judgment calls. I'm not going to second-guess it," says Dr. Robert Redfield, a visiting fellow at the Heritage Foundation, a conservative think tank. Redfield also ran the Centers for Disease Control and Prevention during the first Trump administration.

Redfield says the Ebola travel ban is also reasonable, though he disagrees with the decision to keep Americans who need treatment from returning to the U.S. "They should be able to come back," Redfield says. "Your likelihood of survival if you do get Ebola will be directly linked to the quality of care that you get."

Copyright 2026 NPR

New federal work requirements are rolling out in stages across California’s public benefit programs, leaving many recipients in San Diego County wondering whether the changes apply to them.

CalFresh work requirements took effect June 1, while similar requirements for Medi-Cal are scheduled to begin Jan. 1, 2027.

San Diego County estimates that roughly 400,000 people could be affected by the changes across both programs.

For CalFresh, some people who previously qualified for automatic exemptions may now need to meet work requirements. That includes some veterans, people experiencing homelessness and former foster youth.

However, many people may still be exempt.

People under 18 or over 64, those who are pregnant, people unable to work because of a physical or mental health condition, caregivers for a child under 14 and students enrolled at least half time may still qualify for exemptions.

At the San Diego Food Bank, CalFresh navigators are helping recipients understand the new rules and determine whether they remain eligible for food assistance.

“Our team has been very focused on connecting with the community, letting them know what the requirements are, and then how we can help find exemptions,” said Josue Castro, who oversees the organization's CalFresh program.

Medi-Cal's work requirements are still months away, but advocates say many people are already confused because the rules differ from CalFresh.

“It’s understandable that there is confusion because this is a brand-new requirement that has never been imposed,” said Linda Nguy, an associate director of policy advocacy with the Western Center on Law and Poverty.

Nguy said the exemptions for Medi-Cal are not identical to those for CalFresh. Older adults, people with disabilities, children, former foster youth, Native Americans and parent caregivers are among those who may qualify for exemptions from Medi-Cal work requirements.

“There is a lot of overlap in terms of the requirements, but they don’t perfectly align,” Nguy said.

In a statement to KPBS, the California Department of Health Care Services said it is reviewing the new federal rules and warned they could change how medical frailty exemptions are evaluated, meaning some people with serious health conditions may need to provide additional documentation to qualify.

Nguy encouraged people to seek help early because qualifying for one program does not necessarily mean they will qualify under the rules for the other.

San Diego County said residents with questions about their eligibility can call the county’s access customer service call center at 866-262-9881 for assistance.

California voters are delivering a split decision on whether they want to pay more sales tax to support healthcare services: Los Angeles County’s measure is clinging to a narrow lead, while Contra Costa County’s went down in defeat, a divide experts attribute to growing anxiety over the cost of living.

In Los Angeles, Measure ER, which proposes a half-cent sales tax for the next five years, led as of Tuesday evening with 50.59% of the vote. The measure requires a simple majority to pass. Supporters estimate that tax, which would not apply to groceries and medications, could generate $1 billion a year.

The county’s voters historically have been supportive of taxing themselves to fund public initiatives, said Mike Bonin, executive director of the Pat Brown Institute for Public Affairs at California State University, Los Angeles. But Measure ER proved to be a hard sell.

Even among Democrats and progressives, Bonin said, there was weariness over the measure’s regressive nature — meaning sales taxes tend to fall harder on lower-income residents than wealthy ones. “This is tough on people, and so there was some resistance to it, which is why I think it took until (Monday) for it to get over the hump,” Bonin said.

In Contra Costa, Measure B would have levied a five-eights-cent tax generating an estimated $150 million a year. Voters rejected the measure, with 57% of voters opposing as of the latest count.

“We’re in a difficult period for middle-income people,” said Marc Joffe, president of the Contra Costa Taxpayers Association who led the campaign against Measure B. “I think the fact that gasoline went up to $6 during the course of the campaign was probably a wind (at) our back.”

The results stand in contrast to Santa Clara County, where voters last fall approved a sales tax with 57% of the vote.

Why counties turned to voters

Both measures were a response to the federal spending package Congress and President Trump passed last summer. Because of changes to Medicaid, also known as Medi-Cal in California, counties are bracing for a spike in the number of uninsured people. And as people lose coverage but continue to seek care, safety net providers stand to lose significant revenue. In L.A., money from the sales tax would also shore up county public health, Planned Parenthood services and emergency preparedness.

Coalitions of safety net providers backed the measures, warning that without new revenue, they could be forced to reduce hours, cut staff or close facilities.

“There’s no way out of this,” Louise McCarthy, chief executive of the Community Clinic Association of Los Angeles County, said on election night. “This is a situation that is being forced upon us. No local decisions made this happen, and no local decisions without revenue can solve the problem we’re in now.”

New estimates by the UC Berkeley Labor Center project that 2.2 million more Californians will go without health insurance by 2030 because of Trump’s spending law and recent state actions. That would nearly double the state’s uninsured rate to 14.7% and erase much of the state’s progress over the last decade at getting everyone insured. Counties, which operate safety net clinics and hospitals, say the federal policies and funding cuts – and not enough support from the state – are leaving them with major budget holes and in search of new ways to generate revenue.

Los Angeles County Supervisor Holly Mitchell, who introduced Measure ER, called the sales tax a “last resort,” saying the county had already enacted hiring freezes, limited overtime and tapped emergency reserves. The county estimates it will lose about $2.5 billion over the next three years because of federal cuts.

The measure was opposed by some cities, anti-tax groups and County Supervisor Kathryn Barger, who represents the region’s sprawling northern exurbs. Lancaster and Palmdale have nation-leading sales tax rates of 11.25%, and in Contra Costa County, sales taxes in Pinole and El Cerrito in Contra Costa have reached 10.25%. Both counties needed Legislative approval to pursue new sales taxes because their measures exceeded state limits.

The sales tax measures came as half of Californians named cost of living as the top state issue.

Susan Shelley with the Howard Jarvis Taxpayers Association, which opposed both measures, argued the proposals were misleading. Because backers structured the measures as general sales taxes — meaning counties can legally use the funds at their discretion — rather than earmarked taxes for healthcare, they required only a simple majority, not the two-thirds threshold that a special tax would have demanded.

For other counties that may consider taking similar measures to voters: “I hope it sends the message that people are taxed enough,” Shelley said.

Jim Mangia, chief executive of St. John’s Community Health, said the county will use the sales tax revenue as intended: for healthcare.

“This is a temporary solution, and we will not stop fighting for the long-term federal funding Angelenos deserve,” he said.

Counties press state for help

Contra Costa County runs one hospital and 11 clinics. Proponents of the measure estimated it would face at least a $1 billion deficit over five years because of funding losses, though opponents disputed those figures.

County Supervisor John Gioia said revenue from the tax would have protected critical services and helped keep people insured. Under Trump’s budget bill counties will soon have to check people’s eligibility for Medicaid every six months rather than once a year, and adults without children will face new work reporting requirements.

Gioia said the tax could have funded additional eligibility workers and bolstered the county’s program that provides basic health services to people with no insurance options.

Los Angeles and Contra Costa looked to Santa Clara County as a model. Voters there approved a similar measure last November; it took effect in April, and county officials anticipate it will make roughly $337 million a year. The county is allocating those dollars toward emergency services, cardiac care, mental health services and maternity care, among other areas.

But even that revenue only covers a third of Santa Clara’s projected shortfall, said County Executive James R. Williams. The county is still cutting and reorganizing staff and services in order to balance its budget.

“We were very clear, right from the outset, when we put this emergency measure on the ballot, that we were staring down over a billion dollars a year in revenue losses as a direct result of” federal spending cuts, Williams said. The missing link, he said, “is that the state has to do its part.”

The California State Association of Counties estimates federal cuts will cost the 58 counties up to $9.5 billion – a cost local officials say they can’t foot alone. The association has been pushing for additional state funding for months without much success. Gov. Gavin Newsom and legislators must finalize the 2026-27 budget by next week.

“For most California counties, raising local taxes to absorb the impacts of (federal cuts) is not feasible,” said Graham Knaus, chief executive of the association. “And the fact that counties are even being forced to contemplate it is unacceptable.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

In Kenya today, protests erupted for a second time in as many weeks. Residents are upset about a quarantine facility that the U.S. is setting up in the town of Nanyuki in the central part of the country about 120 miles from the capital, Nairobi.

Its purpose is to quarantine and observe American citizens who have had a high-risk exposure to Ebola in the Democratic Republic of Congo, South Sudan, or Uganda. Public health officials worry that the outbreak could become the world's most devastating Ebola crisis to date. The U.S. has already committed $13.5 million to Kenya to support the country's own Ebola response efforts.

Many Kenyans complain that their government hasn't been fully transparent about the quarantine center — an initiative that they worry might bring the virus into the country. But the U.S. isn't backing down from preparing the facility for possible patients, despite the tensions that it has inflamed.

Secretary of State Marco Rubio laid out the rationale behind the facility at a Cabinet meeting on May 27. "The number one priority of our foreign policy is to protect the American people," he said. "We cannot and will not allow any cases of Ebola to enter the United States."

A week later, Rubio called his statement a "misunderstanding," saying that Americans could return to the U.S. for treatment if they're sick. But officials remain undeterred in their plans to construct the quarantine facility on an air base in Nanyuki.

In an email to NPR, the State Department elaborated, "Kenya was selected due to proximity, airports in the region having limited capability, and to ensure Americans can be evaluated and receive assistance in a timely matter."

In response to today's demonstration, police fired tear gas on the protesters in Nanyuki. Last week, two protesters were fatally shot.

The Kenyan government has approved the facility. Kenyan President William Ruto said, "When President Trump asked the government of Kenya to support them by having a center… I gave the okay because it was an agreement and a partnership with friends who have worked with Kenya for 30, 40 years."

A high court in the country has ruled against the facility, however. The Nairobi-based Katiba Institute brought the lawsuit against the government "to determine whether the Executive can expose the public to such significant risks without complying with constitutional safeguards."

Some Ebola specialists believe that this facility isn't the wisest public health approach either, including individuals who were on the ground in West Africa during the 2014 Ebola outbreak.

"This does not make America safer," says Nahid Bhadelia. She directs Boston University's Center on Emerging Infectious Diseases and has been involved with multiple disease responses over the years, including time she spent in Sierra Leone in 2014 and 2015 during a previous Ebola outbreak. "It actually makes us less secure when the rest of the world is this pissed off at us."

Craig Spencer is an emergency medicine physician and professor of public health at Brown University who treated Ebola patients and himself contracted the virus in Guinea in 2014. He wound up being treated at Bellevue Hospital in New York City.

"People on the street in Kenya are angry because for many of them, this looks like colonial decision making all over again," he says. "That we can come into a country, decide what we want to bring in, do whatever the hell we want has led to an incredible amount of anti-American backlash."

"It's build the wall, but for viruses"

The State Department says an individual who had a high-risk exposure would volunteer to be transported to the facility in Kenya shortly afterward but before becoming contagious and starting to show symptoms. There, they would be monitored and likely repatriated if they don't develop symptoms within 21 days. According to the government, if they were to fall ill, they might be transported to Europe or the U.S. for "appropriate treatment."

The State Department says that no one who's had high-risk exposure has chosen to take advantage of the facility yet. (So far, only one American has contracted Ebola.) The Department wrote to NPR: "U.S. citizens who decline this assistance will remain subject to relevant U.S. and foreign government health, travel, and screening measures" but did not elaborate further.

Spencer says this approach is consistent with how President Trump has been discussing the best way for the United States to react to an Ebola outbreak for years. "Go back to 2014 before Trump was president and look at what he tweeted about Ebola," he says. One such tweet read, "Ebola patient will be brought to the U.S. in a few days — now I know for sure that our leaders are incompetent."

"It's this idea that you externalize the threat," says Spencer. "And if you keep it out, it can't get in. It's build the wall" — a reference to the Mexican border wall Trump is erecting — "but for viruses."

A possible alternative

"This is a bad idea," says Bhadelia succinctly. "They should just transport people back [to the United States]. It's cheaper, it's safer, it's better for Americans overall." Her rationale is that it's better for individuals to "quarantine closer to a potential biocontainment care unit that has a higher quality of medical care than what can be set up with a field hospital."

Spencer also has strong reservations about the approach. "I do worry particularly about the quality of care that may be offered in this facility for people who may be infected and may ultimately need treatment for Ebola," he says.

He's concerned because caring for a patient with Ebola can require a set of urgent interventions that may not be available in Kenya, such as mechanical ventilation or continuous kidney dialysis. The State Department didn't confirm whether such treatments, which are crucial to prevent respiratory and renal failure, would in fact be offered at the facility.

Spencer worries that this policy could jeopardize the lives of American health workers who have traveled to the outbreak to treat those who are infected. And that may complicate their decision to respond in the first place.

"We continue to think that if we protect ourselves here, that's sufficient," he says, "as opposed to the only thing that's actually going to lower risk for the average American is making sure there is no Ebola."

And that, says Spencer, means reassuring those traveling abroad to end the outbreak that they'll receive the best care they may need — which he believes is not the case with the facility in Kenya. The State Department didn't reply in time for publication when asked about the quality of care that will be available.

"This is a profound abdication of the moral responsibility we have to our own citizens," he concludes. "And it's ultimately a failure of what we owe American citizens, particularly at the time when they need us most."

Copyright 2026 NPR

Tobacco companies spent decades honing marketing strategies, flavor engineering and processing technologies that helped addict consumers to cigarettes. Then, in the 1980s, they started buying up large food firms and deployed these same strategies to sell more ultra-processed foods.

So says Laura Schmidt, a professor and researcher at the University of California, San Francisco, who has been studying old tobacco company archives.

She's one of dozens of researchers who contributed to a new series of papers published June 3 in a special section of the American Journal of Public Health. Together, many of them make the case that the fight to curb our over-consumption of ultra-processed foods should become the new war on tobacco.

The researchers say these foods — things like salty chips, sugary sodas and prepackaged meals that now dominate the American diet — have become major drivers of poor health, and the time to act is now.

The new research "adds to a growing body of evidence that these [food] products are associated with chronic disease, that they have addictive characteristics, and that they were also intentionally developed by tobacco and food companies," says Nicholas Chartres, an associate editor of the journal and one of the authors of the new papers.

He and other researchers say the same sort of public health strategies that were sharpened during the war on tobacco could help Americans cut back on these foods.

How cigarette science helped shape ultra-processed food

Back in the 1980s, tobacco giants began aggressively expanding into manufactured foods, buying up some of the biggest food firms. For example, Philip Morris used to own Kraft General Foods and R.J. Reynolds owned Nabisco. This was the era when ultra-processed food production really ramped up in the U.S., Schmidt says.

She says tobacco firms had spent decades amassing research on how to make cigarettes more pleasurable and addictive with chemical additives. And she says internal company records show they deliberately applied this knowledge to food manufacturing.

"The very technologies that were used to figure out how to optimize the addictive properties of nicotine using added sugar and artificial flavorings — that core technology was transferred from the tobacco industry to ultra-processed food development," Schmidt says.

She says these kinds of additives have now become one of the defining characteristics of what makes a food ultra-processed. Her study looks at the development of Lunchables, and how Philip Morris applied the same flavor technologies used to make lower-nicotine cigarettes more palatable to creating lower-fat cheeses and processed meats.

The cigarettes business also informed marketing strategies for ultra-processed foods, researchers say. For example, take the concept of king-size candies and other packaged snacks. The term "king size" actually originated as a way to market longer cigarettes. For consumers worried about health, tobacco companies used to sell so-called light cigarettes.

"They applied the same strategies to developing light and reduced food products with the express goal of retaining customers who might otherwise stop consuming some of their products, such as cheeses and other items that customers had concerns about due the health harms," says Tera Fazzino, an associate professor in the department of psychology at the University of Kansas.

Fazzino's prior research has found that during the period when tobacco giants owned major food firms — from the 1980s through the mid-2000s — they saturated the market with ultra-processed foods that were more likely to be classified as hyper-palatable. Basically, these are foods that contain unnaturally high combinations of fat, sugar, sodium and carbohydrates that activate our brain's reward system in ways that make it hard for us to stop eating.

Schmidt found a quote from a former Philip Morris CEO who said that ultra-processed foods and cigarettes were really similar businesses. He said they were both low-cost consumer packaged goods with a huge market.

Tobacco companies Reynolds and Altria, which operates Philip Morris, did not respond to NPR's request for comment by the time of publication.

Natalie Rubino, director of media relations at Consumer Brands Association, which represents packaged food and beverage companies, pointed to the safety of its brands.

"As consumers continue to seek a diverse selection of foods and beverages, the makers of America's trusted household brands provide a wide variety of affordable products to choose from, along with access to the information consumers need to make informed choices. Companies adhere to the rigorous evidence-based safety standards and nutrition policy established by the FDA to deliver safe, affordable and convenient products that consumers depend on every day," she said in an email.

Adding to the body of research

The new papers also look at the health and environmental impacts of the ultra-processed food industry.

A large body of research already exists that links over-consumption of ultra-processed foods to a host of poor health outcomes — from obesity to diabetes to all-cause mortality. Several of the papers in the special section add to this body of evidence.

For instance, one study that followed more than 5,000 older Americans over 10 years found a possible association between higher consumption of ultra-processed foods and an increased risk of cognitive impairment and dementia.

And ultra-processed foods take a toll not just on the body but also on the environment, an editorial in the section argues. Previous research has identified ultra-processed food companies like Coca-Cola, Pepsi and Danone as being among the top five plastic polluters globally.

The Consumer Brands Association statement did not address NPR's request for comment on the environmental impact.

A threshold for change?

The new issue includes a survey of a nationally representative group of 2,000 adults. It found that, across party lines, the majority of people who responded said they want the government to regulate ultra-processed foods.

"It feels like we've reached a tipping point between the strength of the science, public support, and then also political will," says Lindsey Smith Taillie, a professor of nutrition at the University of North Carolina and co-author of the papers. "And those three factors combined to me suggest that we might be at a place where we start to see real policy action on this topic the way that we did in tobacco."

The food industry is powerful, and many policy experts say we are likely to see change at the state level first. Several states have passed restrictions or bans on the use of synthetic dyes in foods, for instance.

Litigation could also be an important strategy against the ultra-processed food industry, Jennifer Pomeranz, an expert on food policy and law at New York University, argues in an editorial. In other words, state attorneys general could file suit against food companies alleging damage to the public health, not unlike the lawsuits filed against tobacco companies in the 1990s.

She and other researchers say now's the time to act, because the Make America Healthy Again movement has become so influential and its proponents are very vocal in calling for removing artificial additives from the food supply.

"The last time there was this kind of universal upheaval about the safety of our food supply was the 1906 Food and Drug Act," Pomeranz says.

Copyright 2026 NPR

This story was originally published by CalMatters. Sign up for their newsletters.

Elias Avalos felt like he was running in circles during his junior year of high school, losing motivation, and burning out. He juggled four AP classes and felt the pressure of being the child of Salvadoran immigrants.

“I’ve been dealing with feelings of burnout and unbelonging for a while,” the now 17-year-old senior says. “I think how I really ground myself when I feel like that is through skateboarding. It’s a hobby that dissociates from any work I have so that I can de-stress.”

He’s one of a growing number of Black and Latino boys who are left to manage their mental health on their own. In the 2026 Children Now report scorecard, 94% of the state's youth ages 14-25 report mental health concerns in an average month, with stress and anxiety the most commonly reported concerns.

Listed on the California Health and Human Services Agency website, there are a number of crisis hotlines, mental health and wellness resources, and resources guides for youth. But families say they are finding it too difficult to access care for their teens because of repeated health insurance denials, difficulty navigating mental health services, and a lack of money. Advocates and parents are pushing for change.

When he’s not skateboarding, Elias works as an intern at the RYSE Youth Center in Richmond where he’s researching the factors influencing youth mental health. Working with a team of other young people, he says teens are struggling with neglect, poor coping skills, and a lack of access to youth-centered spaces.

“So what I learned is that here in Richmond, we don’t have access to a lot of support systems, which leads youth to go down different paths,” he says. “I know many people in my neighborhood that have to sleep on the streets, sell drugs to support their families and people that I know lost their lives. It’s a harsh reality that youth, in Richmond, really do face.”

Kelly Hardy, one of the lead authors of the Children Now report, says these numbers reflect that children’s mental health is in crisis. She said mental health resources need to be available where young people are, in schools and in the community.

The Oakland-based nonprofit organization supported a law that took effect in 2024, allowing minors age 12 and older to consent to their own mental health treatment or counseling. This year Children Now is backing Senate Bill 363, Hardy says, which would require health insurers to report the number of treatment denials or modifications. The goal is to make mental health care services, like counseling and therapy, more accessible to young people.

