When there’s an outbreak of a vaccine-preventable disease, state health officials typically take certain steps to alert residents and issue public updates about the growing threat. That’s standard practice, public health and infectious disease experts told KFF Health News and NPR. The goal is to keep as many other vulnerable people as possible from getting sick and to remind the public about the benefits of vaccinations.

But in Louisiana this year, public health officials appeared to have not followed that playbook during the state’s worst whooping cough outbreak in 35 years.

Whooping cough, also called pertussis, is a highly contagious, vaccine-preventable disease that’s particularly dangerous for the youngest infants. It can cause vomiting and trouble breathing, and serious infections can lead to pneumonia, seizures, and, rarely, death.

Madison Flake, a pediatric resident in Baton Rouge, cared for a baby who was hospitalized during this year’s outbreak. Less than 2 months old, he was sent to the intensive care unit.

“He would have these bouts of very dramatic coughing spells,” Flake said. “He would stop breathing for several seconds to almost a minute.”

Infants are not eligible for their first pertussis vaccine until they are 2 months old, but they can acquire immunity if the mother is immunized while pregnant.

By late January, two babies had died in Louisiana.

But the Louisiana Department of Health waited two months to send out a social media post suggesting people talk to their doctors about getting vaccinated. The department took even longer to issue a statewide health alert to physicians, send out a press release, or hold a news conference.

That lag is not typical, according to Georges Benjamin, the executive director of the American Public Health Association.

“Particularly for these childhood diseases, we usually jump all over these,” said Benjamin, a physician who has led health departments in Maryland and Washington, D.C. “These are preventable diseases and preventable deaths.”

Because infectious diseases spread exponentially, if officials don’t alert the public quickly, they lose a key chance to prevent further infections, said Abraar Karan, an instructor at Stanford University who has worked on covid and mpox outbreaks.

“Time is perhaps one of the most important currencies that you have,” he added.

General Promotion of Vaccines Banned

Because pertussis vaccine immunity wanes over time, cases can ebb and flow. But in September 2024, Louisiana health officials started seeing a “substantial” increase in whooping cough cases, part of a national trend.

In late January, physicians at one Louisiana hospital warned their colleagues that two infants had died in the outbreak.

On Feb. 13, the state’s surgeon general, Ralph Abraham, sent a memo to staff ending the general promotion of vaccines and community vaccine events.

He sent that email a few hours after Robert F. Kennedy Jr., an anti-vaccine activist, won Senate confirmation as the new secretary of the U.S. Department of Health and Human Services.

Also that day, Abraham posted a public memo on the state health department’s website. In it, he said public health has overstepped with vaccine recommendations, driven by “a one-size-fits-all, collectivist mentality.” Abraham has called covid vaccines “dangerous” and been a vocal supporter of Kennedy.

Four days later, in response to a request from WVUE Fox 8 News in New Orleans, the Louisiana Department of Health in an email confirmed the deaths of two infants from whooping cough for the first time. WVUE published the news on Feb. 20.

But Louisiana’s health department sent out no alerts, according to a review of external and internal communications by NPR and KFF Health News.

Over the next month, two more infants were hospitalized for whooping cough, according to internal health department emails obtained through a public records request.

In March, after inquiries from NPR and KFF Health News about the growing number of pertussis cases, the department put out its first social media communications about the outbreak and offered interviews to other journalists.

Then on May 1 — at least three months after the second infant death — the health department issued what appears to be its first and so far only official alert to physicians. It put out its first press release the next day and then held a news conference about pertussis on May 14.

By then, 42 people had been hospitalized for whooping cough since the outbreak began, three-quarters of whom were not up to date on their whooping cough immunizations, according to the Louisiana Department of Health.

More than two-thirds of those hospitalized were babies under the age of 1.

Throughout the summer, pertussis cases continued to climb in Louisiana. But there were no further public communications from the state health department.

NPR and KFF Health News contacted the department for comment on Sept. 25. Emma Herrock, a spokesperson, did not answer specific questions about the lack of communications but referred to a Sept. 30 post on X by the state surgeon general.

In the post, Abraham said the department “consistently reported cases of pertussis and provided guidance to help residents stay protected” in 2025. He called the pertussis vaccine “one of the least controversial” and said he recommends it to his patients.

