Category: English

Source: The Conversation – USA (3) – By David Higgins, Assistant Professor of Pediatrics, University of Colorado Anschutz Medical Campus

More than three-quarters of U.S. counties and jurisdictions are experiencing declines in childhood vaccination rates, a trend that began in 2019, according to a September 2025 NBC News–Stanford University investigation. The report also found a “large swath” of the U.S. no longer has the “basic, ground-level immunity” needed to stop the spread of measles.

Dr. David Higgins, an assistant professor of pediatrics at the University of Colorado CU Anschutz Medical Center and a pediatrician who researches vaccines, discusses the dangers of not vaccinating your children.

The Conversation has collaborated with SciLine to bring you highlights from the discussion, edited for brevity and clarity.

What vaccines are typically required for schoolchildren, and why?

David Higgins: The vaccine requirements for kids to attend school are set by states, not the federal government. Most states require kindergartners get vaccines for pertussis – that’s whooping cough – and tetanus, measles, mumps, rubella and chickenpox.

For older kids, a booster of the tetanus and pertussis vaccine is typically required, as well as a vaccine for meningococcal disease.

Vaccines reduce the risk of outbreaks in places where transmission of these diseases is easy. Not only do vaccinations help keep both students and teachers safe, it also encourages overall higher community coverage for these vaccines.

How do scientists track the safety of vaccines over time?

Higgins: Before vaccines are approved, they undergo rigorous trials. During this process, scientists look at the safety and effectiveness of the vaccine, testing it first in small groups to assess safety, then in larger groups to confirm protection and detect uncommon side effects. That process continues after the vaccine is approved. Those systems continually monitor the safety of vaccines, both here in the U.S. as well as around the world.

What are the vaccination coverage trends for kindergartners?

Higgins: What we have seen is a small downward trend since 2019, the year prior to the COVID-19 pandemic. It slipped from 95% of new kindergartners being up to date on many of their routine vaccines to about 92%.

That’s a small percentage decrease, so a great majority of parents are still vaccinating their kids. But at the same time, anything below our target of 95% for diseases like measles becomes a problem, because that’s below the level that’s needed for what we call herd immunity, or community immunity. When that happens, it’s not a matter of if, but when, we see an outbreak of these infectious diseases.

And while nationwide rates are important to look at, outbreaks happen at local community levels. For example, earlier this year, an outbreak of measles in West Texas spread rapidly through communities where vaccination rates had slipped well below the state average.

So, the vaccination rate at your own school or community is much more meaningful than what the national vaccination rate is.

How do non-medical vaccine exemptions work?

Higgins: First, actual medical exemptions are rare, and these occur when the vaccine is unsafe for the child to receive, like when he or she has a known severe allergic reaction to vaccine ingredients.

Non-medical exemptions for vaccines are often for religious, personal or philosophical reasons. They have been increasing for the past several years, rising from the range of 1 to 2% up to 3.6% in the 2024–25 school year. That’s a small increase, but again, it’s still concerning.

{What are some reasons why parents are} Why are some parents vaccine hesitant?

Higgins: There are multiple reasons. These include misinformation which algorithm-driven echo chambers on social media can spread at an alarming rate right now. Also, Americans report less trust in institutions and experts, and studies have found growing partisanship around vaccines.

Additionally, vaccines are victims of their own success. They have worked so well that many diseases like polio aren’t routinely seen anymore. That might lead a parent to think the risk for their child is so low that the vaccine is not necessary. But the fact is, vaccines are simply holding these diseases at bay. And as vaccination rates drop, these diseases will come back and more kids will be at risk.

What advice do you have for parents?

Higgins: The most important thing you can do as a parent is to keep your kids up to date on required vaccines. That includes the annual flu shot. Follow your state’s requirements and current recommendations from trusted sources like the American Academy of Pediatrics and your own personal pediatrician to know which vaccines your child should have.

You also want to reinforce other common sense approaches to keeping your children healthy. Make sure they know how to wash their hands properly and that they stay home when they’re sick. Teach them to sneeze and cough into their elbow instead of into their hands – even though doing so isn’t a perfect solution.

As a pediatrician, I love when my families come and talk to me about their concerns. I help them walk through their worries so they can feel more confident that they’re making a truly informed decision that’s in the best interest of their child’s health.

SciLine is a free service based at the American Association for the Advancement of Science, a nonprofit that helps journalists include scientific evidence and experts in their news stories.

David Higgins is a member of the American Academy of Pediatrics. He is also on the board of directors (volunteer) for Immunize Colorado.

– ref. Even small drops in vaccination rates for US children can lead to disease outbreaks – https://theconversation.com/even-small-drops-in-vaccination-rates-for-us-children-can-lead-to-disease-outbreaks-265555

Source: The Conversation – USA (3) – By Richard J. Callahan, Jr., Associate Professor of Religious Studies, Gonzaga University

In October 2025, Cecil Roberts will officially retire from his role as president of the United Mine Workers of America. A sixth-generation coal miner, he has led the union for 30 years. Only one man held the role longer: John L. Lewis, whom many consider one of the most important labor leaders of the 20th century.

Roberts has seen the union through an especially difficult period for the coal industry and grew up immersed in it. He was raised in Cabin Creek, West Virginia, where his great-grandmother – an activist in her own right – let miners camp on her property during a legendary strike in 1912. Bill Blizzard, his great-uncle, led miners during the Battle of Blair Mountain, the largest labor uprising in U.S. history. Both of his grandfathers died in mine accidents.

And there’s another way Roberts is steeped in Appalachian history: Before an audience of workers, observers have often noted, he speaks like a preacher. Roberts likens miners’ struggles to biblical stories, references the power of God and the teachings of Jesus, and speaks in the dynamic cadences found in an Appalachian church.