“We know that mental health has an impact on physical health and whether kids turn to substance abuse in order to manage mental health symptoms. Those are all the consequences that can come out of living a less healthy life,” she says. “We need to be responding with care, treatment, and services rather than with punishment.”

'I didn't want to be a burden'

Elias never learned to process his emotions at home; some spaces weren’t safe for him to open up, so he learned to keep things to himself. That’s part of why he’s never been to therapy. Like many young Latinos, he says, he was afraid that whatever is shared with a therapist will be later shared with parents.

“I didn’t want to be a burden to my family and friends with my problems because I didn’t want to add something extra,” he says about the time he was dealing with burnout. “Everyone is going through something. It’s just something I got to get out of myself.”

When his family asks about the internship, he keeps it surface-level — focusing on the values he's gained rather than the harder realities he's researching. “From my experience, I was raised to be more of an observer than a speaker,” he says.

Dr. David C. Turner III, assistant professor of Black Life and Racial Justice at Luskin School of Public Affairs at UCLA and senior adviser at the Alliance for Boys and Men of Color, says not enough is being done to address the systems in place that contribute to poor mental health outcomes for Black and Latino boys. He points to systemic racism, the over criminalization of Black children, and the education system as longstanding structural issues.

“The overcriminalization of young people in schools oftentimes forces them to disengage from education. It demonstrates to these young men that they don’t matter, their opinions don’t matter, how they learn doesn’t matter and it creates a very dehumanizing environment for them,” he says. “It’s one of the primary driving factors as to why these brothers don’t go on to college … because schooling has been a place of violence for them. When I say violence, I mean like having their spirit broken.”

Oftentimes, he says, children of color are left with added burdens to bear and little support systems to lean on. Part of his work involves advocating for legislation that implements mental health services in school systems. And he’s working to dismantle the school-to-prison pipeline, a disciplinary practice that disproportionately pushes Black and Latino students out of school and into the criminal justice system.

Looking for 'better ways'

Bryce Collins, a 16-year-old high school junior, is waging his own fight to protect the rights of Black and Latino youth in the Los Angeles Unified School District. Since October, he’s been working with Students Deserve, an organization working to end the school-to-prison pipeline. And he’s advocating for more spaces inside school that protect students' mental health. The reason he’s joined this work, he says, is because too many Black youth like him are dealing with racism, stress, and anxiety — alone.

“Being a young Black male lets me know how I have to approach some of these areas … I can’t do what everybody else do,” he says. “I don’t got the privilege. I have to hold myself to a higher standard because that’s not how society views us typically.”

As the youngest of seven siblings, he says, his older brothers have helped him prepare for racial profiling. Around the age of 12, Bryce remembers beginning to notice non-Black people turning their heads and watching him when he entered different spaces. He knew it was because of his skin color. Lately, the pressures of being a young Black man, preparing for college, and family life have been adding to his stress.

Those pressures, he says, still sometimes force him to shut down.

“My goal is to find better ways to manage my mental health besides going unresponsive to people,” Bryce says. “Even though it's what I have to do for my mental health's sake. I feel like I should come up with better ways instead of not talking or not letting people know what’s going on in my life.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

There is mounting evidence to suggest GLP-1 obesity treatments also help reduce cancer risk, according to several recent studies. The studies are correlative, but appear to show that the drugs not only reverse the carcinogenic risks that come with obesity, they may also have additional anti-inflammatory effects that help suppress tumors.

GLP-1 drugs' potential use in preventing or controlling cancer was a major theme among the research presented at the influential American Society of Clinical Oncology meeting last month.

The group highlighted four studies — some of which were published in its affiliated Journal of Clinical Oncology. The most prominent among them tracked medical and prescription records of over 10,000 patients with early-stage cancer, and found GLP-1s reduced cancer risk in 6 out of 7 cancers — four of them at statistically significant levels. Breast, liver, colorectal and non-small cell lung cancer risks declined significantly; kidney and prostate declined somewhat; pancreatic cancer rates were affected the least.

It's notable that the effects were seen across cancers, not just those with a known connection to obesity. For non-small cell lung cancer, for example, the incidence of progression to Stage IV disease was 22.3% for patients not on a GLP-1 versus 10% among people taking GLP-1s.

GLP-1 drugs were originally developed decades ago as diabetes treatments that alter the hormonal makeup of the brain and gut — reducing hunger and slowing digestion. Because the drugs act on powerful metabolic levers, they've also since proven useful against obesity, heart disease, sleep apnea, as well as potentially addiction and now cancer.

Studies show just correlation, so far

Experts say the latest data is still far from being able to conclude that GLP-1s are effective treatments for cancer. These analyses used retrospective medical databases that did not include relevant nuances like a patient's comorbidities, or their exercise or eating habits, for example, says Dr. Julie Gralow, chief medical officer of ASCO.

But, Gralow says, the data is consistent with what is known about how obesity is a driver for about a dozen cancers, and how healthy living is significant in both illness and recovery.

"It ties into a body of knowledge about exercise and healthy lifestyles after a cancer diagnosis."

Breast cancer risk reduction

Another data analysis, also presented at the research conference, matched mammogram images to a prescription database showing women between age 45 and 80 who took GLP-1 drugs were 30% less likely to develop breast cancer. Cancer risks decline in general when patients lose weight, whether that is through diet or bariatric surgery, for example. But radiologist Elizabeth McDonald at the University of Pennsylvania, who co-authored that study, says the protective effects with GLP-1s appear greater than with other treatments or lifestyle changes. "The weight loss alone just didn't account for the magnitude of the observed effect," McDonald says.

How?

McDonald suspects that GLP-1 medicines, as they regulate hunger and digestion hormones, also trigger other metabolic pathways. They may reduce inflammation, for example, which is a known driver of cancer.

New research underway

More trials are now starting to look at how GLP-1s might influence things like chronic inflammation or immunosuppression, both of which might contribute to cancer growth.

Oncologist Coral Omene at Rutgers Cancer Institute, for example, plans to follow 40 breast cancer patients starting tirzepatide, a GLP-1 drug sold under the brand names Mounjaro and Zepbound. Omene plans to regularly measure blood samples and track changes in cancer markers, and biopsy participants' abdominal fat cells every six months, to see how those respond, in terms of hormones or inflammation. "And as we're treating them, we are going to trace and see how the immune cells are behaving," Omene says.

That information, she says, will hopefully lead to a better understanding of how best to use GLP-1 drugs against cancer.

Copyright 2026 NPR

In March 2025, Nicholas Enrich was the top U.S. official for global health when two major events were happening at the same time: The Trump administration was dismantling USAID, and an Ebola outbreak was spreading in Uganda.

It was Enrich's job to manage the U.S. response. He says he was stymied at every turn.

"I was told by one of the political appointees, who was the head of the Bureau for Humanitarian Assistance, that Ebola is a scam," Enrich says.

A year later, as the worst Ebola outbreak in more than a decade spreads in the Democratic Republic of the Congo, Enrich has published a timely book with a title drawn from Elon Musk's plans for the premier U.S. foreign aid agency: Into the Woodchipper: A Whistleblower's Account of How the Trump Administration Shredded USAID.

It's written from the perspective of a civil servant who served at the premier U.S. foreign aid agency under four administrations –- until he was put on leave and then dismissed after leaking memos about plans to dismantle the agency.

In an interview with NPR , Enrich talked about his view of the agency and his perspective on the current Ebola outbreak in a world where USAID no longer exists.

This interview has been edited for length and clarity.

Let's start with a controversial question. The administration gave various rationales to justify the sunsetting of USAID –- accusations of political bias, waste, fraud and abuse. Did you agree with any of their points?

Okay, I'm gonna say yes, but before I talk about them, it's important to recognize that the agency was not destroyed because it was wasteful or because it didn't work or because they wanted to realign aid with the American First priorities. It was destroyed by a bunch of people who did not understand what the agency did, who were completely uninformed and unqualified about our programs, and who were there tearing down the agency that they didn't get for the sole purpose of soothing the ego of a billionaire.

That's a very stark explanation.

One of the reasons I wrote this book was to make sure that it's very, very clear why the agency was destroyed and why it wasn't. That said, I think that there are ways that aid could have been more efficient and could have been less likely to foster dependency in ways that it had.

But you know, I also want to make the point that USAID actually was considered one of the most efficient agencies within the government [operating] on less than 1% of the federal budget. We, among many other things, saved the lives of 92 million people over the last 20 years alone, which is a staggering impact for a relatively shoestring budget. So it's not that we weren't efficient, it's just that, of course, there were ways that we could have become more so.

You were put on leave immediately after leaking the memos. Looking back, is there anything you would have done differently in your final months there?

I do feel like I was quite naive. I was a civil servant for my whole career, and I was no activist or advocate. So it did not come naturally to me to stop and say: "Wait a minute. This is not an opportunity for me to figure out how to administer the policies of this administration. This is completely off the rails and is a violation of laws, of court orders, of congressional intent and it is unethical and causing destruction and harm to public safety." And I wish that I had been able to say earlier, "This is not okay and I cannot continue to work within the bounds of these walls that are collapsing around me to try to save this tiny bit of our program."

I wish I had said I need to not agree to some of the directives, because I did [agree]. I did implement directives from our political leadership that I'm not proud of, like making lists of our staff, knowing that some of those people would be terminated, or taking life-saving activities off the list of what I was asking to be approved.

For example…?

I was told by the political appointees, for example, that they wouldn't be approving any of the Ebola activities, because Ebola was a scam, and so I made a decision that I regret to this day of removing Ebola activities from those that I was hoping to get approved.

You were involved in Ebola efforts even before the Uganda outbreak last year. What was the agency's position on the virus?

I was thrust into the top official of global health role for the agency and my job was to set up a robust U.S. government response to the Ebola outbreak, and I was just stopped at every single turn. It started with the refusal to even allow us to screen passengers at international airports for symptoms of Ebola before they got onto flights that were headed to Europe and potentially onward to the United States.

And we were never able to even get a team into the country. They had banned us from communicating with our sister agencies like the CDC, which made it extremely difficult to manage an Ebola outbreak in the ways that we were used to. For example, in preparation for an outbreak like this one [we] had pre-positioned personal protective equipment in nearby Kenya so that it could be delivered to the outbreak zone within a matter of hours. But we were never able to move that, because the warehouse was owned by the World Health Organization, and our political leadership wouldn't even let us talk to the World Health Organization.

What's going through your mind as you see the news of the current Ebola outbreak in the Democratic Republic of the Congo?

This is the first Ebola outbreak since USAID has been destroyed. I think about the systems and the expertise and the experience that USAID had in leading and coordinating responses to Ebola outbreaks — the way that we would immediately get our DART [Disaster Assistance Response Team] teams into place to move PPE [personal protective equipment], to coordinate partners in the country, to do contact tracing on a massive scale and community education and safe burial procedures. This is what we need in an outbreak — response with speed — and what instead we have without that expertise and systems from USAID is a State Department that, in the best of light, is rapidly trying to respond but is reinventing the wheel and trying to improvise systems that used to exist.

You were at USAID during the 2014 outbreak of Ebola as well. Were there lessons learned during that response that could have been implemented now with this outbreak if the agency were still around?

Because of the 2014 Ebola outbreak, we completely changed the way that we do infectious disease preparedness and have an entirely new global health security strategy. We invested billions of dollars in that time period to set up what my former boss [Atul Gawande] used to call the global immune system, which allowed for early detection and early response efforts. So we could make sure that our surveillance is in place and our testing is working and our community health workers know what to be looking for –- so we are detecting outbreaks at such an early stage that there's no time for them to spread.

And what has happened to that system?

That entire system was ripped apart in 2025. What we're seeing with Ebola in DRC {Democratic Republic of Congo] and Uganda and the recent hantavirus outbreak, these are a couple of examples within just a few weeks of how far American leadership has fallen in detection and response to infectious disease outbreaks.

It does make me nervous that if there is a pathogen that is more likely to be the next pandemic that we're just way, way underprepared as compared to how we were just a few months ago.

How do you think we should be talking about USAID at this moment?

 I think of it as an era that I'm very proud of in American history and extremely proud of myself for getting just the opportunity to be a part of when the official policy of the United States government was to make the world a safer and healthier place. I'm sad that it's gone. I do remain optimistic, however, that we will need to have a new and independent agency that does international development and foreign aid — in the same way that no one would be satisfied folding the State Department into the Department of Defense because they do completely different pillars of foreign policy, so too does international development need a separate and unique kind of organizational structure to provide the third leg of the foreign policy stool.

Copyright 2026 NPR

Andrea Bloom, 59, of Pleasanton, Calif., learned she had osteopenia, or low bone density, after a bone density scan. "When I saw my results, it was pretty shocking because I was one-tenth of a point away from an osteoporosis diagnosis," she says.

More than 40 million adults in the United States ages 50 and older have osteopenia, which can progress to osteoporosis, leaving bones brittle and weak.

Bloom's doctor prescribed the Food and Drug Administration-approved Osteoboost belt, a wearable device that delivers targeted vibrations to the spine and hips, approved for post-menopausal women with osteopenia. Now, every morning when she walks her dog, she straps it on. "It's a black belt that you wear around your hip area. And it's a very, very light vibration," says Bloom, who wears it about 30 minutes a day.

How it works

The device works by mimicking some effects of exercise. The low-magnitude vibrations produce mechanical signals similar to those generated when muscles contract, stimulating bone-building cells called osteoblasts.

"So for 30 minutes a day, when you wear the belt, you're stimulating those bone-building cells," says Dr. Pamela Peeke, chief medical officer for Osteoboost, who says she uses the device while she's on her elliptical, which she says gives her another "layer of stimulation."

The science behind vibration therapy traces back to NASA-funded research. "The original vibration plate was developed through funding from NASA to come up with a therapy that astronauts could use in space to fend off the effects of zero gravity on bone loss," says Mike Jaasma, one of the Osteoboost's founders. "That sparked some of the early research into the effects of vibration."

In zero gravity, bones deteriorate because they need mechanical stress to maintain themselves. On Earth, walking and carrying your own weight, as well as doing weight-bearing and resistance exercises (such as squats, lifting weights, walking, running), put stress on bones to promote bone-building. That stimulus disappears in space, and bone loss accelerates.

What the research shows

The FDA approved the Osteoboost device in 2024. In a randomized, double-blind, controlled trial of 126 women in their 50s and older, those who used the device regularly showed significantly less bone strength loss in the spine over 12 months.

"The placebo group lost 2.84% of their bone strength over the course of the year. Those who received the vibration therapy lost only 0.5%," Jaasma says. "What we saw at the end of 12 months was an 83% reduction in the loss of bone strength in the spine," he says.

The clinical trial did not test whether users have a lower fracture risk (which would have taken longer to determine), and a group of bone health and aging scientists says there are shortcomings to the clinical findings and they are critical of the way the Osteoboost researchers described their findings. "While we recognize there could be potential benefits to slowing bone loss at a singular site directly beneath a wearable device," the scientists wrote in a letter (to the journal that published the study, Journal of Bone and Mineral Research), "the investigators' conclusion that such a focal treatment could be prescribed as a treatment strategy for osteopenia, a systemic — not a local — disease, is not supported by the study results."

Osteoboost researchers responded that the device was designed to target the lumbar spine and hips, the sites where fractures carry the most serious consequences.

Bones and muscles work together

Researchers at MD Anderson Cancer Center are studying vibration plate technology in animal models, with the goal of protecting bone health in cancer patients. Biomedical engineer Gabriel Pagnotti says the benefits may extend to muscle as well.

"The vibration plates can reproduce some of the dynamics of exercise on the muscle," he says. "What we're doing is stimulating the bone cells that form new bone or mineralize the preexisting bone," which may improve bone health.

"Bone and muscle are being maintained in a crosstalk fashion," he adds. "A lot of forces from one are transmitted into the other. And the health of the bone can dictate the health of the muscle," he says.

A tool that works in combination

Osteoboost is the only FDA-approved vibration device specifically authorized to treat osteopenia and is available by prescription only. It costs about $1,000 out of pocket, as insurance does not cover the device. Many over-the-counter vibration plates are widely available, but evidence supporting their benefits is limited.

Dr. Eric Ascher, a primary care physician at Northwell Health in New York, says vibration devices should be considered an add-on, not a replacement, for bone-health habits: weight-bearing exercise, adequate calcium and vitamin D, good sleep and good nutrition. He says that while the devices are generally safe, on their own they're unlikely to be a panacea. "It might help, it can't hurt," he says.

Ascher says people should consult their healthcare provider if they want to use an over-the-counter vibration plate. He says people with certain conditions may want to avoid using them, including people who have a blood clot, a recent concussion, or those with a pacemaker. Ascher says be cautious with social media claims, as the hype can get ahead of the science.

Bloom's most recent bone density scan showed significant improvements, and she says, for her, the belt is worth it. It could be that a combination of the belt, diet changes — including adding dried plums, which have been shown to support bone health — and adding in more exercise is all helping.

"I'm trying to add more jump roping in because they say things like that are really good," she says. "And I do cardio three times a week."

Copyright 2026 NPR

Remote work has soared in popularity since the COVID-19 pandemic. But, a new study suggests the practice has made workers more socially isolated, anxious and depressed compared to people who work in-person in offices and other settings.

"Other studies have found that workers are willing to give up 4 to 10% of their earnings in order to have the ability to work remotely," says Natalia Emanuel, an economist at Federal Reserve Bank of New York and the main author of the new study published in the journal Science. "So there is a great desire for remote work."

Yet she and her colleagues found that people in remote jobs have seen a rise in hours spent alone during the workday, and more visits to mental health care providers. In self-reports, they also assess their own mental health negatively.

How does working from home change us?

The findings suggest that "people might be choosing poorly," when it comes to their well-being, says Nicholas Epley, a professor of behavioral science at the University of Chicago's Booth School of Business, who wasn't involved in the study.

That's probably because "it's very easy to recognize that the commute is a pain in the neck and the traffic sucks," compared to anticipating how missed social connections at work will impact us down the line, he says. His own research has documented that people "underestimate how well things will go when we actually reach out to connect with other people," he adds.

Epley says Emanuel and her colleagues found a way to answer a question he gets asked often: "What work from home does to us?"

"Everybody wants to know how is that changing things? And usually the answer is we can't really tell," he explains. "We can't really tell because people weren't randomly assigned to work from home or not as a terrible experiment."

"Remotable" vs. "non-remotable" jobs

To get around that problem, Emanuel and her colleagues looked at data from five large national surveys on American workers, both in jobs that allow remote work, like software engineering and marketing — so-called "remotable jobs" — and those in jobs that can't be done remotely ("non-remotable jobs" like surgery, or mechanical engineering).

They found that workers in remotable jobs had experienced a 58% rise in hours spent alone compared to people in non-remotable jobs. These workers also saw a 72% rise in chances of spending their whole day with no human contact.

"Not even like a wave to a barista, not somebody also checking for ripeness of the avocados at the grocery store," says Emanuel. "Just no human contact at all."

Remote workers aren't making up for that lost social connection by socializing after work, she adds. "We even see a decrease in spending time with friends after the work day relative to people in non-remotable occupations."

More psych meds, too

People in remote jobs also saw a rise in symptoms of emotional distress, evaluated with a standardized questionnaire about symptoms of anxiety and depression. They also had more visits to mental health care providers and used more prescription psychiatric meds.

All these impacts were worse for remote workers who live alone. For example, they saw the largest increase — 83% — in chances of spending their days with no social contact.

"Likewise, the increase in mental distress is almost twice as large for those living alone as for those living with their family," notes Epley.

That's no surprise, he adds. Scores of past studies have documented the negative impacts of isolation and loneliness on our mental and even physical health.

"Being alone compromises your immune system functioning, your cardiovascular system functioning," says Epley.

Studies have also documented that the biggest predictor of well-being and happiness is "the quality of your social relationships," he adds.

"Psychologists believe this feeling of human connection and belonging is just absolutely crucial to us as humans, that we cannot thrive, we suffer, if we don't have that need met," says psychologist Gillian Sandstrom at Sussex University and author of a book called Once Upon a Stranger: The Science of How 'Small' Talk Can Add Up to a Big Life.

While the new study's findings are important, Epley notes that they "don't suggest that every office should be forcing everybody to come in to work."

Other studies have documented that remote work increases productivity in many industries, and that working from home is particularly helpful for certain groups, like caregivers and neurodivergent individuals.

Epley notes that employers should take into account that remote work can take a toll on workers' mental health, and employers should make working in the office "more attractive for people."

As many organizations are starting to bring employees back to work, Epley suggests, they should make sure that those who come in have other co-workers there, too. "What they're providing that's rewarding at work is social interaction, social connection," he says.

And for those still working remotely, Sandstrom, who also often works from home, recommends being intentional about seeking daily human interactions like she does.

"I leave the house every day. I go for a walk, I see my neighbors, I pet some dogs," she says. "I have my activities that I do. I play tennis. I have hobbies that mean that I see other people."