The X post included a year-by-year graphic of pertussis cases that omitted 2024 and 2025. The post also provided a more specific timeframe for when the infant deaths occurred — one in late 2024 and the other in early 2025.

A ‘Train Wreck’ of Cases

Louisiana should have started warning the public within days of the first infant’s death instead of waiting months, said Stanford’s Karan.

“At minimum,” he said, “it should be like heavy promotion of: ‘Hey, infants are at high risk. They get infected by people who have waning immunity. If you haven’t gotten vaccinated, get vaccinated. If you have these symptoms, get tested.’”

Deaths from a vaccine-preventable illness are tragic, but they can also serve as an opportunity to educate the public about the benefits of vaccines and try to save lives, said Joshua Sharfstein, a former Maryland health secretary and now a professor at the Johns Hopkins Bloomberg School of Public Health.

“The risk of pertussis is always there, but when you have two infant deaths it’s a really good opportunity to communicate that this is a real threat to the health of children,” Sharfstein said.

Karan said that by not acting more quickly, the Louisiana Department of Health may have set itself up for a worse outbreak.

“Because then what we see is this train wreck thereafter, of like an insanely large outbreak, a lot of hospitalizations,” he said.

The Outbreak Continued

As of Sept. 20, the most recent date for which data is available, Louisiana had counted 387 cases of whooping cough in 2025, according to the Centers for Disease Control and Prevention. In data going back to 1990, the previous high was 214 cases, in 2013.

Until the Sept. 30 post on X, the Louisiana Department of Health did not appear to put out any public communications about pertussis over the preceding four months, though hospitalizations continued and case levels surpassed the 2013 levels.

The health department should be responding aggressively and consistently, said Joseph Bocchini, the president of the Louisiana Chapter of the American Academy of Pediatrics.

Health officials should make sure “people are updated on a regular basis and reminded of what needs to be done,” he said. “Get your vaccines. Moms, if you’re pregnant, get vaccinated. And if you have a cough illness, see your doctor.”

Benjamin, with the American Public Health Association, said the ongoing goal of public health communication is to prevent the next hospitalization or death.

“The bottom line is, it’s not too late,” he said. “It’s not too late to be much more aggressive and proactive about dealing with pertussis.”

This article is from a partnership that includes WWNO, NPR, and KFF Health News.

Oct. 30

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July 3

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June 26

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June 19

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April 17

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March 20

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March 13

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Jan. 30

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The KFF Health News Minute is available every Thursday on CBS News Radio.

John Cleveland is ready to pay a lot more for his health insurance next year.

He hasn’t forgotten the pile of hospital bills that awaited him after he had a seizure while tending to customers in his Austin, Texas, barbershop four years ago. Once doctors hurriedly removed the dangerous tumor growing on his brain, a weeklong hospital stay, months of therapy, and nearly $250,000 worth of medical expenses followed.

The coverage he has purchased for years through the Affordable Care Act marketplace covered most of those bills.

“That saved my ass,” said Cleveland, who owns three barbershops across the city.

Even with Cleveland’s monthly premiums expected to soar next year — from $560 to about $682 — he will still sign up for a plan that requires him to shell out $70 if he sees a doctor and 50% of the cost for any emergency room visits. Still, Cleveland is most worried about some of his employees, who might risk going without insurance once they see the high prices.

Small-business owners are among those who stand to lose the most should Congress let the additional, generous federal subsidies put in place during the covid-19 pandemic lapse. The looming change threatens not only their own coverage but also that of their employees, who often depend on marketplace coverage.

Whether to extend the enhanced ACA subsidies that cost taxpayers billions of dollars yearly poses a serious political conundrum for Republicans. After years of unified opposition to Obamacare, the party now faces pressure from one of its most loyal constituencies, small-business owners, who will bear the brunt of rising premiums if the subsidies disappear.

Most of the roughly 20 employees who work on Justin Miller’s 113-year-old family fruit farm in rural Northern California purchase coverage through the Obamacare marketplace.

He’s agonizing over what it could mean if health insurance through the marketplace becomes unaffordable for his employees. He fears they might consider leaving his farm for a job that comes with health coverage.