Copyright 2026 NPR

Updated June 8, 2026 at 11:40 AM PDT

KINSHASA, Democratic Republic of Congo — Health authorities in the Democratic Republic of Congo have confirmed 27 new Ebola cases, according to a report released late on Sunday, warning that protective measures need to be scaled up quickly.

Congo's National Institute for Public Health (INSP) said the country now has 515 confirmed Ebola cases, following the 27 new infections reported within a 24-hour period.

The total number of confirmed deaths is now 91.

More than 94% of the recorded cases are in Ituri, a province in eastern Congo plagued by some of the country's most violent armed groups, such as the Allied Democratic Forces, or ADF, which is affiliated with the Islamic State. The threat posed by these armed groups is making the health response much more complicated. But Ituri's health system is also dire, and it's hard to get around given the few paved roads in the province.

As aid workers struggle amid trying circumstances, European Commissioner Hadja Lahbib visited Ituri for several hours on Sunday to show support to people on the ground.

"We need to be able to provide diagnoses more quickly," she told reporters, in Congo's national language, French.

She added that treatment outcomes were better for those who sought medical help early. "Many patients arrive with situations that are already dire, so it's much harder to save them." On Friday, Congolese health authorities had also warned of "rapid community spread" of the disease after discovering 71 new cases of Ebola.

Since the government first declared an outbreak on May 15, the disease has spread to 17 out of 36 health zones in Ituri. The provinces of North Kivu and South Kivu, both in eastern Congo, have also recorded cases.

There are also confirmed cases in Uganda, a neighboring country that shares a long land border with Ituri — although the scale of the outbreak there is much smaller. Ugandan health authorities have so far recorded 19 Ebola cases.

With the virus still spreading quickly, Congo reimposed travel restrictions to and from Ituri's capital city, Bunia, on Saturday, according to an official Congolese aviation notice consulted by NPR. The government has not publicly announced the reasons behind the decision. However, there are fears that the outbreak in eastern Congo is much larger than the official figures suggest.

The U.S. Centers for Disease Control and Prevention modeled how far the virus could spread in a new study published on Friday. According to some scenarios, the ongoing outbreak in Congo could rival the 2014-2016 West Africa Ebola epidemic. That outbreak was the worst in recorded history, with more than 28,000 reported cases and about 11,300 deaths. For example, the U.S. CDC projected that if only 20% of patients during the current outbreak in Congo are isolated, there is a 65% chance of case numbers exceeding 20,000 within just three months.

Despite rising international alarm, Congo's government insists that the situation is under control. It has repeatedly been pointed out that the country successfully overcame 16 previous Ebola outbreaks. Some patients have also begun to recover, offering a glimmer of hope.

Congolese health authorities said this weekend that three patients had left the hospital, with the total number of recovered patients in the country rising to 12.

And on Saturday, American doctor Peter Stafford — who contracted Ebola in eastern Congo and was evacuated for treatment in Germany — was cleared to leave quarantine after repeatedly testing negative for the disease.

Copyright 2026 NPR

THE GREAT NICOBAR ISLAND, India — Fireflies illuminate the edge of a forest on the Great Nicobar Island as field biologist Sumit Kumar tries to find a particularly shy creature.

A soft hoot wafts through the thicket. Kumar scans the trees with his flashlight: Sitting on a branch is a rare, wide-eyed, fat Nicobarese Scops owl. It narrows its eyes into what feels like a death-glare. Kumar smiles: "When you spot them, they look at you as if to say, 'You don't belong here.'"

And he says, they're not wrong.

The Great Nicobar Island is part of an archipelago that lies deep in the Indian Ocean. Until mainland Indians started settling here a few decades ago, its humans consisted of around a thousand indigenous folks.

It's governed by India but is so distant that it takes a flight from the mainland and a 30-hour ferry ride to arrive.

The Indian government hopes to change all that.

The upcoming Great Nicobar Project is set to transform this sleepy island into a bustling township over the next three decades.

Once complete, the island will have a civilian and military airport, a transshipment port that caters to container ships, a power plant and a new town equipped to host a million tourists a year — nearly 100 times its current population.

The project will cover an area twice the size of Manhattan, and potentially feature high rises, discos, even Disneyland-like theme parks.

Environmentalists and critics have a list of concerns. They say farms, beaches and hills will be swallowed up and a million trees will be felled. They worry about the impact on endangered animals, like leatherback turtles, largest of all sea turtles, and the Nicobarese pigeon, the closest living relative of the dodo, with its distinctive fluorescent green and orange plume.

The Great Nicobar Project "sounds like an open invitation to disaster," says Manish Chandi, a scholar who has studied the Andaman and Nicobar archipelago for over two decades. "It poses a threat to a huge amount of natural resources, its biological diversity and its indigenous communities." 

Chandi argues the purported benefits of the Great Nicobar Infrastructure project reflect a flawed understanding of "development." Residents are not the primary beneficiaries, he says. "It's a model that sees money-generation as the only way forward." He says the price of that extraction isn't taken into account.

It's a tussle mirrored in many state-backed infrastructure projects across India, from a coastal road underway in the Arabian Sea that cuts through mangrove trees to an upcoming dam in the Himalayas that will decimate chunks of forests. The clamor to protect nature has grown sharper as India sees a rise in heatwaves, glacial floods and extreme rainfall in recent years. 

After some public criticism last year, the environment minister Bhupendra Yadav insisted that the project "poses no threat to the island's tribal groups, does not come in the way of any species and does not jeopardize the eco-sensitivity of the region."

Indian ministers and departments overseeing this project did not respond to NPR's emails with a list of questions about the potential negative impacts of the project.

Why this project?

The global presence of China looms over the project.

In a press release in May, the Indian government said the goal is "to enhance India's national security, strategic and defense presence, strengthen the islands' economic position, and accelerate holistic development in the region."

And more plainly, the Hindu nationalist Bharatiya Janata Party that governs India has described the project as a "strategic gateway to crush China" in a series of social media posts.

It says the project can also help "challenge the dominance" of China in the Indian Ocean. Analysts say the shipping blockade in the Strait of Hormuz stemming from the Iran war has lent an air of urgency.

"If we think about global choke points today, especially in light of conflict in the Strait of Hormuz, India is one of many countries that are looking to secure their own supply lines," says Nitya Labh, a maritime researcher from the think-tank Chatham House.

"The project here is a great opportunity to do that because it sits along such a major international shipping route," she says, referring to the Strait of Malacca, a narrow maritime pathway that lies between Malaysia, Indonesia and Singapore.

In a 2023 press release, the Indian government said nearly 75% of India's maritime cargo today is handled at ports outside India. With a new project, it said, "Indian ports can save $200-220 million each year on transshipment cargo" and grab a share of the regional goods traffic.

There's been a massive outcry against this project for years — from former bureaucrats, the political opposition Indian National Congress party, academics and indigenous communities. They accuse the government of downplaying its ecological impact and overstating its economic and security benefits. Some have also filed lawsuits.

Others, like Abhijit Singh, a former Indian naval officer and expert on maritime affairs, have questioned the government's claims.

"This strategic and commercial gain that we are talking about seems to me a bit notional," says Singh. "But the damage to the environment is going to be very real."

Singh says India already has military infrastructure in the region to counter Chinese threats. He adds, a transshipment port only makes sense if it can lure shipping companies from their current stopovers in Singapore and Sri Lanka.

"A transshipment port does not just come up in a vacuum. It requires a logistical network. The big problem with Nicobar is that it is over 700 miles away from the Indian mainland. That means the markets and cargo production centers are quite far off from the transshipment port."

India's ruling party has bristled at criticism of the project.

In April, the country's political opposition leader Rahul Gandhi described it as the "biggest scam and gravest crime" against nature and "indigenous communities" during a visit to the island.

Days later, the ruling party accused him of sabotaging the project on behalf of China and George Soros, echoing widespread antisemitic conspiracy theories that the billionaire Jewish philanthropist seeks to subvert popular rule.

And many fear reprisals from the government for speaking out.

Nearly a dozen environmentalists, think tanks, public officials and residents declined to comment when NPR reached out, or they requested anonymity. Some said they worried about their ability to obtain funding for their projects or obtain access to the island if they publicly criticize the project.

But India's ruling party has promised the project would bring new roads, power, internet and more than 50,000 jobs to the island. The interior minister Amit Shah promised in a speech earlier this year that "in a decade, this region will draw the most tourists in the world."

For many islanders, that is a major incentive.

Two populations: Settlers and islanders 

On a recent spring afternoon, around two hundred men and women sit in neat rows at the community hall in Gandhi Nagar, a settlement built by mainland Indians when they migrated to the island five decades ago. A dozen bureaucrats had flown down for the public hearing scheduled this afternoon. They sit behind a small table, looking somber.

At the five-hour public hearing, residents ask for guarantees: jobs, houses, farmland and a hefty payout, not the pittance they say they're being offered and that the government confirms: a dollar-and-a-half per square meter of their land.

"We're no ordinary people," says an elderly man with a long white beard, who did not give his name during the public hearing. From the 1970s, he says, the government shipped hundreds of Indian citizens from the mainland to build roads and tend to farms, and to act as India's eyes and ears against Burmese poachers and foreign powers. They lived through earthquakes and diseases, staying put even when the deadly tsunami of 2004 devastated the island. "Had we run away, the Chinese flag would've fluttered on Great Nicobar," the man says. The crowd cheers.

But for the indigenous communities, the threat is existential.

Around a hundred members of the hunter-gatherer Shompen tribe live in the Great Nicobar's rainforests. The Indian government forbids outsiders from most contact with the tribe because their bodies aren't immune to modern day diseases. In the past, thousands of the indigenous Great Andamanese people living in the region died after contact with British colonizers led to an epidemic of measles and syphilis. The nonprofit conservation group Survival International, which focuses on the rights of indigenous people, says massive tourism risks contact between the island's indigenous tribe and outside visitors.

The Indian government insists that the safeguards are in place, and the rights of the Shompen will "not be affected adversely." But anthropologist Vishvajit Pandya, who interacted with the Shompen people as part of an official study in 2019, told NPR that the project's official maps he has studied include areas they're known to inhabit.

To prevent interactions with outsiders, the government's environmental impact report proposed using barbed wire to fence off areas Shompen communities are known to inhabit.

The island's other indigenous folk — the Nicobarese — are also worried. They do have contact with outsiders and have spoken to reporters, including NPR.

For generations, around a thousand Nicobarese people have lived in coastal villages. It was a simple life, says chief Barnabas Manju. "We fished in the sea, got honey from forests, squeezed oil from coconuts."

The 2004 tsunami wrecked their thatched-roof homes near the coast and forced them to relief camps in the island's administrative center. Manju says Indian officials had promised to help them return when things got better. That never happened.

Over syrupy tea and biscuits, Manju and his three deputies recalled how the lives of his community members have fundamentally changed. They now labor on building sites for money and sleep in tin sheds instead of the thatched-roof homes in their village. Their diet includes processed food. They buy fish and coconuts from the market instead of doing their own hunting and gathering for free.

Four years ago, Manju says, officials told him about the Great Nicobar project. "They had brought with them a consent letter. They didn't even give me time to read it — and just asked me to sign."

Manju says they promised him the project wouldn't impact their ancestral lands. When he saw the project's maps later, he realized part of the port would be built over his community's ancestral lands.

But Manju says what keeps them going is faith.

Every Sunday, they pray at their church, then ask for blessings for everyone: friends and family, island officials and India's prime minister.

Manju says he will lead his people back to their thatched-roof homes in their villages one day. And when that happens, he hopes officials understand why it was so important to them: "Because a country's development shouldn't come at the cost of its people's identity."

Leesha K Nair is a freelance journalist from the Andaman and Nicobar Islands, focusing on intersecting themes of environment, climate, mental health and Indigenous issues.

Copyright 2026 NPR

This essay first appeared in the Up First newsletter. Sign up here.

It can be hard to remember what the HIV/AIDS epidemic in Africa looked like decades ago: Hospitals across the continent were overwhelmed with young men and women, dying excruciating deaths.

South Africa was at the center of the epidemic. Activist Lucky Mazibuko remembers, vividly.

He told me that at the time, the country "was filled with the stench of death."

It seemed, he went on to say, that there would be no end to the suffering.

"There was no hope, there was basically no light," he told me. "And even if there was a light at the end of the tunnel, it looked like that of an oncoming train."

PEPFAR changed everything — across the continent.

President George W. Bush announced the President's Emergency Plan for AIDS Relief, or PEPFAR, in January 2003. The program is often cited as the most effective public health campaign ever, and is estimated by the State Department to have saved roughly 26 million lives since its inception. And for decades, the program enjoyed widespread bipartisan support.

But the Trump administration has radically changed the way the U.S. delivers foreign assistance, making sharp cuts and creating uncertainty about future funding. So as my colleagues and I tracked these developments, we wanted to see first-hand what these sweeping changes could mean for the worldwide fight to combat HIV/AIDS.

That curiosity is what led us to Soweto Township in South Africa to sit down with Mazibuko. He's an activist and former journalist, who we met at the restaurant he now runs.

Back in 1999, at a time when the disease was still shrouded in stigma and shame, Mazibuko disclosed his own HIV-positive status in a column in South Africa's biggest newspaper.

Even at funerals for those who had died after contracting HIV, Mazibuko told me, "people spoke in hushed voices about what the cause of death could have been, even if they knew."

When I asked him why he chose to come forward so publicly, he grew emotional as he told me that he felt he had no other choice.

Over the course of nearly two weeks of reporting, alongside my All Things Considered colleagues Matt Ozug and Vincent Acovino, we heard stories of how the shifts in foreign aid have destabilized long-effective programs in South Africa and neighboring Mozambique.

South Africa still has the highest number of people with HIV of any country, and the U.S. Embassy in Mozambique notes it is home to the second-largest AIDS epidemic in the world. Our reporting in both countries was supported by the Pulitzer Center.

We spoke with public health workers who worried that the shifts have created uncertainty that could lead to loss of life or more infections. But perhaps what stuck with me the most were the stories of resilience.

From the health workers going without a full paycheck to make sure they still have the trust of patients in their communities; to the innovative TV show educating viewers on healthy relationship dynamics; to the advocates doing everything they can to offer sex workers personalized care after the closure of a U.S.-funded clinic – everywhere we went, we met people who remained deeply committed to their work.

You can hear our stories here, and see more in the coming days across NPR's social media channels.

Copyright 2026 NPR

When Emmanuel de Merode looks around, it's a picture of serenity.

"Most evenings there are elephants crossing the river and pods of hippos," says de Merode, director of the Virunga National Park, which encompasses about 2 million acres in the Democratic Republic of Congo.

The Mitumba Mountains, home to lowland gorillas, rise up before him. Behind him are the Rwenzori Mountains with glaciers and snow-capped tops beside the equator.

"It is one of the most beautiful places in the world," he says.

But beyond this picturesque scene, there is a volatile combination of brutal rebel violence and a burgeoning Ebola outbreak. De Merode and his team of over 800 park rangers are on the front lines as they try to combat both of those threats with severely limited resources.

In a region that's seen decades of bloody wars and a 2018-2020 Ebola outbreak, de Merode says the past few weeks stand out. "The situation we're living through now is certainly the worst we've experienced in the past 30 years," he says.

He points to the lack of a vaccine for the strain of Ebola currently circulating, the dramatic drop in international aid and the "extremely violent armed conflict" that surrounds them.

Still, his team isn't stopping. They are busy building Ebola screening posts in the park to help the country contain the outbreak — and some rangers are also protecting the mountain gorillas from Ebola since the virus is particularly deadly to them.

On June 3, NPR spoke with de Merode — who has been in eastern DRC with the National Park Service since 1993 — to understand the situation and his team's critical role in combating Ebola. Here are highlights of the conversation, edited for clarity and length.

Virunga National Park is more than 180 miles from north to south. It stretches along a critical section of the border between Uganda and DRC, right in the Ebola-affected area. You are building screening posts to check travelers for symptoms of the virus. Explain the logic. 

The national park serves as a natural firewall, of sorts. It's the only area where you can almost guarantee 100% screening. If you build the posts where roads cross rivers, it's almost impossible to pass without being screened. Anywhere else [where people cross borders] is very permeable — the populations can move around the screening sites.

Screening means that if you do get a case spreading eastward into the rest of the province — or indeed into East Africa: Uganda, Rwanda, or Kenya — you can trace everybody that they've traveled with and that enables you to contain an outbreak much faster.

In addition to Virunga National Park, Okapi Wildlife Reserve blocks the west and the north from the spread of the disease toward the big city of Kisangani, and downstream of the Congo River all the way to [the capital of] Kinshasa. So using these as natural barriers obviously has an enormous significance — enormous importance.

The park is footing the bill to construct five screening posts  on all roads leaving the Ebola-affected area. Some will be done by the end of next week, others later this month. Each costs $44,000. What do these sites do and why this price tag? 

These are quite, quite complex constructions. They're not just barriers on the road. There are at least six buildings that go with it. You have to channel sometimes large crowds through controlled passageways to avoid people contracting the disease from other travelers. [In 2018, there were two posts that screened between 3,000 and 4,000 travelers per day.]

We have to build a diagnosis room. They all need reliable internet connections. There's an analysis room, and the staff need computer equipment, and then there needs to be a very robust, rigorously built isolation center next to the control point, for suspected cases.

And then we have to accommodate and protect 30 staff per post. Two thirds of that staff being security against militia attacks. There will also be eight paramedics at each post, who are being recruited at the moment. We don't know how long the Ebola epidemic is going to go on, and we have to maintain these posts as long as they're needed.

The DRC has been particularly hard hit by the massive drop in foreign aid in the past year and a half. U.S. aid in 2024 amounted to $1.4 billion, and 2025 figures are just over $400 million. What's the impact on the Ebola response in the park and the region?

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Our level of preparedness is catastrophic, in part because there's been very, very little international response.

The health services in Congo are critically under-resourced in terms of handling this epidemic. One of the outcomes is that many, many, many health workers have already contracted the disease and died. This [lack of international support] really is what makes this particular epidemic so much more concerning than anything we've experienced before with respect to Ebola outbreaks.

So, for example, we're a part of the Ebola Response Committee and in North Kivu Province which has 11 million people — they had two body bags. That's dangerous because the bodies of people who've died of Ebola can spread the virus, [if they are not handled properly]. The cost of body bags is not that great, but it's just getting them here very, very quickly. So, we were able to purchase 100 body bags within 48 hours and get them to the health services, and then another 1,000 are arriving tomorrow.

Likewise with special [infrared] thermometers that avoid physical contact [because the virus spreads through contact with fluids]. There just aren't any in the province, so we can't diagnose cases very easily. And then for movements, the health services have practically no vehicles. Five of the park's vehicles have been assigned to the health services so they can do their work.

The last Ebola epidemic lasted 18 months, and all the signs are that it'll be significantly worse this time. The reality is that this could become an international problem — not just a Congolese problem —- if the international response doesn't materialize. It's very worrying.

Violence is, unfortunately, not new in eastern DRC. But there's been a spike in attacks in the park related to the armed conflict that's beset the region for more than 30 years. What's happening?

The rangers are working under conditions of extreme violence.

Two of our staff were killed 10 days ago in a militia attack in the center of the park. And then we had another five injured – three of whom were critically injured; one of them lost his eye — last Thursday. This morning, we suffered another attack in which two people were killed amongst our staff. So it's been an upsurge in violence over the last couple of weeks, which is really unprecedented for us.

I can't say for certain whether it's because of the outbreak of Ebola, but the two are certainly associated. And it really worsens the challenge of trying to manage the broader Ebola situation.

Virunga National Park is famous for its gorillas. In 1985 there were only 350 mountain gorillas left in the world. Today, it's estimated that there are over 1,200 between Uganda, Rwanda and DRC, with about a third of that population in Virunga National Park. But gorillas are thought to be very susceptible to Ebola -– by some estimates 98% of gorillas who get Ebola die from the virus and it's already reduced the global gorilla population by approximately one-third. How are they being protected from the ongoing Ebola outbreak in humans? 

Our primary concern is for the human population but we've taken very strong measures to protect the mountain gorillas. We know that they're vulnerable. There was the case in Central Africa and Western Africa — in Gabon and the Republic of Congo — where it's believed tens of thousands of western lowland gorillas were killed by an Ebola epidemic in the early 2000s. So that threat is very real, and it's something we are managing.

We have about 200 rangers in the south of the park around the mountain gorilla population. We've closed down tourism — both because of the situation of armed conflict and because of the Ebola epidemic — and so we don't expect there to be very much contact at all with the mountain gorillas, which will help protect them. And the job of those rangers is to ensure that there isn't any contact at all because there is some level of poaching.

Plus, at the moment, that area [where the gorillas live] doesn't represent a major threat, there's been just one Ebola case in Goma, which is about 20 kilometers away.

We were very effective at managing the situation [regarding gorillas] in the 2018-2020 Ebola outbreak. And we're reasonably confident that we can do it this time.

Copyright 2026 NPR

Updated June 5, 2026 at 4:41 PM PDT

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The Ebola outbreak that's raging in Africa could rival the outbreak that hit West Africa a decade ago, resulting in upwards of 20,000 cases and 4,000 deaths within the next three months alone.

These projections appear in new analyses from the U.S. Centers for Disease Control and Prevention, which modeled just how widespread the current outbreak could get.

Both Democratic Republic of Congo and Uganda are racing to contain this outbreak, which was declared an international health emergency by the the World Health Organization in May.

The analyses published Friday afternoon by the CDC emphasize that large-scale and sustained public health interventions similar to those deployed in the 2014 West Africa outbreak are needed to avoid a worse-case scenario.

"If only 20% of cases enter isolation within two days of symptom onset, more than 20,000 cases are projected," said Jason Asher from the CDC's Center for Forecasting and Outbreak Analytics at a late-afternoon press briefing where the analyses were released.

Those 20,000 cases would occur in just the next three months, according to projections. If the outbreak continues beyond that, the numbers could climb much higher, which would make this the worst Ebola outbreak on record.

About 28,000 cases occurred in the 2014-2016 outbreak in West Africa, which is the largest to date.

While the worst-case scenario may sound dire, conditions on the ground are difficult right now. During the outbreak a decade ago, there was a large and sustained international response. But the CDC notes that this new outbreak is occurring in an area where there's armed conflict, difficulties accessing healthcare and people are frequently displaced.

As one of the new analyses notes: "The scope of the outbreak is likely larger than that represented by available data and might prove challenging to contain and control."

The CDC says isolating people after they are exposed to the virus is the key to limiting the spread. And if international efforts can increase the number of those isolating, the scale of the outbreak could be far lower.

"If 70% of cases started isolating within that two-day period, there's a 94% probability of limiting the outbreak to fewer than 10,000 cases" in the next three months, Asher said.

Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health, said, the CDC analysis "affirms what we have worried about since the beginning: This outbreak is following a dangerous trajectory and will get a lot worse unless we do more to stop it at its source."

While the new CDC projections "correctly point to the potentially explosive nature of the outbreak and the importance of contact tracing and isolation in containing it," things don't necessarily need to be so pessimistic, says Justin Lessler, an epidemiologist with the University of North Carolina. He says local efforts to curtail the outbreak could make a difference.

That said, "a lot depends on where the virus gets to as it spreads across east Africa, which is home to large cities and densely populated areas, and outbreaks in the size range they project are completely possible," he said.

One of the three papers released Friday specifically addresses the risk to the U.S. "The domestic risk remains low for the general U.S. population," said Satish Pillai, the CDC Ebola response incident manager.

However, the paper stated that this could change if the outbreak spreads to urban, international hubs.

While Ebola is a very dangerous disease, it doesn't spread nearly as easily as, say, COVID or the flu, and the U.S. has the capability to quickly identify cases and isolate people.

As of now, Pillai says there's no reason anyone in the U.S. should change their behavior, or even worry about traveling internationally other than to the Democratic Republic of Congo or Uganda.

Despite the dire warnings about the scope of the outbreak in Africa, Pillai reiterated that it's not too late to act. "We've responded to Ebola outbreaks before," he said. "We know how to end this. Our goal is control, containment and ending the outbreaks in DRC and Uganda. And we are working every day towards that goal."

But Jeremy Konyndyk, president of Refugees International, says he's "very, very worried" about the current outbreak. Konyndyk was involved in the Ebola response when he worked at the United States Agency for International Development during the Obama administration.

"If I compare this to past outbreaks, this one has more momentum at time of detection than the huge West Africa outbreak in 2014 did," he told NPR.

The Trump administration dismantled USAID last year, and CDC has experienced ongoing challenges from funding cuts. Konyndyk says that could have hampered the initial response and allowed the virus to spread:

"We are just in a much, much weaker position now to respond to a challenging Ebola outbreak like this one than we would have been even 18 to 24 months ago."

Brown's Nuzzo is also concerned about the U.S. response to the current outbreak.

"The U.S. has always been a top leader in marshaling a swift and effective international response to contain deadly Ebola outbreaks," she said. "This time around the U.S. has spent much of the time on the sidelines."

Copyright 2026 NPR

Updated June 5, 2026 at 2:04 PM PDT

JOHANNESBURG — South Africa rolled out a new, biannual HIV prevention drug on Friday that has the potential to drastically cut infection rates, but U.S. aid cuts mean access will be limited.

Lenacapavir, a kind of Pre-exposure Prophylaxis (PrEP), is injected into the stomach every six months and is basically failproof at preventing high-risk individuals from contracting the virus.

South Africa is not the first African country to introduce injectable Lenacapavir. The drug is rolling out across Africa faster than any HIV prevention option to date, and South Africa becomes the ninth country on the continent to launch it. But in a nation with the highest number of HIV cases in the world, the long-acting injection is being hailed as a potential game changer.

"The launch today of Lenacapavir marks a turning point in our nation's fight against HIV. To us, this incredible, incredible treatment is not just a medicine or a drug, to us it represents a major turning point in South Africa's national story," said South African President Cyril Ramaphosa at the launch.

The rollout is beginning in 360 health facilities in high-burden districts.

South Africa, which has about 8 million people living with HIV, according to UNAIDS, has made great strides in treatment, with a majority of the population on Antiretroviral drugs. But prevention is still an issue, with about 160,000 new infections every year.

Most of those infections occur in adolescent girls and young women aged 15 to 24, with about 1,000 in this demographic infected each week. Among the reasons for this are unequal relationships, sometimes transactional, that these girls and women have with older men.

South Africa already has some PrEP in the form of a daily pill, but adherence is a problem. Experts are hopeful that Lenacapavir could be the breakthrough that makes prevention more effective and accessible.

"Lenacapavir gives us something we have never had before in HIV prevention: a twice-yearly option that might be significantly easier to fit into people's lives," Dr. Saiqa Mullick, a PrEP specialist at Wits RHI at the University of Witwatersrand, told NPR.

But to really turn the tide on the epidemic, Mullick says South Africa will need far more than what International health financing partnership the Global Fund has provided — enough to put about 456,000 people on the drug over two years.

"We have a game-changing technology, but impact will depend on implementation. A breakthrough product only changes the epidemic if it reaches the people who need it most," she said.

Currently, access is being hampered by two things: the fact the Trump administration slashed the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) funding to South Africa last year, and the lack of a cheap generic.

"U.S. funding cuts have affected HIV prevention infrastructure, community programmes, outreach, youth services and key population services. The cuts have undermined prevention programmes just as South Africa needs them for Lenacapavir rollout," said Mullick. "Some replacement financing is emerging but it doesn't fully replace the scale of PEPFAR funding."

Linda-Gail Bekker, an HIV expert who leads the Desmond Tutu Health Foundation, also noted the impact of the U.S. cuts.

"Had Pepfar been in place, we would have I think been the recipients of more Len doses, as it happens, we're getting at least some from the Global Fund, but clearly we would have been able to receive both Global Fund as well as Pepfar support in this regard," she said.

Currently the cost of Lenacapavir, made by U.S. pharmaceutical company Gilead, is prohibitive: about $28,000 per person a year in the U.S.

But generics are on the way after a deal to make them available to 120 low and middle-income countries, says Mullick. And sub-Saharan African countries are a priority.

"South Africa is also seeking local manufacturing capacity to improve regional access and reduce dependency on external supply," she said.

The generic version of Lenacapavir is expected to become available in 2027 at a cost of around $40 per person per year.

"Clearly once the generics come online we're very hopeful that the South African government will also be able to make a large contribution towards purchasing Len on a larger scale," said Bekker.

Scientific modeling shows that if one to two million HIV-negative people take the shot between now and 2043, AIDS could cease to be a major public health problem in South Africa.

Copyright 2026 NPR

Millions of people are about to pack stadiums across the U.S., Canada and Mexico for the World Cup, starting June 11.

Public health officials have been working to ensure the health and safety of the masses of fans they're expecting at the 104 matches across 16 cities through mid-July.

In the U.S., World Cup preparations are coming in a time of a diminished federal health presence and funding. It's upped the workload for host city health departments, as they're also strapped for federal funding.

Nevertheless, World Cup host city health officials say they're prepared for the many challenges that come with large-scale celebrations and gatherings.

"We've been focusing on expecting the expected" — issues related to weather, health and human behavior, says Dr. Marcus Plescia, district health director for Fulton County, Georgia, which includes Atlanta.

Planning for the event is ongoing, says Dr. Philip Huang, director of Dallas County Health and Human Services in Texas. "To be able to begin preparations a year out is a luxury for us, compared to a lot of the situations that we deal with," he says.

"We call Atlanta 'Hotlanta' for a reason"

For public health departments, the World Cup is a big deal –- but they're well prepared for the biggest challenges.

Summer heat, for instance. "We call Atlanta 'Hotlanta' for a reason," says Georgia's Dr. Plescia, "It's going to be hot and humid here -– so heat-related injuries are going to be an issue."

Atlanta is hosting eight World Cup matches and the team from Uzbekistan. At downtown Centennial Olympic Park, a month-long fan festival is expected to draw some 15,000 people a day. Cooling stations will offer air-conditioning and hydration.

Then there's feeding the crowds. "The biggest lift for us and for all health departments is that our environmental health workers have to inspect all of the food vendors –- and there will be a whole lot of food vendors," Plescia says.

Inspectors will check every day to ensure the facilities are in working order and the food is safe to eat. "We want to make sure that people feel confident that they can go out to eat and have a good time –- and they don't have to worry about getting food poisoning," Plescia says.

When lots of people gather, germs tend to spread. "We're worried about sexually transmitted infections because there's going to be a lot of people here and it's going to be a festive atmosphere," Plescia says. "And then we're worried about things maybe we wouldn't have been worried about as much before, particularly measles." Measles is highly contagious among those who haven't been vaccinated, and there have been 30 U.S. outbreaks this year.

Dallas is hosting nine World Cup matches — the most of any city. The health department is stepping up disease surveillance in wastewater, expanding sites and covering more area, says Dr. Huang, the county health authority. Beyond looking for typical threats like influenza and COVID, they're also testing for "whatever might appear" through genomic sequencing, he says.

They're also broadening mosquito surveillance –- setting insect traps and testing for pathogens they can spread. "We always test for West Nile virus," Huang says, "But we're also increasing our testing for dengue, chikungunya and Zika because of all the [incoming] international travel."

Medical staff are also looking out for symptoms of Ebola or hantavirus, due to outbreaks.

Keeping track of which diseases are circulating means they'll be able to alert hospitals and the public quickly if they see a spike. "It's a lot of things we normally do but certainly more enhanced," Huang says.

They're also preparing health tips for the public in different languages: Wear a hat and sunscreen and hydrate when it's hot out. Bug spray and long sleeves help prevent mosquito bites. Stay home if you're sick. "It's the same messages [we always share], but it's really concentrated because we've got so many people coming during a hot period of time in Dallas," Huang says.

"Most of our staff are not taking vacations"

The World Cup finals are jointly hosted by New York and New Jersey on July 19.

Officials have been running practice simulations to prepare for outbreaks and mass casualty events. "We plan for the worst case scenario and go through it before it actually happens," says Dr. Alister Martin, New York City's health commissioner.

They've also set up "incident command" to "divert resources from normal stuff so that we can manage any potential emergencies," Martin says, adding that the operation will continue through much of the summer, for other big events planned in New York, including America's 250th anniversary, Pride month and the Puerto Rican Day parade.

In Los Angeles, which is hosting eight games, including the U.S. opening match versus Paraguay, risk-assessment teams will monitor the surroundings for chemical exposures and biological threats.

In L.A., diminished federal assistance means the health department is counting on existing staff to do the extra work. "Most of our staff are not taking vacations during the month of the World Cup because they'll need to work -– we'll be obviously accruing overtime costs," says Barbara Ferrer, the L.A. county health director.

And much of their regular work, like routine food inspections, gets put aside. "I know it would be easier if we weren't in a resource constrained environment," Ferrer says. "But I want to provide assurance that even in a resource constrained environment, we're well prepared."

Ferrer says they've successfully planned and managed other events of national significance, like the 2022 Super Bowl. "This work isn't new to us," she says, adding that staff are making great efforts "to make sure this is a joyous time in L.A. county and [that] we're all safe."

This year's experience will better prepare Los Angeles to host other events, she says — like the 2027 Super Bowl and the 2028 Summer Olympics.

Ferrer hopes these events will help authorities see that public health is key to public safety — and worth investing in.

Less of a federal presence

On the federal level, the Centers for Disease Control and Prevention, which serves as the nation's public health agency, has a muted presence this year.

"Usually, the CDC is a visible lead when we have international events in the United States, particularly across the country, versus just in a single state," says Dr. Debra Houry, former chief medical officer for the CDC who resigned last year.

The current Trump administration has pushed thousands of workers out of the CDC workforce and tampered politically with some of its functions, such as setting vaccine policy and publishing scientific papers. The agency's scientists rarely speak directly with the public anymore; their messages are filtered through politically appointed leadership.

Other governmental groups that would typically be involved, such as the National Security Council's biosecurity group, the Office of Pandemic Preparedness and Response Policy, and the Assistant Secretary for Preparedness and Response, have been disbanded, left vacant or don't have permanent leaders, Houry says.

The diminished federal presence serves as the backdrop for the World Cup.

Emily Hilliard, press secretary for the Department of Health and Human Services which oversees the CDC and ASPR, wrote in an email response to NPR: "HHS and the Centers for Disease Control and Prevention (CDC) are actively coordinating with state, local, and global partners to ensure public health and safety during FIFA World Cup 2026 and enhance any measures, as needed."

Localities have found that the federal presence is late in coming, and not as coordinated as it may have been in the past, says Lori Freeman, CEO for the National Association of County and City Health Officials, which represents health departments.

Freeman says the CDC started holding coordination calls and issuing some guidance a few months ago –- long after host cities started their own preparations. She notes: "When it comes to merging public health, emergency response and preparedness, that is an area we worry constantly about because the federal government is the agency that must manage across state jurisdictions between and among states."

Some have stepped up to fill perceived gaps. For instance, Georgetown University has set up a Health Security Operations Center to track infectious diseases and send out daily reports, to inform places expecting an influx of travelers throughout the World Cup.

Copyright 2026 NPR

Before this year, I had singlehandedly planned every one of my family's trips, and I was over it.

Since I'm a travel journalist, the job has always defaulted to me to know where to stay or how to fly cheap.

But after years of being the planner and booking every flight and hotel for my husband and two kids — plus parenting in general — I was burned out.

So, my husband took the lead on planning a "just us" trip. Together, we landed on a budget we were both comfortable with, then he booked the flights, rental car and a spa in Quebec, Canada.

It felt like a huge gift because I didn't have to plan a thing. But before we hit the road, I wondered: What else could we do to make sure our vacation was a success?

Couples trips can feel exciting but can also feel like a lot of pressure. How do you plan a getaway that satisfies the needs of both people? How do you take financial stress out of the equation? What happens if you get into a fight?

I asked seasoned couples therapists — one of whom is also a travel advisor for couples — and a financial coach how to pull off a trip that brings both partners back home connected, refreshed and ready to plan the next one. Here's what they said.

Find your "why"  

Don't just pick a "where" and "when" — decide why you're going and how you want to feel when you get there, says couples therapist and travel advisor Marissa Nelson. "Is this vacation about ease? Excitement? What does fun look like on this trip?"

Don't forget the big picture. The point is to take time to notice each other — to remove yourselves from the responsibilities of regular life long enough to remember why you like being together in the first place.

By talking this out with your partner, you'll set yourself up for success — not mismatched expectations.

For our trip, my goal was simple: to just show up. We both wanted our trip to be about relaxation and reconnection, and I wanted a break from my planner status. I said to my partner, "I don't care, just book something."

Then, let your "why" inform your "where." My partner chose a spa a couple hours outside of Montreal because I'd been there before and loved it. It was a place where we knew we'd have a balanced stay: healthy food and also some wine; massages and also adventurous hikes in the snow. It was wonderful.

Prepay what you can 

If you don't want to squabble with your partner about finances on vacation, try to pay for as much of the trip as you can in advance, says Jenny Whichello, a financial coach who works with couples. (Of course, paying in advance means saving in advance, too. This episode has good tips on how to do that.)

"Then, when the time arrives to actually go on that trip, you're not thinking about money," she says.

My partner and I took this tip to heart. We went the all-inclusive route — which meant the flights, car, accommodation costs and even our meals were paid for upfront.

That way, once we got to the spa, we could just focus on enjoying our time together because we had zero surprise bills to bicker over. (OK, one small surprise gift-shop bill after I realized I'd completely forgotten to pack a bathing suit.)

Plan some alone time 

The best couples trips balance together time and alone time. Couples therapist Will Messer told me he gets easily overstimulated in general, and is more introverted than his wife, with whom he loves to travel.

So he's learned over the years to ask for "a little pullback time and space," he says. Feel free to take a break, go for a walk, plan a solo activity or some downtime — alone time, in moderation, has been shown to boost wellbeing and ease stress.

Then, come back and spend time together, says Nelson. This way, you're "prioritizing self and us at the same time."

For my husband, who's the less social of the two of us, this manifested as some longer solo runs and even taking time to cold-plunge into a frozen Québécois lake — definitely an activity I was more than happy to skip!

Don't fear conflict 

A fight might happen. And if it does, that's OK — and normal! Being prepared for conflict and knowing how to handle it will ensure you move through it easier and faster so you can get on with having a good time.

When you and your partner inevitably butt heads about something, try to name your emotion to yourself first, Nelson says. It will help you regulate your own emotions — and better communicate them to your partner. (Need more tips? Check out this story about how to have more constructive fights with your partner.)

For me on our trip, I noticed I felt angry after my husband told me how happy he was to be taking a break from our kids. How rude! I thought. I miss our kids!

But once I checked in with myself, I realized I was just feeling protective of the kids and navigating what it was like to be away for the first time. After I acknowledged this, I was better able to appreciate that my husband was enjoying our time together.

Take the good vibes home 

So your trip is coming to an end, and maybe you had a conflict or two, but overall you and your partner had a pretty amazing time. How do you keep that feeling going back in the real world?

On your way home, talk about your trip highlights and how you might replicate them in your everyday life, Messer says.

For example, if you loved all those slow, quiet moments with your partner on your trip, you might say, "When we get home, I'd like to get in the habit of sitting on the back porch with a glass of wine, just chilling," Messer says. "Maybe there's a smaller way we can make this a more regular part of our life."

My husband and I loved being offline on our trip so much that when we came home, we decided to set up our house Wi-Fi so that it turns off automatically every evening. Less distractions, more focused time together — as easy as flipping a switch. Who knew we had to fly all the way to Canada to figure out such a simple tip?

Amelia Edelman is a writer, editor and content strategist who has worked with outlets such as the BBC, Lonely Planet and Travel + Leisure. She has traveled to 38 countries, often with her kids.

This story was edited by Malaka Gharib. The visual editor is CJ Riculan. We'd love to hear from you. Email us at LifeKit@npr.org. Listen to Life Kit on Apple Podcasts and Spotify, or sign up for our newsletter.

Copyright 2026 NPR

Human rights advocates rallied Thursday in San Diego as part of a statewide effort to prevent Gov. Gavin Newsom’s proposed cuts to healthcare coverage for low-income Californians, known as Medi-Cal.

“These cuts aren't just a temporary fix to a difficult budget season. They represent a moral failing, one that can take years, if not decades, to recover from,” said Nicole Lillie, executive director of the San Diego-based youth advocacy nonprofit Our Time to Act.

The governor’s budget proposed several changes to healthcare coverage, including excluding undocumented immigrants, including refugees, asylum-seekers and survivors of violence, from most health care services. For example, the policy proposes cutting dental care as a covered benefit and imposing $50 monthly premiums.

It would also significantly cut asset limits. When people apply for coverage, the state checks what they own that has value. The current limit is $130,000, but the proposed budget suggests lowering it to $2,000 for seniors and adults with disabilities.

Michelle Krug, a San Diego resident and member of the California Alliance of Retired Americans, said the lower limits would force people to spend their emergency savings.

“Seniors (who are) disabled, on a fixed income, if we have $2,000 that we're trying to save, for example, to fix a leak in our own our roof or pay or repair on a car, and then we suddenly are not eligible for health care or don't get health care that winds up affecting every other part of our life,” she said.

Newsom has argued that the cuts are necessary due to a looming multi-billion-dollar state deficit. At a news conference announcing updates to the proposed budget last month, he said California has done more than other states to help undocumented immigrants but that deciding to slash expensive services is “called reality. It's called math.”

The Legislative Analyst’s Office estimated that Medi-Cal spending reached an all-time high of $200 billion during the 2025-26 fiscal year budget.