“Being a small-business owner, especially in a field like ours, where it is tough work and we really understand how hard everybody works, we have to look everybody in the eyes every day,” Miller said. “Knowing that they’re going to have to pay $4,000 or $5,000 more a year to stay on their insurance is a tough pill to swallow.”

Miller says he already pays a minimum wage of $22.50 and provides sick leave, vacation, retirement, and employee housing benefits.

Adding health insurance for his employees, he said, would be too costly to keep his farm in business.

GOP Pollsters Issue ACA Caution

About half of the 24 million people enrolled in Obamacare coverage are, or are employed by, small-business owners — a group that is more likely to vote Republican and overwhelmingly backed President Donald Trump in last year’s election. Farmers, dentists, real estate agents, and chiropractors are among the professions most represented among enrollees.

Even Trump’s own pollsters have found deep support for the Obamacare subsidies, warning that failing to extend them could cost Republicans in next year’s midterms.

A poll conducted last month by Republican pollster John McLaughlin found that a majority of independent voters would be less likely to vote for politicians who voted to let the enhanced tax credits expire.

Given that “approximately 4 million” people would lose coverage and premiums would “skyrocket by an average of 75%,” the poll also concluded that: “A candidate for congress who let the healthcare tax cuts expire would also be vulnerable to more pointed messages.”

Red States Benefited From the Subsidies

Some red states have seen Obamacare enrollment balloon since the federal government began offering extra help paying premiums in the form of more generous subsidies.

Texas and Florida have added 2.8 million enrollees each since 2020, far outpacing growth in most other states. Together, the two states now account for more than a third of marketplace enrollment nationally.

A small chorus of Republican lawmakers — up for reelection next year, mostly in competitive races — have proposed an extension of the subsidies, urging Democrats to vote to reopen the government while simultaneously pleading with House Speaker Mike Johnson to work out a bipartisan deal that doesn’t allow them to simply lapse.

At Cleveland’s barbershops in Austin, about a third of his 18 employees rely on Obamacare coverage. He’s talked to them about their health insurance options for next year but said many hadn’t started thinking about open enrollment, which began Nov. 1.

He’s worried they’ll be baffled once they see the new prices, which currently reflect what customers will pay next year without an extension of the extra subsidies.

“There’s a couple of my barbers that are going to go without, because they’re healthy and young, but I thought I was too when everything happened to me,” said Cleveland, now 47.

Republicans, meanwhile, remain wary of voting to extend the additional Obamacare subsidies, said Rodney Whitlock, a vice president at the McDermott+ consultancy who was a longtime congressional staffer and advises on health care policy.

No Republican voted for the extra subsidies when they were introduced in 2021 or continued in 2022. Approving them now, he said, is viewed by many as a band-aid that would temporarily help a program GOP leaders have long lambasted as problematic and too costly.

But, Whitlock noted, many in the party are coming to terms with how the subsidies might affect their changing constituencies. Nearly 6 in 10 Obamacare enrollees live in a Republican-held congressional district.

“Republicans are slowly starting to grasp that the lower third of income earners are their voters,” he said. “For the first time, I think they’re getting there. That battleship turns slowly.”

Rep. Marjorie Taylor Greene, a Georgia Republican who has firmly backed Trump, broke with her party last month, calling on the GOP to extend the subsidies. Greene said in an interview that rising health care costs are the “No. 1 issue” she hears about from people living in her district.

“I know a lot of small-business owners, like a family of four, and they’re paying $2,000 a month,” Greene said during the television interview, adding that rising deductibles make the insurance hardly functional for anything other than catastrophes.

She warned in another TV interview that “ignoring” the issue could be “very bad for midterms” next year.

Miller, the farmer who lives in a conservative district in Northern California, expects monthly health insurance premiums for himself, his wife, and two of his children to jump from $264 to $600. His deductibles and copayments are going up, too. He expects all these new expenses will still be on his mind when he goes to vote in the midterm elections next year, he said. Describing himself as an independent, Miller said he is frustrated that few American politicians talk about the type of universal health care coverage that’s available in other countries.

“I’m definitely voting for those that will protect the working American, regardless of party,” he said.