Medi-Cal, the state’s version of the federal Medicaid program, enrolls more than 14 million Californians. According to data from the UCLA Center for Health Policy Research and the UC Berkeley Labor Center, about 210,000 recipients in San Diego County could lose their health care coverage if the changes are adopted.

In San Diego, the rally took place outside state Sen. Akilah Weber Pierson’s Office.

“Our state leaders have a choice ahead of them this June,” Lillie said. “Right now is their chance to put the state’s money where our morals are. Now is a chance to say no to cuts to our healthcare.”

In a statement, Weber Pierson, a physician-turned lawmaker, said, in part, that she understood access to Medi-Cal is fundamental to Californians, especially the most vulnerable communities.

“As budget negotiations continue, I am focused on ensuring that we protect access to care, maintain stability in coverage, and try to avoid policies that would create new barriers for patients who are already medically vulnerable,” she said.

Lawmakers have until June 15 to agree on a budget and begin final negotiations with the governor. The new fiscal year begins July 1.

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As Americans worry about the risks from hantavirus and Ebola, many state and local health officials now have less power to protect the public from all kinds of disease outbreaks than during the COVID-19 pandemic.

That's because some jurisdictions weakened their public health authorities in response to criticism of lockdowns, school closures, mask mandates, vaccine requirements and other COVID-era restrictions.

"There's been such an enormous backlash from the COVID-19 pandemic right across America, particularly in red states," says Lawrence Gostin, a professor of public health law at Georgetown University. "It's become part of our national lore of overreaching government."

The Trump administration has reined in the Centers the Centers for Disease Control and Prevention with budget cuts, staff reductions and tighter oversight by political appointees.

But most public health powers reside with the states, and more than half have made changes to their own state, city and local powers, according to the Network for Public Health Law. The changes affect their ability to respond to public health emergencies. Many watered down those authorities.

"Taken all together, we're in a much weaker position post-COVID in handling a health emergency," Gostin says.

At least 15 laws in 11 states, including Alabama, Virginia and Louisiana, imposed new restrictions on declaring public health emergencies — declarations necessary to do things such as muster disease fighters and clear away red tape.

State lawmakers have a bigger say

"There have been examples where they have said, 'Well, if you want to do this, you now need to come to the legislature to get it.' Or the legislature has the authority now to reverse it," says Dr. Georges Benjamin, who heads the American Public Health Association. "I'm worried that many public health officials will now have their hands tied."

Some localities, such as Kansas and Utah, have hamstrung use of traditional public health tools such as quarantining people who might have been infected with a dangerous pathogen or isolating people who are already sick.

"In some states where there has been a lot of activity around public health power, it's going to create confusion," says Elizabeth Platt, director of research and operations at the Center for Public Health Law Research at Temple University. "And so just understanding if your public health entity has these authorities is going to take time. And as we learned during the pandemic, time is of the essence."

Backlash over COVID mandates 

Some states, such as Florida, Oklahoma and Texas, pulled back the authority to impose mask mandates. Others limited vaccination requirements. Some curtailed the power to restrict gatherings.

"If you think about what that really means, it's like telling the police department that you can't arrest people, that you can't protect people when you know there's extreme weather happening," Benjamin says.

At the same time, some state and local health departments have lost staff and funding. And some state and local health officials have gotten more skittish about pulling the levers they have left. Some were harassed and threatened over COVID. And some who objected to the pandemic response are now in charge.

"There are a lot of public health commissioners now who are not traditional public health people and who are much more MAHA or MAGA," Gostin says. "And so I think all in all you've got weakened authority, you've got weakened political backing and you don't have traditional public health scientists at the head of public health agencies."

Still, there is support for some of the changes as a way to build trust and as an understandable response to criticism of some COVID measures.

"You're building a level of accountability into how we utilize some of the most restrictive public health measures in the United States," says James Hodge, director of the Center for Public Health Law and Policy at Arizona State University. "I'm fine with that."

Copyright 2026 NPR

The first Ebola vaccine was approved for use in 2019, three years after the horrific outbreak in West Africa that took more than 11,000 lives.

That vaccine is designed to target a different species of Ebola than the one that's rapidly spreading in the Democratic Republic of Congo and Uganda. Many researchers think the approved vaccine, called Ervebo, won't work very well against the rarer Bundibugyo species, for which there are no approved vaccines or treatments.

This week, a pair of global vaccine non-profits are trying to jump start a Bundibugyo vaccine with an infusion of more than $100 million dollars.

The Coalition for Epidemic Preparedness Innovation, or CEPI, announced a commitment of roughly $62 million to fast-track research and development for three vaccine candidates. And a separate, $40 million dollar commitment from Gavi, a global vaccine alliance, seeks to create a market for a vaccine, if it proves safe and effective.

"We know Ebola is a deadly killer, and we've seen over multiple outbreaks what a difference a vaccine makes, if it's matched to the Ebola strain," says Nicole Lurie, executive director for preparedness and response at CEPI. When she and her colleagues learned this outbreak was driven by the rarer Bundibugyo species, they began surveying the landscape of Bundibugyo-targeted vaccines in the works.

"We decided, because of the urgency, that we would go ahead and accelerate vaccine development," she says.

Even with all this cash, it'll be months before researchers can figure out whether the vaccines in development can offer meaningful protection against this deadly disease — and even longer before they're widely used. But given that the DRC outbreak is already one of the largest on record and shows no sign of slowing down, any future vaccine could still make a difference.

"We are very happy to see commitment to fast-track candidate vaccines," Anaïs Legand, a WHO technical officer said during a Wednesday press conference. "They will still need to undergo testing," including clinical trials that comply with ethical guidelines.

Discussions on how to conduct those trials are ongoing, according to briefings by World Health Organization officials. Historically, the U.S. has had a major role in researching experimental vaccines and treatments amid ongoing outbreaks. Now that the Trump administration has withdrawn from WHO and dismantled much of the U.S. infrastructure that supported this research, it is unclear what role the U.S. will play.

For instance, during the 2014 Ebola outbreak in West Africa, the Division of Clinical Research at the U.S. National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, partnered with affected countries to design and run clinical trials of the vaccine that eventually got approval in 2019.

"That division is now gone," says Elizabeth Higgs, who was the associate director for strategic research partnerships within the Division of Clinical Research at NIAID. She left NIH in February and is now working with WHO on planning for therapeutic and vaccine trials amid the ongoing outbreak.

"If this outbreak would've been two years ago, then we would have already mounted an emergency research response from the NIAID/NIH," she says. "But I think we're doing very well without the NIH working with the global community," she says, referring to disease preparedness research networks set up by the WHO.

Vaccines in the works

Three vaccine makers — IAVI, a non-profit that develops vaccines, University of Oxford and biopharmaceutical company Moderna — are receiving the funds from CEPI. Each vaccine candidate has strengths and weaknesses in terms of how quickly it might get developed and approved.

IAVI will receive up to $3.2 million to develop its candidate, which is the furthest along in terms of testing. It uses the same approach as an approved Ebola vaccine, called Ervebo. IAVI's vaccine uses a harmless virus, called a vesicular stomatitis virus or VSV, to deliver instructions to the immune system on how to recognize the Bundibugyo species of Ebolavirus.

Thomas Geisbert, a vaccine researcher at the University of Texas Medical Branch, helped develop this vaccine over 15 years ago, after the first Bundibugyo outbreak in 2007. In a 2014 study, he and his colleagues showed their Bundibugyo vaccine worked in monkeys.

"We vaccinated monkeys one time, which is good for outbreaks because you need something that works quickly, and then we exposed those monkeys to Bundibugyo and they were all protected, they didn't even get sick."

A subsequent study, published in 2023, showed vaccinating monkeys 20 to 30 minutes after exposure also offered high levels of protection. That's key, says Geisbert, since vaccinating soon after a possible exposure — a strategy known as ring vaccination — has been critical to stamping out prior outbreaks.

But there currently are not enough doses of IAVI's vaccine to conduct larger clinical trials. Making more could take seven to nine months, according to the non-profit, given it takes time to grow the vaccine viruses.

The two other candidates could be ready faster but haven't yet been studied in animals.

One is from the University of Oxford, which will receive up to $8.6 million from CEPI. That vaccine uses the same strategy as the Oxford/AstraZeneca COVID-19 vaccines, but targets the Bundibugyo species of Ebola. Oxford researchers have partnered with the Serum Institute of India, a major vaccine manufacturer, and say that doses could be ready within one or two months.

Finally, CEPI is awarding Moderna up to $50 million to develop an mRNA vaccine against Bundibugyo. In 2018, researchers showed that an mRNA vaccine provided 100% protection against the Zaire species of Ebola in guinea pigs. Those animals needed two doses for protection, as opposed to one.

"That's not ideal when you're trying to control an outbreak," says Darryl Falzarano, a vaccine researcher at the University of Saskatchewan. "You need rapid time to protection."

It's unclear whether Moderna is pursuing a one- or two-dose strategy. The company did not respond to a request for information.

The challenge of clinical trials

Months from now, all of these candidates will need to be tested in clinical trials in the Democratic Republic of Congo or Uganda, where the Bundibugyo species is currently spreading.

Conducting clinical trials in any outbreak can be hard, since it's tough to know where cases will be in the future. This particular outbreak could be especially difficult, given the ongoing conflict in northeast DRC.

"It's a very challenging area to work in," says Laurie, of CEPI. "And unfortunately there is just so much mis- and disinformation about vaccines, a lot of distrust in the communities." Rumors circulating on social media claim Ebola isn't real, or that aid workers are killing patients who enter clinics. Already, community members have attacked several clinics.

That environment could make it difficult to enroll participants in a clinical trial and track whether a candidate vaccine protects them from Ebola, says Laurie. "We all need to start beginning now to think about how we engage communities and community organizations in helping get ready even to test these vaccines."

Higgs, the former NIH staffer now advising WHO on these trials, says that's happening now. "We're doing everything we can to establish trials that are going to quickly and rigorously assess the safety and efficacy of these candidate products."

Copyright 2026 NPR

CONCORD, Calif. — Ninth grader Soraya Martin is a bubbly, social teenager who recently found a new passion.

"I'm a very creative writer, I love to write stories for fun," she says.

Stories come naturally to Soraya, but reading and writing don't. That's because she has dyslexia. "Academically, school has always been a really big challenge for me."

Then last school year, she started using technology that allows her to do a number of things: dictate her writing rather than type, listen to books rather than read them on a page and take photos of notes on the board.

It changed everything. Instead of getting caught up in whether a word is spelled right, Soraya finds that with speech-to-text built into her school laptop, she can simply let the words flow from her brain out of her mouth.

"I started getting really good grades," she says. "It made me feel like … I'm not stupid, I have so much to say and it just made me like 'I can do this, I can do school and I can be good at it."

This, her mom, Heather Martin, says, is the kind of promise screens hold for students like her daughter — students she worries are being forgotten in the nationwide backlash against screens in schools. Screens are increasingly being blamed for getting in the way of student learning: More than 30 states have banned cellphones in school. Some states have gone further with proposals or policies to entirely remove screens like laptops and tablets from classrooms. In late May, the U.S. Department of Health and Human Services issued a surgeon general's advisory warning of the "harms of screen use," citing its effects on children's health and educational outcomes.

Much of the pivot away from screens in schools has come from parents who are concerned screen use is getting in the way of their children's learning — an argument Heather Martin hears in her own community in Concord, 30 miles northeast of San Francisco. She shares some of those concerns, but says, "Never once in the conversation has there been a discussion, except for me bringing it up with the other parents, about kids with disabilities."

Advocates worry those students are also being left out of the national conversation.

Screen-time policy proposals are often "a blunt instrument"

Students with disabilities make up a quickly growing share of students in this country — there are more than 8 million of them. Many rely on assistive technology to get through the school day, including for note-taking, reading and writing. For example, blind and low-vision students may use screen reading or magnifying software to read. Others, like Soraya, use speech-to-text and audiobooks.

States including Alabama, Tennessee and Utah already have laws limiting screens that take effect as early as July.

"My concern is that that's a really fast period of time for this to happen," says Lindsay Jones, CEO of the Center for Applied Special Technology (CAST), an education research nonprofit that focuses on making learning environments accessible.

Jones points out that some of these laws do make exceptions to restrictions on screens for students with disabilities — often a line in the text mentions assistive technology. But she says that should be the bare minimum and worries many policy proposals are "a very blunt instrument."

"They've moved so fast that we've really left our educators and our communities of people with disabilities this summer to figure it out," she says. Perhaps with more time and input from disabled people, policies would better protect their rights, Jones adds.

Beyond concerns about state- and school-level bans on cellphones and screens, disability advocates point out that the shrunken U.S. Department of Education is far less equipped to enforce civil rights. Those rights include access to assistive technology for students with disabilities. The Trump administration also recently delayed a long-expected digital accessibility rule for public institutions, including schools.

"For some kids, the screen is their accessibility tool"

At Soraya's high school in northern California, this past school year was the first that students' phones were locked up in pouches for the entirety of the school day — as they are in many schools across the country. Heather Martin worries the phone ban could open the door to a broader ban on screens at her daughter's school.

"A completely screen-free environment feels like it's throwing the baby out with the bathwater," she says. "It's not looking at 'screen free' versus 'accessibility free.' And for some kids, the screen is their accessibility tool."

As she talks about the change at her school, Soraya tenses up. "I hate them," she says of the locked pouches. She says her phone isn't just a distraction, it's a safety net to call her parents if she has a panic attack, for example. And she feels singled out when she has to ask to get her phone out of its locked pouch for note-taking.

Soraya's individualized education program (IEP), a legal document that outlines the accommodations and modifications she is supposed to receive at school, says she can use her phone for note-taking, along with other assistive technology. But because the cellphone ban is new, her teachers are still adjusting. Because she has several different classes and teachers throughout the day, she says it's easy for some teachers to be unfamiliar with her accommodations.

This is the kind of "unintended consequence" Jones worries about as she considers a near future in which more schools move away from technology that she says has been game-changing for people with disabilities. When technology is used intentionally, she says, it can "actually allow us to create much more flexible environments, and those are really needed for people with disabilities."

Jones' organization, CAST, invented an educational framework called Universal Design for Learning that encourages educators to design their classrooms to account for the different ways students learn. For instance, a teacher might give a math lesson using blocks, a diagram and a video to help impress the same lesson upon diverse learners. Or perhaps class reading is provided as an e-book so students with low-vision can magnify the text, while those with dyslexia can listen.

As screen limits ripple through the nation's schools, Jones hopes people with disabilities aren't forgotten. "We need educators, we need people with disabilities, we need assistive technology providers," to weigh in on how such policies are implemented in the classroom, says Jones. "That is going to be the best way forward for everyone to achieve their goals without trampling on people's rights."

For Soraya, using these kinds of tools has led her to embrace her learning differences. In fact, she just finished researching and writing a series of essays exploring how people with dyslexia learn. She has straight As for the first time in her life, but more importantly, she says she can express herself in a deeper, more meaningful way.

"I have so much more to say … It made me feel more confident in myself."

Edited by: Nirvi Shah
Visual design and development by: LA Johnson

Copyright 2026 NPR

Advocates for people with serious illnesses, like cancer and HIV, say the strict Medicaid work rules that the Trump administration released this week are likely to put ongoing treatments in jeopardy.

States must put the work requirements into effect by January 1. That was already a tight timeline, says Adrianna McIntyre, assistant professor of health policy at the Harvard T.H. Chan School of Public Health.

"It takes states literally months — usually years — to make the types of changes to their systems that they needed to make for this new rule," she says. "They were severely constrained by the timeline having a year and a half from the time of the law being passed to implement all of this."

At stake is health coverage for 68 million low-income Americans on Medicaid, the health insurance system jointly funded by states and the federal government.

States must "make the changes, test the changes to make sure they're not going to break the system, and then go live," McIntyre says.

The nearly 400-page interim final rule released Monday makes that process even harder. For months, federal officials have been meeting with states informally and giving them guidance, and states understood that people with conditions where continuous health insurance coverage was really important would be exempt.

"What the rule says, as published, is that that's actually not enough," McIntyre explains. "The condition or the disease needs to be actively interfering with your ability to work. So people with early stage cancer who are in radiation treatment but still have the capacity to work, or people who have HIV but can still technically work, are not exempted from the work requirement."

McIntyre and others foresee situations where a person newly diagnosed with cancer, who is working, loses Medicaid because they don't fill out the paperwork correctly. That could lead to patients losing coverage when they need it most.

Pitched as "a path to prosperity"

Republicans have long heralded work requirements as a way to encourage personal responsibility.

Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, presented the policy to reporters at the White House Tuesday.

"If you're sitting at home, which is true for the millions of people who are able-bodied on Medicaid, on average, you're spending 6.1 hours watching television, or just hanging around," Oz said. "So, as a path to prosperity, Congress very wisely said, 'Let's get you back into the workforce.'"

One conservative group closely aligned with the Trump administration, the Paragon Health Institute, wrote in a statement that the rule "strikes the appropriate balance between necessary program integrity protections and accommodations for those who genuinely need assistance."

Republicans passed the new rules in their big budget bill that President Trump signed on July 4, 2025. That law, which passed without any Democratic support, used major cuts to Medicaid to fund Trump's policy priorities, including tax cuts and the crackdown on immigration.

The work requirements are part of a $900 billion cut to Medicaid, and they are designed to limit who can be on the government health insurance. The Congressional Budget Office estimated that about a third of that $900 billion cut comes from the work requirements. CBO also said 5 million people will lose Medicaid coverage.

Most on Medicaid already work 

The new requirements apply in the more than 40 states that expanded Medicaid under the Affordable Care Act. For years, that has meant any low-income adult who does not have access to affordable insurance at work could enroll in Medicaid.

Starting in January, adults in those states, from age 19 to 64 will have to periodically prove that they are either working, going to school or volunteering at least 80 hours a month. Alternatively, they will have to prove that they are exempt from the work requirement.

Most adults who get Medicaid are already working, according to an analysis of government data by the health policy research organization KFF. About 1 in 5 people are not meeting the 80 hours-per-month threshold, KFF found, and this population had barriers that kept them from the workforce. Some could not find jobs; others were laid off; others had retired.

Advocates warn of dire consequences

Medical groups and advocates for patients uniformly panned the rule. A coalition of 48 patient organizations wrote in a joint statement: "Our organizations are deeply concerned the interim final rule does not protect people with serious or complex health conditions and would instead dramatically and inappropriately increase the number of people who will lose their healthcare coverage."

Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, had been lobbying for months for people living with HIV to have a blanket exemption to no avail.

"We're just going to lose people to Medicaid and then they're going to get sick and then they're going to die," he says. "So, yeah, I'm upset."

He says his group will file comment on the final rule, and start lobbying state by state to try and get exemptions. He thinks there will be lawsuits filed as well. (Comments are open on the interim final rule until July, and the government has the option to make changes to it or not.)

The American Academy of Pediatrics also urged the government to change the rule.

"The new burdensome requirements that many parents will face under this rule will ultimately undermine families' health and financial stability," Dr. Andrew D. Racine, the president of the AAP, wrote in a statement. "The policies to narrowly define who qualifies for exemptions will add to the state costs to administer the program, create headaches for families trying to navigate the bureaucracy, and harm the very people that Medicaid is meant to serve."

No help to find work

Jennifer Wagner, who analyzes Medicaid eligibility and enrollment at the left-leaning Center on Budget and Policy Priorities, points out that there's no funding here to help people find or keep work, as there is in other public programs with work requirements, like food assistance.

"That just implies or suggests that somebody could get a job if they wanted — they just need a little shove," Wagner says. "Which just reflects a complete lack of understanding of what people are actually going through."

She expects that, rather than improve workforce participation, the complex rules laid out by federal health officials will cause chaos and confusion. "We know from past experience in Medicaid and other programs that it's usually the eligible people who lose coverage because of the work requirement," she says.

"Even if there's an exemption on paper that they qualify for, even if they are compliant technically of the policy, the act of reporting it — understanding what they have to do, filling out the right paperwork, providing the right verification if necessary — there's so much that can go wrong in that process that often leads to eligible people losing coverage," Wagner explains.

Some Republican-led states are launching the requirement early, but most are expected to launch by January 1.

Copyright 2026 NPR

The Trump administration is pursuing a bureaucratic rule change that could allow for greater political influence over billions of dollars in federal research grants. The new rule would have a broad impact on research fields, including housing and transportation. Health and science funding would be most significantly affected.

"Although research has bipartisan support in the US Congress, and trust in science is above 75% across the country, the Trump administration seems as determined as ever to mortally wound the nation's scientific enterprise," Holden Thorp, editor of Science magazine, wrote in an editorial about the proposal.

Published in the Federal Register on May 29, experts say the proposed changes would both codify the administration's strategies to dismantle certain fields of study in the U.S. and lend it new authority to "advance the President's policy priorities."

In science, the impacts could reverberate across fields of research as varied as public health, vaccine testing, biotechnology, social and behavioral science and climate science.

The proposal is animating advocacy and science groups across the country.

"This would be the end of American science as we know it," said Cole Donovan, a policy analyst from the group Stand up for Science who has been organizing to protest the change. "We're gonna make sure that it doesn't fade quietly into the night."

End of peer review as the gold standard

Since the post-World War II period, the U.S. scientific community has relied heavily on a system of peer review to offer feedback on studies and maintain integrity in research. The same has been true for federal science agencies when evaluating proposals for research funding. Typically, agencies adopt recommendations from independent advisory committees on issues including vaccine schedules, environmental standards, or census methodology.

While not legally binding, peer review in practice has been enormously influential and become part of the norms of government.

" While it's been true that peer review panels have always been treated as advisory by agencies, it was usually the combination of peer review with a non-political career expert at an agency that made the determination of whether to issue an award or not," said Donovan.

Under the new rule, peer review would not be eliminated, but political appointees — not necessarily scientists — would be required to review grants before awards are made. Critics say that effectively gives political officials veto power over projects, even when they have passed scientific peer review.

The reaction from scientists and advocates has been swift and vehement.

" If this sort of rulemaking or rule-breaking becomes the norm, then government itself will cease to work," historian Tim Snyder said in an online forum Tuesday organized by Stand Up for Science. Snyder studies the former Soviet Union and remarked that the Trump administration's proposed rule change reminded him of "late Stalinism."  

"We're asking ourselves whether we wanna repeat that Stalinist situation where people who know nothing about science are the ones who are making the decisions about what's going to go forward," said Snyder.

Others compared the moment to a period in the United States in the 1950s when government officials scrutinized people's ideology and politics rather than their credentials.

"Proposed rule would replace scientific merit with McCarthy era politics," read the headline from a statement by the Infectious Diseases Society of America.

The rule change was proposed by the White House's Office of Management and Budget, which is led by Director Russell Vought. Administration officials argue that the rule change is in the interest of efficiency. In a statement, an OMB spokesperson wrote it would "improve the ability of agencies to identify and respond to waste, fraud, and abuse."

Critics say there's no evidence that the existing peer-review system needs such sweeping changes and that empowering political actors to make decisions about science is dangerous.  

"When we're designing a study to a new cancer therapeutic, do you want Russell Vought — who is not a scientist — to determine which immunotherapy is ready to go into a phase three trial?" said Elizabeth Ginexi, a former staffer at the National Institutes of Health who has been speaking out against the proposed changes.

In addition to giving the administration increased authority, the proposed rule officially bans research on diversity, equity and inclusion or gender as grant conditions, and places broad prohibition on international scientific collaborations.

" We are involved in a huge amount of international collaboration," said Donovan from Stand Up for Science. "Much of the work that's considered high-impact is based on international collaboration."

Limited role for congressional pushback

Several Democratic lawmakers spoke at the meeting on Tuesday in an effort to rally support from the public.

" When promising research is denied because it doesn't fit the political agenda of the moment, the American people will pay the price," said U.S. Rep. James Walkinshaw of Virginia.

" The question isn't whether politics will influence research under this proposal," the Democratic lawmaker added. "That's the point."

Beyond exhortations to action from the public, however, Congress is unlikely to take action on the rule change.

The proposed rule is open for public comment until July 13. After that, OMB will review those comments before deciding whether to issue a final version.

In the event that it is passed, Donovan said, he anticipates it will "almost certainly" be challenged in court.

Copyright 2026 NPR

Scientists who've spent decades learning how the brain works say they're now ready to start fixing it when it breaks.

That's the premise of the Brain Health accelerator, a collaborative effort launched by the Allen Institute in Seattle, which has become a major player in brain research.

The $400 million initiative includes plans to develop new genetic therapies — a term that includes gene editing as well as traditional gene therapy — for diseases including Alzheimer's, Parkinson's, ALS, Lewy body dementia and Huntington's.

"The latest genetic treatments allow scientists to control the activity of particular genes," says Ed Lein, who directs the institute's brain health programs. "That opens up the possibility for very specific precision therapies for brain disorders."

The accelerator is an outgrowth of the BRAIN Initiative, an ambitious research program unveiled by President Barack Obama in 2013. The goal of this public-private partnership was to create tools that would allow scientists to see the brain's inner workings and, eventually, to develop treatments.

But the effort has progressed far faster than many scientists expected.

"I am shocked at how far we've come in the last 10, 12 years," says John Ngai, a senior investigator at the National Institutes of Health who directs the BRAIN Initiative. "It's just been beyond my wildest imagination — and I've been accused of having a pretty good imagination."

Support for the accelerator includes a $200 million commitment from the Allen Institute, $100 million from the Bezos family and $100 million from sources including the National Institutes of Health, Amazon Web Services and EverythingALS. Collaborators include a wide range of hospitals, universities and research centers from around the world.

From mice to humans

The Allen Institute's Brain Health accelerator is attracting a range of scientists intent on translating their knowledge about the brain into treatments for its disorders.

Jeff Carroll, for example, was a teenager when he learned that his mother had Huntington's disease, a fatal, inherited disorder that destroys brain cells.

"The whole reason I'm in science started with this frustration with not being able to understand what was happening with my mom," he says.

Carroll eventually learned that he, too, carried the Huntington's gene.

He spent years at the University of Washington studying mice with the condition, which causes nerve cells to produce toxic levels of a certain protein.

To Carroll, the solution seemed obvious: "Since we know that all the bad stuff in Huntington's comes from this one gene … let's get rid of that gene."

But finding a way to do that was beyond the reach of his own relatively small lab at a university. So Carroll joined the accelerator effort.

"It's difficult to do the scale of research that you need with a team of five or six or even 10 people," he says. "The hundreds of people they have here at the Allen Institute [allow for] an entirely different approach to science."

And one of the first targets for that approach will be Huntington's disease.

Carroll says he's optimistic.

He notes that genetic therapies have already had success treating at least one nerve disorder, a rare genetic condition called spinal muscular atrophy. It's caused by a gene mutation that leads to the death of motor neurons in the spinal cord.

"Every kid with this horrible mutation died when they were like 18 months [old]," Carroll says, "and now they're going to high school. So things that were unimaginable can change."

Carroll says his goal is to help accelerate that change.

Big science, shared

The Allen Institute was founded in 2003 by the late Paul Allen of Microsoft fame and his younger sister, Jody Allen.

Its goal was to speed up science research. And it has done so by developing technologies that allow scientists to rapidly characterize and map millions of cells.

"We now have a complete description of the types of cells that make up the brain, and also the genetic underpinnings of their properties," Lein says. "This foundation then lets you study disease."

Allen scientists have already begun studying how Alzheimer's disease changes nerve cells in the brain.

"It affects very specific types of neurons that are lost early in the disease and then over the course of the disease," Lein says.

Genetic therapies designed to protect these neurons might delay or prevent symptoms, he says. Similar approaches might also work to preserve the neurons affected by Parkinson's or ALS.

Ultimately, though, the Allen Institute may not be the place that develops these therapies. Its policy of making its databases available to anyone means that scientists around the globe can help look for answers.

Copyright 2026 NPR

The city of San Diego's Project Heart Beat held a free workshop in the Civic Center’s breezeway Tuesday to train people how to do CPR and use an automated external defibrillator, or AED.

The organization wants to make AEDs as accessible as fire extinguishers. They’ve helped place more than 11,000 in the San Diego region since 2001, saving 223 lives so far.

“Which may not seem like a lot. But if it’s your loved one, it’s huge,” said program manager Maureen O’Connor.

O’Connor said anyone can learn how to save a life in five minutes with CPR or an AED. You don’t need to be certified to do it. You just need to be willing to intervene.

“Any CPR is better than no CPR, so you just do the best that you can. I've taught people with difficulties, disabilities, how to do CPR in different ways. We've taught the blind. We've taught the handicapped that don't have use of their upper body, but can do some cardiac compressions through their legs in the heel of their foot. Anything is better than nothing to keep that heart beating,” she said.

But too often, bystanders don’t jump in.

If the person needing help is a woman, they’re even less likely to get it.

“Only 39% of women in public – so less than half – receive CPR because the public are afraid to bare the person's chest and put their hands on the person's chest. But if they don't do that, they may as well just stand there and watch that person die,” O’Connor said.

Standard training mannequins are male, not offering participants a chance to practice overcoming those hesitations.

Studies show minority and low-income patients are also less likely to receive bystander CPR or defibrillation, partly due to less training and fewer available AEDs in their neighborhoods.

Members of the public request CPR training in their community and training kits through UC San Diego’s Revive and Survive initiative.

Project Heart Beat will host its next free workshop on June 16 at the Point Loma Hervey Branch Library.

County workers found West Nile virus in two dead crows picked up near the Rolando and Skyline neighborhoods, prompting health officials to remind people to take precautions against mosquitoes, which spread the virus.

Mosquito season typically starts in April, but on Monday the county reminded everyone to follow three steps: Prevent, Protect, and Report: Prevent mosquito breeding at home, protect yourself from bites, and report mosquitoes and dead birds to the Vector Control Program.

"One of the best ways to stop mosquitoes is to remove standing water around your home so they can't breed in it," a county statement said.

A dead crow found in North Park in March was the first positive case for West Nile virus. No human cases have been reported this year.

The virus is primarily a bird disease, but it can be transmitted to humans when certain types of mosquitoes feed on an infected bird and then bite people.

West Nile virus remains a potentially deadly threat. In 2015, 44 San Diego County residents tested positive for West Nile virus and six died.

Most people who get West Nile virus have no symptoms or mild symptoms such as headaches, fever, nausea, feeling tired, skin rash or swollen glands. In rare cases, it can make people very sick or even cause death.

Warmer weather allows mosquito season to start earlier and the pests' activity has already been detected by the county. In response, San Diego County's Vector Control is increasing surveillance and treating mosquito breeding sources. This strategy includes monitoring around 1,600 potential mosquito breeding sites and applying larvicide by air, boat, truck and hand crews.

Residents were urged to dump out standing water or remove items that can hold water, such as plant saucers, rain barrels, buckets, garbage cans, toys, old tires and wheelbarrows. The Vector Control Program is also offering free mosquito fish, which can be placed in stagnant water sites to control mosquito breeding.

Residents were also advised to wear long sleeves and pants, and wear insect repellent while outdoors to protect themselves.

Mosquito activity or mosquito breeding sources can also be reported to the Vector Control Program by calling 858-694-2888 or emailing vector@sdcounty.ca.gov.

Reporting for this story comes from the series Safe to Drink, a podcast that follows stories of water contamination in New England by Mara Hoplamazian from New Hampshire Public Radio.

"Forever chemicals" are everywhere — in our drinking water, in our food and in products like nonstick frying pans, raincoats and even some types of floss.

Also known as per- and polyfluoroalkyl substances, or "PFAS," these chemicals have been linked to negative health outcomes, including certain cancers.

PFAS are strong and can repel both water and oil, which is why they're widely used in manufacturing. But they don't break down easily in the environment, and they can linger in our bodies. In fact, according to the Agency for Toxic Substances and Disease Registry, nearly everyone in the United States has PFAS in their blood.

"They have really unique properties, and that's part of what has made them so attractive to industry. Unfortunately, we're learning that it is also something that makes them toxic and causes problems in the human body," says Megan Romano, an epidemiologist at Dartmouth who studies PFAS.

Eliminating all sources of PFAS in your life would be impossible, according to one report from the National Academies of Sciences, Engineering and Medicine. And researchers are still trying to pin down which actions reduce exposure.

But it's worth trying. Research has found that when people remove their exposures, the levels of these contaminants in their bodies decrease over the course of several years.

If you'd like to reduce your exposure to PFAS, there are a few actions you can take. Some are simple, like looking for third-party-tested PFAS-free products. Others aren't as straightforward; the U.S. is still trying to figure out where these chemicals are showing up in food and water.

Check if your water has been tested 

If your community has water contaminated by PFAS chemicals, drinking water could be your main source of exposure. According to the U.S. Geological Survey, they're in nearly half of the nation's tap water.

Many cities and towns have already tested public water for these chemicals, so a good first step is to check with your water utility to see if they have published those results. To do that, you can call your utility's customer service line or look online to see if they've published PFAS data in water quality reports.

In many states, environmental regulators may also be able to share information about PFAS levels in public water. The deadline for water utilities to test for PFAS chemicals under the current Environmental Protection Agency regulations is 2027, so if results aren't available yet, they should be by then.

If you're on a private well instead of on public water, you may need to test your water yourself. Some states have programs to help with the expense and logistics.

The U.S. Geological Survey has a map that shows their testing results across the country. An interactive EPA map shows testing results for public water systems, with systems testing above national limits in brown. Another map, from a nonprofit called the Environmental Working Group, shows results from several national testing efforts.

Once you figure out the levels of PFAS chemicals in your water, you can compare them to the EPA's regulations. You can also enter them into the Centers for Disease Control and Prevention's blood level estimation tool, which can give you a sense of what the levels of these chemicals in your blood might be.

See if your community is installing filters, or consider getting your own

If you find out your water has levels of PFAS chemicals above the EPA's limits, check to see if your community is planning to install a filtration system that can catch those substances. Public water systems are required to reduce PFAS in water by 2029, or by 2031 under an extension proposed by the Trump administration. 

There are a few kinds of treatment systems that work on PFAS contamination: activated carbon filters, ion exchange treatment and reverse osmosis.

If you decide to get your own filter, make sure it is certified to treat PFAS contamination. You'll want to look for certifications from NSF International and the American National Standards Institute (ANSI). Specifically, filters that are "NSF/ANSI 53"- or "NSF/ANSI 58"-certified should work to reduce PFAS chemicals — though their current requirements aren't based on the latest EPA limits.

The upfront cost of in-home water treatment can range from around $20 for pitcher-style filters to hundreds or thousands of dollars for whole-home systems. But make sure to factor in maintenance costs, too — it's important to follow the instructions that come with the treatment system and replace parts as needed.

Consider your food 

When PFAS chemicals get into the environment, they can make their way into our food.

According to the National Academies report, diet is likely the primary way people are exposed to PFAS in places without drinking water contamination. But, researchers say, longer-term studies are needed to assess how effective different interventions might be for reducing exposure from food.

Some meat, dairy products and chicken eggs have been found to contain PFAS chemicals, but initial results from Food and Drug Administration research show that most detectable PFAS were found in seafood. Federal regulators recommend people avoid eating fish from waterways that have been impacted by PFAS. Produce grown with contaminated water can also become a source of exposure.

Take an inventory of products in your life that may contain PFAS  

Researchers are still studying how much consumer products influence the levels of PFAS in our bodies, and the National Academies report says there's not enough evidence to suggest that changing our use of consumer products would decrease our exposure.

But knowing which products contain PFAS can still help if you're trying to limit those chemicals in your life.

PFAS chemicals have been used widely in consumer products, in part because they are very good at making things waterproof, slippery or resistant to the elements. If you want to start looking for PFAS in your home, look for items that have those properties.

In the kitchen, you might find PFAS in nonstick frying pans, waffle irons, rice cookers or muffin tins. In your closet, they may be in waterproof coats or hiking pants. Carpets, upholstery, tablecloths and other household items treated to be durable, waterproof or stain-resistant could also contain PFAS.

Personal care products like dental floss, diapers, menstrual products, moisturizer and makeup are also potential sources of PFAS exposure, though some companies are discontinuing the use of those chemicals in their products.

Consider replacing items you use most

Dartmouth's Megan Romano says she usually recommends starting with the products that have the most contact with your skin.

"Look for moisturizers or foundations or bronzers, things that you're going to put on your face or your body and leave there all day," she says.

The use of PFAS in cosmetics may be declining, according to a FDA report from 2025. That report said the safety of most of the top PFAS chemicals used in cosmetics could not be determined, because the federal government does not have enough data on their toxicity.

If you're looking for PFAS-free products, try to figure out if a company has conducted third-party testing, meaning they've had their products tested by an independent lab.

When buying new products, you can look for the ingredient "PTFE" or other ingredients with "fluoro" in the name to figure out if PFAS chemicals have been added intentionally. The Consumer Product Safety Commission may be able to answer questions about PFAS in household goods.

These days, more and more manufacturers are phasing out PFAS. Chemical companies like 3M and BASF are stopping their production and use of the chemicals, and major brands like Dick's Sporting Goods and Sephora say they're working to remove or reduce PFAS in the products they sell.

The website PFAS Central has a directory of PFAS-free products, which includes more than 150 brands that say their products are PFAS-free.

And when major manufacturers cut down on PFAS use, that affects our health, too. Research shows that when the production and use of certain PFAS chemicals declined, the levels of those chemicals in the blood of Americans dropped over time. 

This story was edited by Malaka Gharib. The visual editor is CJ Riculan. We'd love to hear from you. Email us at LifeKit@npr.org. Listen to Life Kit on Apple Podcasts and Spotify, or sign up for our newsletter.

Copyright 2026 NPR

Doctors "checked" on former President Joe Biden moments after his disastrous debate with President Trump — a poor performance former first lady Jill Biden said made her wonder whether her husband was having a "stroke." Previously, the Biden administration said doctors examined the president "days" following the debate, not moments after.

Jill Biden recounted the night of that 2024 presidential debate to All Things Considered Host Scott Detrow on NPR's Newsmakers video podcast.

"We got off the stage," Biden said. "I went to get my stuff. He went with his group, and then we met up in the car, and then the doctors, you know, checked him out and said, 'Oh, he's fine.'''

Few know President Biden better than his wife Jill Biden. Yet in a new memoir, View from the East Wing, Biden had few answers for what caused her husband's presidential debate performance. She called it "inexplicable."

"When people say to me, 'What happened in that moment?' … I don't know," Biden told Detrow. "I mean, I don't know what happened."

Biden insisted she had never seen the president in that state before or since, and pushed back against reports from Axios and other outlets that quoted former staffers who claimed the performance was not a one-off.

"No one came to me and said that," Biden said.

Shortly after this debate, Biden bowed out of the presidential race. Former Vice President Kamala Harris then took up the Democratic nomination and lost the election to President Trump. In Harris's own memoir, 107 Days, she criticized the Bidens for questioning her loyalty and their handling of the 2024 campaign.

Jill Biden confirmed to Detrow that her husband had planned on only serving one term as president, but that he later changed his mind.

"Originally, he thought, you know, just like you're saying, 'I'm going to do four years and get out,'" Biden said. "But then… Everybody kept saying, 'You've got to… The midterms were good. We've got to keep going.' … And so that's why he made the decision to keep running."

When asked if she would have done anything differently, Biden said she regretted the hurt her family endured.

"So to look back, I wouldn't want anybody to go through that," Biden said. "No, I never want to go through that again."

Hear more about the former first lady's life in the White House, her thoughts on Harris and why President Biden changed his mind on pardoning his son, Hunter Biden, in the full Newsmakers interview out Thursday.

NPR's Newsmakers is where you'll find NPR's biggest interviews. Follow or subscribe on Spotify, YouTube, or wherever you watch or listen to podcasts so you always get the latest episode as soon as possible. You can also find Newsmakers on the NPR app.

Recent Newsmakers episodes:

• Graham Platner: Will Maine voters extend 'forgiveness' to another controversy?
• Dana White: Head of the UFC says it's an 'honor' to build a fight arena on the White House lawn
• Zohran Mamdani: NYC mayor says Iran war speaks to a 'broken kind of politics'

Tyler Bartlam and Ashley Brown contributed to this reporting.

Copyright 2026 NPR

Ebola is a wily pathogen.

After jumping to a new person through the bridge of bodily fluids, it goes straight for key immune cells. In typical infections, these immune cells help mount a targeted response to the virus with the goal of clearing it out. But the virus that causes Ebola somehow disables this response.

"That adaptive immune response that we hope for in terms of getting full clearance is often very strongly delayed," says John Connor, a virologist at Boston University.

That gives the virus a head start in rapidly spreading throughout the body. It goes first to the lymph nodes, then to the spleen, liver and kidneys, replicating and damaging these tissues as it goes.

"The cleaning and garbage disposal units of the body are backing up, and that backs up into the blood system, [and] that has a lot of negative consequences," says Connor.

By this point, the immune system still isn't creating antibodies that flag the invader for clearance by other cells. But the immune system has sensed that something is wrong, and spurs a more brute force reaction. In many Ebola patients, this response can go overboard, causing a frenzy of immunological activity known as a cytokine storm – named for the proteins that stoke an inflammatory response.

"That can lead to a lot of essentially collateral damage rather than focused removal of virus from infected cells," says Connor, contributing to multiple organ failure. Later symptoms include vomiting and diarrhea, which can cause patients to lose over 2.5 gallons of fluids a day. In some cases, blood vessels become so damaged they leak. Losing all this fluid is often what kills roughly half of patients who get infected.

But this high mortality rate isn't inevitable, even in the absence of approved treatments targeting the virus.

What clinicians call supportive care — replacing fluids, managing blood pressure, treating other infections — can help keep patients alive long enough for their bodies to counter Ebolavirus' stealth maneuvers. But such care is often out of reach for patients at the epicenters of Ebola outbreaks, including the one currently spreading in the Democratic Republic of Congo, because of under-resourced medical facilities.

Basic support is hard to deliver

Krutika Kuppalli still remembers her first day treating Ebola patients in Port Loko, Sierra Leone.

The infectious diseases physician, now at UT Southwestern Medical Center, arrived there in November 2014, to help care for patients during the massive Ebola outbreak in West Africa that killed over 11,000 people.

"It was really hard," she says. "I remember going in the first day, I still have the picture in my mind of these three patients slumped over the bed, and I didn't know if they were alive or not."

Her number one job was helping her patients replace lost fluids. She'd try to get patients to drink oral rehydration salts, akin to Pedialyte, if they could keep it down. "It tastes really horrible," she says. If they couldn't, an IV could replace lost fluids and electrolytes.

In the thick of an Ebola outbreak, that kind of basic care is hard to deliver, she says.

"First of all, you have to put on all the PPE to get into the treatment unit," she said. "I'm covered head to toe in a Tyvek suit, a face mask, goggles and double gloves, I can't really do much to assess a patient other than look at them."

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In the tropics, overheating in PPE is a major concern, says Armand Sprecher, a physician with Doctors Without Borders. "When you sweat, it doesn't evaporate, you don't get rid of heat, it just ends up being puddles in your boots," he says. "When you get wrapped up in the PPE, the clock starts. Passing out is a real possibility, and clinicians only have about 45 minutes at a time.

During those windows, they need to see dozens of patients. Within such constraints, a health care worker can only do so much.

"People talk about 15 minutes with their doctors, not [being] enough. Imagine five minutes with your doctor if you've got Ebola," says Craig Spencer, an emergency medicine physician at Brown University who treated Ebola patients in Guinea. "That was just a reality of not having enough providers and not having the resources that we needed."

Disparities in care

Spencer experienced an entirely different reality when he returned from Guinea in 2014 with Ebola himself. After developing symptoms, he ended up at Bellevue Hospital in New York.

"In Guinea, I was taking care of 30 to 40 patients at any time. In the U.S., there were probably 30 to 40 providers on call anytime just to take care of me," he says. Those providers were in air-conditioned rooms, allowing them more time with Spencer. They could also run a whole suite of tests to precisely tailor Spencer's treatment and keep up with fluid loss, something largely unavailable where he worked in Guinea.

U.S. hospitals with Ebola patients could provide even more specialized care, like dialysis to make up for damaged kidneys, or putting patients on ventilators to help with breathing.

"It was seemingly unlimited access to anything and everything that you might need to improve your chance of survival," he says. The difference in outcomes is clear — of the 11 people ever treated for Ebola in the U.S., 9 survived. That's a dramatically higher survival rate than was seen in West Africa in 2014, where only about half of patients walked out of treatment clinics.

Since then, new Ebola vaccines and treatments have made caring for patients easier. But caring for patients now in the Democratic Republic of Congo may be similar to what happened in that 2014 outbreak, given that the vaccines and treatments developed for that strain aren't approved for the rarer Ebola species circulating now. Additionally, ongoing conflict in northeastern DRC could make dispatching clinical care teams even harder.

"The goal is to be able to provide a higher standard of care than we were providing a decade ago," says Spencer. "But I think initially it's going to be pretty blunt triage in terms of what we're capable of doing."

Copyright 2026 NPR

Starting June 1, new federal rules will require many adults ages 18 to 64 receiving CalFresh to show they worked, volunteered or attended job training at least 80 hours a month.

CalFresh is California's version of the federal Supplemental Nutrition Assistance Program, or SNAP.

"Populations that were previously exempt are now having to jump through hoops just to get $30 to $40 a month to help supplement their groceries for their families," said Amy Elits, director of programs at the San Diego Food Bank..

People experiencing homelessness, veterans and individuals with unstable work schedules could face the biggest challenges meeting the new requirements, Elits said.

The San Diego Food Bank is preparing for a possible increase in demand if recipients lose access to benefits.

"We serve, on average, over 400,000 a month already. So that's looking at almost a 25% increase in the output that we're gonna have to be able to provide to meet that need," Elits said.

To help residents navigate the changes, San Diego County and 211 San Diego launched a website that connects people with job training programs, volunteer opportunities and other qualifying activities that can count toward the federal requirements called the WorkReady Hub.

San Diego Assemblymember LaShae Sharp-Collins, (D-79) said the new rules could also place additional strain on county workers.

"We desperately need resources to support county employees who now will have to spend more time helping recipients maintain their eligibility," Sharp-Collins said Monday during a virtual news conference.

Most recipients will not lose benefits immediately because they will continue receiving assistance until their annual recertification, Elits said.

"But as we start to see folks roll off some of these benefits, we're not entirely sure what that's going to look like two, three months from now," she said.

A costly emergency

When 33-year-old Tabitha Babcock brought home her Newfoundland puppy Cerulean, she thought she was starting a new chapter.

“So it’s the color blue. It was my favorite Crayola crayon when I was little,” she said.

But just a week later, everything changed.

“He was really sick and he had to go to the E.R. and basically was set on blood transfusions and glucose drips. And it was really sad and life threatening,” Babcock said.

The emergency visit cost about $4,000. At just nine weeks old, Babcock said she was forced into a heartbreaking decision — signing a do-not-resuscitate order.

“I signed it because it was as much as my savings as I had and I was like, ‘I just can’t,’ especially when there was no hope really,” she said.

She said veterinarians didn’t expect him to survive the night.

“(I) dug a little grave for him in my backyard and just laid on the floor with him and was like, you know, ‘Buddy, can you please, like, fight as hard as you can?’”

Cerulean put up a fight.

Now seven years old and weighing about 150 pounds, he’s still by her side. A calm, gentle giant.

“He was such a miracle,” Babcock said. “So that was how we started our journey together. Little trauma bonding.”

But the financial impact lingered.

“We lost that whole cushion. So then it was like, everything else we had to buy continuing on for those multiple months…whether that be medication, special food…it was a stressor for me for sure,” she said. “It probably took a year to feel comfortable in life again.”

The rising cost of care

An analysis of federal inflation data shows prices for veterinary services have jumped about 40% since 2021. That’s faster than overall inflation during the same period.

And dog owners in San Diego spend about 38% more on veterinary care than the national average — about $1,100 dollars a year.

The price increases are especially notable for preventative care.

In 2021, dog dental cleanings in San Diego were estimated at around $320. Now, the cost is estimated at closer to $700. And that's before any extractions or additional treatment.

“It's a big worry that I think of quite often and we try to do a lot of preventative health…for his teeth…but I do know he'll probably need some help and that'll be a big chunk of change,” Babcock said.

Beyond the vet bill

For Babcock, the costs extend well beyond clinic visits.

Food, supplements, and routine care to keep Cerulean healthy can total about $375 every couple of months.

“We used to do raw diet purely for his health and preventative issues later on," she said. "That has absolutely gone up so we absolutely do not do that anymore right now.”

Pet insurance is one option for dog owners to offset unexpected medical bills. But monthly premiums can range from about $30 to more than $150 per month, depending on the dog's age, breed, and coverage limits.

Cerulean has a pre-existing condition. Babcock said it makes finding useful insurance coverage more complicated.

“I had all the comparison charts, all the insurances, what would work…and so ultimately it wasn’t going to help me at that point,” she said.

Now, as Cerulean gets older, she’s reconsidering it.

“We've paid out of pocket, since then, he's not had any major health issues. So we're just, you know, praying and hoping that it continues that way.”

Making it work

Across San Diego County, dog owners say they are feeling similar pressure as the cost of living continues to rise.

Some say they cut spending elsewhere just to keep up with pet expenses. Others say they weigh every decision more carefully when it comes to veterinary care.

For Babcock, the rising cost of caring for Cerulean has also forced bigger questions about staying in San Diego long term.

“I think a big worry is, would I have to move in order to afford a comfortable lifestyle because it is so high in San Diego?” she said.

Still, she says she makes it work.

“He brings me a ton of comfort, a ton of peace,” she said. “I’d sell all my furniture before he’s not going to be taken care of.”

Connie Franciosi, 80, noticed a suspicious spot on her skin and was diagnosed with melanoma in 2020. "It was considered a late diagnosis," she says.

The skin cancer can be difficult to treat if it's not detected and treated early, and it can spread to other parts of the body. There are approximately 112,000 melanomas diagnosed in the U.S. each year and about 8,500 deaths.

After Franciosi had surgery to remove the melanoma, she was told she had a high risk of recurrence and was offered a spot in a clinical trial testing a new messenger RNA (mRNA) vaccine combined with Keytruda, an immunotherapy drug.

At the time, mRNA technology was in the news because of the recently developed Moderna COVID-19 vaccine. This melanoma trial, which included 157 patients in Australia and the U.S., all of whom had surgery to remove their tumors, was set up to test whether the same mRNA technology could be used to create a personalized cancer vaccine, explains Dr. Janice Mehnert. Mehnert is a melanoma specialist and researcher at NYU Langone Health and senior author of a new paper published Monday analyzing the five-year results.

"This is an incredibly interesting trial because the approach is just so unique," Mehnert says. "It is a personalized immunotherapy strategy," tailored to each patient's tumor.

The results are striking. After five years of follow-up, 68.8% of patients who received the combination therapy remained cancer-free, she says, compared with 49.1% of patients who received Keytruda alone, which amounts to a 49% reduction in risk. "That's pretty exciting," Mehnert says.

In addition, 92% of patients who received the combination therapy were alive at the five-year mark, compared with 71% of those who only used Keytruda. "I think this is strong evidence that this therapy, when used in combination with immunotherapy, can demonstrably reduce the risk of dying from this disease," she says.

The results of the study are being presented at the American Society of Clinical Oncology conference today and are published in the Journal of Clinical Oncology.

Mehnert says that predicting when melanoma will recur is difficult.

"Sometimes recurrence is easily treated with surgery or radiation, but sometimes it happens in the lungs, the liver or the brain," and then it can be challenging to treat, she says. That's why a preventive approach makes sense. "We're trying to harness the power of the immune system early in a patient's disease course to optimize their outcomes," she says.

Dr. Sarah Arron, a dermatologist and skin cancer surgeon in the San Francisco Bay Area who was not involved in the research, says the results are significant and demonstrate the potential of mRNA vaccines.

"I think this is a landmark advance in how we treat these very advanced, high-risk melanomas," she says.

Arron notes that while Americans became familiar with mRNA technology through the COVID-19 vaccine, this application is fundamentally different.

"The COVID vaccine was the same RNA fragment given to everybody. Whereas in this case, the antigen itself is not one virus, it's [each] patient's tumor," she says. Since each person's melanoma can differ, each vaccine is tailored. "By matching this RNA treatment to the patient's melanoma, we can really boost the immunotherapy by driving it toward the patient's tumor."

How the combination works

Cells in the immune system, known as T cells, are built to find and destroy threats like cancer, but cancer can be sneaky, putting up the equivalent of a "don't attack me" shield that hides them. To simplify, Keytruda works by lifting that shield so T cells can see the cancer again. The personalized mRNA vaccine then amplifies the effect.

Scientists sequence a patient's tumor to identify up to 34 unique molecular fingerprints called neoantigens and encode them into a custom vaccine. When it's injected, the vaccine trains T cells to recognize and target those specific neoantigens, giving the immune system a blueprint for attacking the cancer. So, each patient's tumor informs the vaccine that they will receive.

In the trial, side effects were mild, including chills and minor pain at the injection site.

Arron says that given the reservations and politicization of the COVID-19 vaccine, it's important to understand how this technology works. "This mRNA vaccine is designed towards boosting a tumor response," she says. And the results are "very encouraging" for the use of mRNA.

Researchers are also studying whether mRNA vaccines can be used to prevent the recurrence of other cancers, including lung cancer.

The next steps

"The results are exciting," says Moderna's chief development officer, Dr. David Berman. The company developed the vaccine, which is called intismeran, and is collaborating with Merck, the maker of pembrolizumab, which is marketed under the trade name Keytruda.

A Phase 3 trial is now underway, which includes nearly 1,000 patients. Once results are analyzed in the coming months, the goal is to seek FDA approval, Berman says.

Berman has been working on melanoma for many years, before joining Moderna, so he says this feels like a momentous step forward.

"The degree of benefit was incredible," Berman says, pointing to the significant reduction in risk of recurrence.

For Connie Franciosi, the results speak for themselves. "I am cancer-free." She says her scans have shown no recurrence. "Life is good."

She recently celebrated her 80th birthday. Her days are packed with the things she loves, including tending her gardens, staying active with her local library, and gathering with friends and playing golf.

"I have some good shots and some not-so-good shots, but I just enjoy the game," she says. "I have a very satisfying life."

Copyright 2026 NPR

Updated June 1, 2026 at 2:21 PM PDT

BUNIA, Congo — At least 282 cases of Ebola disease have been confirmed in Congo's growing outbreak, the central African nation says, as more joyful stories from recovered medical workers emerge. One nurse spoke of his "indescribable joy" at beating the illness.

The outbreak remains focused in eastern Ituri province, where 264 cases have been confirmed, the health ministry said. Congo has reported more than 1,000 suspected cases of the Bundibugyo virus, the species of Ebola that was confirmed weeks after the outbreak quietly began. There is no approved medicine to treat it, or vaccine.

The disease outbreak has killed 42 people in Congo and one person in neighboring Uganda, according to health authorities in both countries.

The outbreak has spread to 22 health zones across three eastern provinces in Congo, government data shows, even as the World Health Organization has sought to highlight signs of progress, like new deliveries of supplies to deeply under-resourced health centers.

Congo's health ministry says the main challenges in containing the outbreak in the remote region include early detection and rapid isolation of cases, rigorous contact tracing, safe and dignified burials and strengthening infection prevention and control in health facilities.

Meanwhile, the Coalition for Epidemic Preparedness Innovations said Monday that it would commit up to $62 million to accelerate development of three experimental vaccines targeting Bundibugyo. The three in development are from the International AIDS Vaccine Initiative, Moderna and the University of Oxford.

Health workers have been at high risk. WHO honored five of them as survivors over the weekend, during a visit by Director-General Tedros Adhanom Ghebreyesus, as he opened a new Ebola treatment center in Bunia, capital of Ituri province.

Baraka Bulambulu, a nurse, said that he was thrilled after the final Ebola tests on him returned negative.

"Coming out of this illness alive is an indescribable joy," Bulambulu said with a wide grin.

Ezo Étienne, another nurse who recovered, said that he had started feeling dizzy as he checked on patients.

"I called the team and told them, 'Something's wrong here,'" he recalled. "I decided to rest for a bit, and a few minutes later I started vomiting."

The virus is spread through close contact with sick or deceased patients' bodily fluids. Treatment has mostly targeted patients' symptoms, WHO has said.

"Your courage gives hope and your living story that this outbreak can be stopped," Tedros told the health workers on Sunday.

Despite challenges that include threats by armed groups and anger against health workers by some wary residents, the recoveries are "a victory worth celebrating," said Dr. Dieudonne Mwamba Kazadi, director-general of Congo's National Institute of Public Health.

"It's a strong message that it is possible to recover from Ebola when seeking care early in a dedicated health facility," he said.

Uganda has reported nine cases of Ebola in this outbreak and closed its border with Congo, seeking to limit its spread. Although more than 20 Ebola outbreaks have taken place in Congo and Uganda, the Bundibugyo virus has been rare.

Attacks in the region by the Allied Democratic Forces, or ADF, a rebel organization allied with the Islamic State group, and a coalition of ethnic militias have also hindered the response.

ADF fighters killed 16 people Saturday in Beni, North Kivu province, an area also affected by the outbreak, the Congolese government said Monday in a statement.

The illness also has been reported in both North Kivu and South Kivu, south of Ituri, where the Rwanda-backed M23 rebel group controls many key cities, including Goma and Bukavu.

Copyright 2026 NPR

Known as "liquid gold," colostrum is the first milk that mammals produce after giving birth. And it's chock full of antibodies, proteins, vitamins and minerals that help build up a newborn's immunity and strengthen their gut lining.

But this substance that's uniquely tailored for newborns is also receiving plenty of attention from adults who've taken to chugging bovine colostrum.

Cows make more than their calves need so excess colostrum is collected, pasteurized, dried, and packaged for human consumption. Wellness influencers and social media personalities are talking up bovine colostrum as a must-have supplement to support gut health among a range of other benefits.

The claim

Among the most common assertions about colostrum is its ability to improve a range of gastrointestinal woes. Influencers also suggest it can help boost the immune system, and help with issues as diverse as skin tone, hair growth and low energy.

The evidence

In addition to animal research, there are a handful of preliminary studies in humans suggesting colostrum may improve certain forms of inflammatory bowel disease, gastroenteritis, and upper respiratory tract infections, as well as stunting in children.

But some caution that it's too early to say definitely that it's effective. "I just don't think that we know enough yet," says Elyce Shapiro, a Chicago-based licensed dietician nutritionist who runs a virtual private practice.

"From a safety profile, I don't have a problem with it," she notes. "I think it has one of the lower risks of some of the other products out there."

Shapiro has seen the studies showing that colostrum can help treat ailments of the gut, but she says that they've tended to focus on particular populations in the short-term, including elite athletes or those contending with a specific medical condition.

So it's unclear how broadly effective colostrum may be for everyday gut troubles, like bloating or constipation. Patients are "looking for solutions," she says, "but typically your solution isn't just sitting in a supplement."

Still, Raymond Playford, a gastroenterologist at the University of West London and medical director of PanTheryx, a company that produces and distributes colostrum, describes the research as promising. Playford has been studying the supplement and its potential health benefits for more than 30 years.

He sees a possible mechanism for it to help the mucous lining of the intestines, which can become overly permeable. "It helps stabilize the gut, strengthen it, stop it being leaky going forward, sealing it," he says.

Playford coauthored a few papers showing benefit from the supplement, including a small pilot study reporting that colostrum reduces some of the GI side effects of GLP-1 drugs like Ozempic, such as acid reflux and bloating.

"In humans," he argues, "we can definitely say that it does have an effect on the human gut."

While he agrees the early data show promise, Rick Bloomer, a nutrition scientist and dean of the College of Health Sciences at the University of Memphis, says a lot of the marketing is "overblown."

He also notes that it may be hard for consumers to discern how best to apply the findings of colostrum studies to themselves. For instance, the quantity administered by researchers can be higher than what's recommended on a typical supplement bottle. "The consumer doesn't know what the dosing needs to be," he says.

Cautions and alternatives

When it comes to tending to gut health, Shapiro and Bloomer recommend focusing on improving one's overall lifestyle first.

Bloomer emphasizes the importance of regular physical activity, a wholesome diet, and sufficient sleep.

"Those things we know are most important when it comes to gut health, immune function, et cetera," he says. "To think that I can use a supplement but ignore those other factors is a big mistake."

Shapiro notes that lifestyle factors also include managing stress levels.

"Stress, it's like a battering ram to your gut barrier lining," Shapiro explains. "So if you have high stress levels, what do we do to help address that stress? We can supplement all we want, but that's not going to get to the underlying root cause of what's going on here."

If lifestyle improvements don't work, Bloomer says it might be worth introducing a colostrum supplement. But it should be done consistently over a period of two months without changing anything else, "just like a scientific experiment in a lab," he says.

"Otherwise, we really don't know — is it the intervention or is it something else they're doing that's leading to that outcome?"

Bloomer says that if the colostrum does work, great. But he generally advises that the money one spends on supplements — which varies but can be as high as $1-$2 per daily dose for colostrum — may be better spent on healthy foods. Incorporating fruits, vegetables and whole grains often have a broader positive impact on the body.

"I think [it's] really important for people to consider the cost-benefit ratio," he says.

One other caution: though there's little evidence of serious side effects from colostrum, Playford warns those who are lactose intolerant to steer clear. "If you suffer from a milk allergy," he says, "then you shouldn't do it. But if you can take milk, you can take colostrum."

The bottom line

The research on colostrum points to potential benefits for gut health, but the research is still in its early stages. It shouldn't be regarded as a quick cure all, and doctors say lifestyle changes are a better first stop for trying to improve gut troubles.

Copyright 2026 NPR

A large Ebola outbreak in central Africa is spreading, and misinformation about the virus is making matters worse.

Rumors on social media claim that Ebola is not real or that healthcare workers are out to profit for themselves.

More than 1,000 suspected and confirmed cases have been recorded, with at least 223 deaths suspected of being caused by Ebola, according to the World Health Organization. Health workers say that's likely a major undercount.

The epicenter of the outbreak is in the Democratic Republic of Congo.

Uganda, which borders the Democratic Republic of Congo, has so far been spared the worst of the outbreak. On May 27, the country closed its official border crossings with Congo.

"We still have a number of porous border points … whereby people continue to cross over," said Leonard Musinguzi. He's a community and surveillance officer for the International Rescue Committee in Uganda.

Musinguzi's job is to track likely cases of Ebola, quarantine refugees, train healthcare workers and prepare his community to battle the disease.

That's an uphill battle, especially because wrong information about Ebola can spread even faster than a virus.

One of the ways Musinguzi tries to combat that misinformation is public health messaging. His organization distributes radio spots, posters and information on hospital televisions meant to educate about the disease.

However, governments like the United States have cut back their support for programs like the International Rescue Committee's. That means Musinguzi has less money for the projects he wants to do.

Before, he might have paid to place educational messages during five radio talk shows. Now, he said, "because of this reduced funding, you only have one."

In a statement to NPR, the State Department said recent federal funding changes did not have any significant effect on U.S. funding levels for global health programs or health security programs in the eastern Congo.

Spokesman Tommy Pigott said, "The United States responded within 24 hours of the first confirmed case, mobilizing a wide range of medical, humanitarian, operational, and consular resources to rapidly respond to the Ebola outbreak."

NPR's Adrian Florido spoke with aid workers and a former U.S. Agency for International Development employee to learn more about the pressures facing the global health system and how federal government cuts may have contributed.

Listen to the full story by clicking the blue play button above.

Copyright 2026 NPR

WASHINGTON — A novel pill helped people with advanced pancreatic cancer live longer, researchers reported Sunday, raising hopes of long-needed better treatments for one of the deadliest types of cancer.

"While not curing the cancer, it is a very large step forward," said Dr. Zev Wainberg, of the University of California, Los Angeles, who helped lead the study.

The drug is called daraxonrasib and it blocks a mutated protein that fuels tumor growth in more than 90% of pancreatic cancer cases — a target that had eluded treatment for decades.

The daily pills nearly doubled survival time, with fewer severe side effects, in a study that randomly assigned the experimental drug or more chemotherapy to 500 patients whose metastatic, or spreading, cancer had quit responding to prior treatment. The findings were published in the New England Journal of Medicine and presented Sunday at the American Society for Clinical Oncology meeting in Chicago.

Those taking daraxonrasib lived for a median of 13.2 months compared with 6.7 months for chemotherapy recipients. While that may seem like a small improvement, Wainberg said it marked the first drug to show a substantial advantage over chemotherapy.

"Having treated pancreatic cancer for 16 years, I actually started crying" when first seeing the study results, Dr. Rachna Shroff of the University of Arizona Cancer Center, who wasn't involved with the research, said from the ASCO meeting. She was struck by how "patients stayed on this treatment because it was providing durable and meaningful benefit to them."

The pills' effects eventually wane but recipients used them for significantly longer than the comparison group stayed on chemotherapy, reporting less pain and a better quality of life as their tumors shrank. Many still were using the drug after the data was analyzed, which Wainberg said means the survival gap may widen as researchers continue tracking them.

Dr. Brian Wolpin, of the Dana-Farber Cancer Institute, presented the findings Sunday. He said the drug should become "a new standard of care" for previously treated metastatic pancreatic cancer, adding that researchers also will explore its use earlier in the disease, including to see if tumor shrinkage might let more patients qualify for surgery.

Side effects most likely to affect pill usage were a rash that can be severe and mouth sores, he said.

Maker Revolution Medicines funded the study and the Food and Drug Administration plans to expedite review of the drug. Meanwhile, the agency is allowing what's called "expanded access" to the experimental drug for patients who meet certain criteria. The drug garnered public attention when former U.S. Sen. Ben Sasse described on "60 Minutes" how he's had less pain while taking it. Oncologists are being flooded with requests as the special access program gets started.

Pancreatic cancer is among the most deadly forms in large part because it's hard to detect before it starts spreading to other organs. The American Cancer Society estimates about 67,000 new cases will be diagnosed in the U.S. this year and more than 52,000 people will die from the disease. The five-year overall survival rate is 13%.

Unlike with other cancers that have benefitted from a variety of chemotherapy alternatives, pancreatic cancer has been harder to tackle.

Cancer specialists not involved in the new research expressed optimism that this may be a turning point in the quest for new options, with dozens of experimental drugs in development.

The new drug targets mutations in the RAS gene family that normally regulates cell growth. So-called KRAS mutations are especially critical in fueling pancreatic cancer. But a structure that made it hard for drugs to stick to the mutated proteins meant this cancer driver was long considered "undruggable."

Revolution Medicines' drug uses what's essentially a molecular glue to bind with multiple KRAS subtypes. Wainberg said researchers next will probe whether the drug worked better in certain of those subtypes.

The drug will change pancreatic cancer treatment, said Dr. Andrew Coveler of the Fred Hutchinson Cancer Center, who wasn't involved in the research.

"This thing works drastically differently," he said.

Wainberg said other drugs in development target specific KRAS subtypes. Other approaches in earlier stages of testing include vaccines designed to prevent recurrence after pancreatic cancer surgery by teaching the immune system to recognize the mutated protein.

Copyright 2026 NPR

As a scorching wind tears across the barren, rocky slopes of Komote Island off the shore of Lake Turkana in northern Kenya, Alfred Lenkutuk sits in the meager shelter of his hut, gazing out over the village where he was born and remembering better times.

As little as 10 years ago, the village wasn't on an island at all. But the lake has steadily expanded, swallowing homes, grazing lands, schools, roads and the burial grounds where Lenkutuk's ancestors were laid to rest. Today, the village is separated from the mainland by about 660 yards of shimmering turquoise water where fishermen paddle on homemade rafts.

Growing up, the 71-year-old remembers going on regular communal hippo hunts around the lakeshore, and fishermen coming home with catches of more than 250 pounds. Now the hippos are virtually wiped out and fishermen are lucky if they come home with even 10 pounds of fish. Families have been divided by the rising waters. Children must take a boat to get to school every morning. Anyone with livestock has been forced to leave.

"Now we depend on the government," says Lenkutuk, a member of the El Molo people, one of Africa's smallest and most marginalized indigenous groups, whose lives have revolved around the lake for centuries. "We're not able to support ourselves."

The government sends supplies of rice and beans every few months, and recently provided the island with a reverse osmosis plant to give them access to fresh water. Lenkutuk says it's not nearly enough.

Lake Turkana is the world's largest permanent desert lake, and its waters have long sustained hundreds of thousands of people in one of the most isolated and neglected parts of Kenya. But now the lake is facing multiple, concurrent threats. Rising water levels -- attributed to a combination of climatic and tectonic factors -- have displaced thousands, damaged infrastructure and services, and disrupted fishing. At the same time, persistent drought across northern Kenya has forced thousands of herders to take up fishing, putting even greater pressure on an already delicate ecosystem and fueling intense competition.

"We used to be able to fish all the way from here to Moitie," says Lenkutuk, referring to a town about 44 miles northwest. "There are too many people fishing now."

In 2018, Lake Turkana was placed on UNESCO's List of World Heritage in Danger. Since then, residents say, conditions have only deteriorated. In Kalokol, a major fishing community on the lake's western shore, many have now been displaced three times as the waters continue to encroach. Teenagers bathe in the floodwaters, and fishermen string their nets between submerged bushes amid the remains of flooded villages.

A few miles to the south, a lodge that was once a mainstay of Turkana's fledgling tourist industry has lost 95% of its land. Nearly all of its staff have been laid off. Its conference center, once popular with NGOs, has vanished beneath the water, and a flooded palm forest in front of the hastily rebuilt guest cottages has become a playground for children.

But of all the groups affected by the changes, the El Molo, who now number barely a few hundred people, have perhaps the most to lose. An El Molo origin myth holds that their people and the lake were created together, and neither has ever existed without the other. For them, the lake is not only a source of livelihood but also a cornerstone of cultural identity.

As the sun rises over Komote island, around two dozen children clad in apple-green uniforms make their way to board a boat that will take them to school on the mainland. They sit crammed tightly together, some hastily finishing the last bites of their breakfast. The 20-minute or so journey costs cash-strapped El Molo families 100 Kenyan shillings (about 75 cents) per child each way. As the boat pulls in, the children clamber over the side, wading through the shallows past abandoned, submerged school buildings.

"We lost two of the girls' dormitories, the dining hall, the library, the early childhood development center, the sports field, the teachers' quarters," says John Wambisa, a geography teacher at the school who began working here in 2005. "They're all underwater."

The new teachers' quarters, he says, are infested with bats whose droppings have triggered a wave of respiratory problems. Flooded school buildings have become breeding grounds for crocodiles, and when the weather is rough or the boat has run out of fuel, half his students don't make it to class. The primary school also lost its fresh water after it was contaminated with lake water. In just a few years, student enrollment has dropped from over 230 to just 139.

"It's affected us a lot," says Wambisa, as he heads off to teach his first class of the day. "We're trying to adjust to climate change."

Lake Turkana's waters -- like those of the other lakes in Kenya's volcanic Great Rift Valley, which cuts north-south through the center of the country -- have always fluctuated as a result of tectonic shifts underground. But researchers say the current rapid rise, which began around 2018, has been exacerbated by climatic and other human-induced factors.

"It's a complex web of interactions that created this situation," says Kevin Obiero of the Kenya Marine and Fisheries Research Institute (KMFRI), who has been studying the lake since 2012.

Alongside the tectonic activity, Obiero says changing weather patterns in southwestern Ethiopia are likely a significant factor, increasing inflow into the lake through the Omo river, its major tributary. He adds that a buildup of sediment -- driven by changing land-use patterns, increased erosion and disruption to rivers that feed the lake -- could be making things worse.

Obiero says the decline in fishermen's catches may also be more complicated than it seems. Gauging overall trends in fish stocks is difficult because historical data is limited, he says, but recent surveys by the KMFRI and its partners suggest that the lake still holds enough fish to sustain a thriving fishing industry. The problem, he says, is that most of the best fishing grounds lie beyond the reach of the subsistence fishers living along the lakeshore.

"Over half of the vessels are rafts made of doum palms," says Obiero. "Only 12% of all the vessels are motorized. Fishers don't have the capacity to reach the deeper parts of the lake, so everyone's fishing in the same areas."

Around the lake, the declining catches and rising waters have played out in different ways. In the northern reaches, thousands of pastoralist herders have switched to fishing after losing their livestock to drought since 2021. Fishermen say increasing competition has spurred a sharp rise in armed conflict, especially between fisherfolk from the Turkana and Dassanech ethnic groups. In a single incident in February 2025, more than 20 people were killed when rival groups clashed near the Ethiopian border.

In January, 24-year-old Nyabonte Kuras was fishing on the lake when he heard engines approaching. Seconds later, he heard automatic gunfire. His cousin, standing next to him on the boat, was fatally shot in the chest. Another friend, whom Kuras had known since childhood, was hit in the leg, before leaping overboard to escape the hail of bullets. The attackers finished him off in the water. A third crew member was hit in the arm. Kuras and the only other uninjured man in the boat fled the scene while returning fire with an AK-47.

"I'm not the only one -- most of us have experienced these things," says Kuras, a Dassanech father of two who has been fishing on the lake since he was a child. "When I was young there were few fishermen and there was no shooting. When the number of fishermen increased, that's what brought this conflict."

Kuras says he feels trapped. In his village of just 30 homes, six people have now been killed by rivals on the lake in the past few years. To avoid the risk of attack, he no longer ventures far from land. Yet he says he's finding it increasingly hard to catch enough to make ends meet in the heavily fished waters near the shore.

"I'm always thinking, if I catch nothing, what will I give my family?" says Kuras.

Armed attack is not his only concern. Alongside those shot on the lake, five others from his village have been killed by crocodiles, he says. Kuras believes the crocodiles are attacking people more often because their primary food source –- fish –- is dwindling. The Turkana County government, however, says the apparent increase in attacks is a result of the rising lake levels, which have created huge expanses of flooded scrubland that are now hunting grounds for both people and crocodiles, frequently bringing the two into conflict.

Ng'ikalei Loito, 33, was bathing in just such an area when she was attacked by a crocodile. She clung to a nearby tree and shouted for help. By the time rescuers arrived, her legs were so badly damaged that doctors had no choice but to amputate them.

Loito's experience illustrates the devastating impact of the region's colliding crises. At the time of the attack, her family was already under enormous strain, having been displaced multiple times from their home near Kalokol by the rising waters.

To pay for her medical bills, the family had to sell most of their remaining cattle and goats, a bitter blow after years of drought had already decimated local herds. And in the same year she lost her legs, her husband was killed in a cattle raid, a practice fueled by drought and the growing competition over livestock and grazing land.

"There's no work I can do," says Loito, who, before her accident, supported her five children with the small income she earned selling tea and donuts. "I'm just sitting around at home."

For Obiero, the fisheries researcher, there's no simple solution to the lake's complex challenges. Rather, what it needs, he says, is a coordinated set of social and ecological interventions.

Fishermen must be supported and trained to use new equipment and techniques that would allow them to reach richer fishing grounds, he says. Fishing villages, only 2% of which currently have electricity, must get access to power. Transport must be improved so fishermen have a cost-effective way to export their catch. Cold-storage and processing facilities should be installed around the lake. Cell phone coverage should be expanded so fishermen can communicate with buyers and call for help when needed. And access to health care and drinking water should be improved.

"We need to come up with innovative solutions to all these problems," says Obiero. "But we still believe the lake can be the backbone of these communities."

Some innovations are underway. The Kenyan government's Lake Turkana Fisheries Management Plan has imposed regulations designed to protect juvenile fish and make certain breeding grounds off limits to fishing. It is also monitoring water quality and carrying out a baseline fish biomass survey. Both the government and nongovernmental organizations are involved in a series of peace-building initiatives to reduce conflict in the north of the lake.

Other NGO-led initiatives, including a major project by UNESCO and the World Food Programme, are working to expand and improve market access for fishers. Some cold-storage facilities have been installed, and some fishing equipment has been provided. The UNESCO/WFP project is also using microfinance, with loans and banking services, to boost alternative livelihoods and help fishing communities diversify their sources of income.

But the broader impact of these interventions has so far been limited. On Komote Island, the El Molo's problems show little sign of abating. Aside from the water plant and meager food deliveries provided by the government, and three fishing boats donated by various NGOs, Lenkutuk says the community has received little assistance.

Mostly, he places his hopes in divine intervention. As the light starts to fade, he lights a small fire on the shore, letting its acrid smoke drift across his beleaguered island in a ritual that he hopes will bring better fortunes for his people. He calls on God to send fish and rain, and asks that his people not be forgotten.

"We'll go on until there are no fish left," says Lenkutuk. "When there's nothing left, we fear how we'll be able to survive."

Tommy Trenchard is an independent photojournalist based in Cape Town, South Africa. He has previously contributed photos and stories to NPR on the Mozambique cyclone of 2019, Indonesian death rituals and illegal miners in abandoned South African diamond mines and won a World Press Photo prize for the images in his story for NPR on clashes between elephants and people in Zambia.

Copyright 2026 NPR

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When Jazelle Eastman was 16, she was shot in the face by a boy she thought was a friend. She doesn’t remember feeling much, but next thing she knew there was blood dripping from her chin.

That was two years ago. She still has a hard time trusting people. “PTSD is so real, I feel like I'm always looking over my shoulder,” she said.

During her hospital stay, a social worker connected Eastman to a mental health counselor. She was hesitant at first; therapy is not something she would have sought on her own. Now she sees the benefit: “Talking to someone made it a lot better,” she said.

That, however, is not every young survivor’s experience. Nationally, just 37% of children received mental health services within six months after a firearm injury, according to a 2023 study published in the American Academy of Pediatrics. For some young survivors, help never arrives at all.

California lawmakers want to change that. Assembly Bill 2247 would require counties and the state to provide and pay for mental health and counseling services for youth survivors of gun violence, regardless of their insurance situation.

The bill would establish a pilot program in Alameda, Los Angeles, San Bernardino and Solano counties, funded by state grants. Any young person touched by gun violence — whether they were shot, saw a shooting happen, or lost a family member — would qualify for free services up to age 25.

Eastman had invited a group of friends for a sleepover at her Vallejo home. She recalls being on her phone when a boy got up from the living room floor, where he'd been sleeping. She doesn't know exactly why he shot her; she thinks it was on purpose, that he'd gotten upset at her for being too loud that morning. He claimed it was an accident.

"I never thought that me trying to have a little get-together with my friends would result in something so bad happening," she said.

The gap in care

In 2020, firearms surpassed motor vehicle accidents as the leading cause of death among children and teens nationally. Researchers estimate that for every fatality, there are at least two survivors of firearm injuries.

In California, about 2,000 youth 25 and younger died or were hospitalized from firearm injuries annually since 2016, according to the California Department of Public Health. This includes suicides. Still, California has the fifth-lowest youth firearm death rate in the country.

“It's very clear that violence, and gun violence in particular, is salient in young people's lives,” said Nicole Kravitz-Wirtz, an associate professor with the Centers for Violence Prevention at UC Davis. Research shows that the trauma of firearm violence can be especially disruptive for young people who are still developing mentally and emotionally, leading to post-traumatic stress disorder, anxiety, depression, hypervigilance, sleep disruption, grief, substance use and suicidal thoughts.

Yet many survivors and their families go without timely help. Some people mistrust the health system. Others may not even know where to start. Getting connected to mental health care isn’t straightforward, even for those who try. People with medical coverage have reported having to wait months to find a therapist that works for them, and those without coverage may not even try because they can’t afford counseling.

Tinisch Hollins, executive director at Californians for Safety and Justice, an advocacy organization sponsoring the bill, said this “made a lot of families kind of give up on the process.”

In California, victims of violence may be eligible for state compensation they can use to reimburse therapy costs, but navigating that system is tricky and not all victims qualify. Eastman has applied twice and has never heard back.

Hollins said the latest bill aims to remove cost and insurance barriers. It would also push counties to standardize how they connect victims to services and promote counseling more widely to victims and their families.

Hollins said the legislation is also a direct response to the disproportionate impact of gun violence on Black and Hispanic communities. In California, 78% of youth who were killed or hospitalized due to firearm injuries between 2016 and 2024 were Black or Hispanic, state data show.

A bill, but no funding

Hospitals, counties and other care providers have no consistent standard for connecting young survivors to mental health care after a shooting.

Handing a person a referral for counseling and expecting them to follow through while in survival mode is not enough, said Kravitz-Wirtz.

“Services for young people impacted by firearm violence are too often fragmented,” she said. “Young people often leave the hospital after a shooting with their physical injuries treated … but without a clear pathway into ongoing mental health.”

Some hospitals do have intervention and trauma recovery models in place, but they’re not universally or consistently available. Youth Alive!, the organization that provided Eastman free therapy, is one. Rhea Corson-Higgs, a mental health counselor there, works with youth who have experienced violent trauma in the Bay Area. In the group’s model, a social worker connects youth to a counselor before they are discharged from the hospital. That counselor goes to their home and provides trauma-informed therapy, prioritizing safety and trust. But her program always has a waitlist, she said.

Even if the legislation were to pass, one key challenge remains: There’s no money behind it. Ashley Anderson, a spokesperson for Assemblymember Sade Elhawary, a Los Angeles Democrat who authored the bill, said her office is still trying to find a funding source.

An analysis of the bill estimates it will cost $7,800 per person per year to provide grants to counties. The Assembly’s fiscal committee scaled back the scope of the bill, replacing its statewide requirement with a four-county pilot project. On Tuesday, the Assembly approved the legislation and it now heads for discussion in the Senate.

Finding help and ‘freedom’

Earlier this month Eastman traveled to Sacramento to advocate for the bill, joining dozens of survivors and families of those who were killed. After a brief march, attendees gathered at Capitol Park, where around a stage they placed poster boards and banners with victims’ photos and messages: “Never forgotten” and “Forever 18.”

Today, Eastman is able to share her story publicly in large part because of therapy.

Bridgett Montoya was also there. She grew up in Pacoima, in the San Fernando Valley; a decade or more ago, gang activity there was commonplace. When she was 21, she was struck by two bullets — one in the head and one in the hip. She was in a coma for about a week and hospitalized for 28 days. A bullet remains lodged on the right back side of her head. Fragments from the hip shot impair her walking.

Two years passed before she saw a therapist. She wants others to have an easier path. “Going to therapy gave me a sense of relief and a sense of freedom,” she said.

James Michael, 20, was shot in the leg while attending an Oakland house party two years ago. At the hospital, before he could even see a doctor, he said law enforcement questioned him aggressively, as if he had something to do with the shooting. He recalls feeling really angry.

He thought twice about therapy, but decided to give it a try. That’s where he met Corson-Higgs at Youth Alive!, who he credits with helping him work through his anger. As he retrained his left leg to walk, he also regained his confidence.

Therapy, he said, “showed me that life is still beautiful, no matter what you go through.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.