“Be like Jesus,” he told a rally in Charleston, West Virginia, in 2015, opposing a “right to work” bill that allowed workers in union-run shops to opt out of paying dues. “Jesus saw the money changers in the temple, and Jesus drove the money changers from the temple. So let me tell the National Right to Work Committee, the Chamber of Commerce, the Koch Brothers, and all those who gave money: you got your money’s worth, but we’re not for sale in West Virginia.”

“How many of you have been to a Baptist church? We’re going to take up a collection. It is altar call time,” he continued. “Now, I’m going to ask you something: Are you fed up? Let me hear you say, ‘Fed up.’… Are you so fed up that you are now fired up? Let me hear you say, ‘Fired up!’”

Capping off the rousing call-and-response, he shouted, “God bless all of you, you’re the salt of the earth!”

Roberts’ style is a glimpse into a bigger story. For over a century, coal has transformed central Appalachia: from the shape of the landscape to place names, and from folk music and crafts to economic conditions.

All the while, religion has been transforming in the mountains, too. Labor and religion are deeply entangled here – a subject I explored in my book “Work and Faith in the Kentucky Coal Fields: Subject to Dust.”

‘Railroad religion’

In the 1880s, two groups rushed into the central Appalachian Mountains: industrialists seeking coal, and missionaries seeking moral reform. Both changed the region forever, and their stories were intertwined.

At the time, central Appalachia was widely depicted in the popular press as a backward, ignorant region whose mountainous terrain kept its people isolated, outside the flow of progress – a stereotype still common today. Equating economic progress with moral progress, many Americans assumed that developing industry would lift people out of what they perceived as fatalism and superstition.

The coal industry used this idea to promote its rapid exploitation of mountain resources. Companies built railroads to connect the region to the national market, developed industrial coal mines and reshaped the central Appalachian economy. Missionaries opened churches, schools and camps.

Company-owned coal towns encompassed miners’ lives. People who had long farmed for themselves and lived, as the Bible told them to, “by the sweat of their brow,” became dependent upon coal companies as mine development shrank the size of family farms. Not only did employers own the miners’ houses, but they also paid workers in “scrip,” which was redeemable only at the company store.

Many company towns included theaters, offered films and music, and even built churches and paid pastors’ salaries. These were typically mainline Protestant churches, such as Methodist or Presbyterian.

To some Appalachian natives, these denominations were known as “railroad religion” because of the way they entered the mountains. And, for many miners, these were the churches of management. When there was labor unrest, the coal town churches tended to side with the companies, advising miners against strikes or agitation.

Faith and action

The churches of most miners born in central Appalachia, meanwhile, were in the mountain communities – independent Baptist or Holiness congregations whose pastors were usually miners themselves.

Pastors preached about the dangers and sacrifices miners faced deep underground, in an age of few regulations. God was on the side of the oppressed and downtrodden, they stressed – and those who gained at others’ expense would ultimately face divine judgment.

Their passionate preaching was meant to inspire action, whether it was committing one’s life to Jesus or to the union. Labor rights were deeply understood as religious issues, rooted in Christian concerns for justice and care.

John Sayles’ 1987 film “Matewan” powerfully depicted the divided role that religion played in West Virginia’s coalfields. One preacher, played by Sayles, equates the union with “the Prince of Darkness.” Another, a young miner, advocates in biblical terms for the union’s righteousness and helps to lead a strike. The result was the Matewan Massacre of 1920: a bloody battle between miners and armed guards hired by the mine owners.

Miner preachers and independent churches were central to the organization of miners in eastern Kentucky in the 1930s, too, during another period of violence between mine operators and miners over conditions, wages and unionization. It was during this time that miner’s wife and singer Sarah Ogan Gunning penned “Dreadful Memories,” turning the traditional hymn “Precious Memories” into a visceral depiction of miners’ struggle and a call for unionization:

“Dreadful memories, how they linger,
How they ever flood my soul.
How the workers and their children
Died from hunger and from cold.”

Looking to the future

Today, it is still not surprising to find religious – particularly Christian – rhetoric in labor organizing. United Auto Workers President Shawn Fain is another example of a union leader whose speeches draw from the Bible.

But the dynamics of religion and class forged by industrial mining have shaped central Appalachia’s culture in lasting ways particular to the coalfields. The history of labor struggle, infused with religious idioms, is a source of identity and values evident in everything from union meetings in churches to prayers on picket lines.

Today, the United Mine Workers of America is focused less on coal itself, which miners know cannot last forever. The union represents members in other sectors, too, including public employees, manufacturing, health care and employees of the Navajo Nation. It has also focused its work on an equitable transition to renewable energy: one that accounts for the economic, cultural and environmental destruction that a single-industry economy has wreaked on central Appalachia.

Likewise, the United Mine Workers of America has fought to hold coal companies to their pension and health care obligations toward retired and sick miners whose work fueled the country and made companies rich.

And that struggle, Roberts would say, is a religious one as well.

Richard J. Callahan, Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. From the pulpit to the picket line: For many miners, religion and labor rights have long been connected in coal country – https://theconversation.com/from-the-pulpit-to-the-picket-line-for-many-miners-religion-and-labor-rights-have-long-been-connected-in-coal-country-262472

Source: The Conversation – USA (3) – By Wendy Netter Epstein, Professor of Law, DePaul University

As the federal government entered a shutdown on Oct. 1, 2025, competing narratives quickly emerged about the cause.

Some Republican lawmakers objected to Democrats’ push to include an extension of the expanded Affordable Care Act premium subsidies in a short-term funding bill and cited concerns about long-term spending. Democratic leaders countered that the subsidies are not a new demand but rather the continuation of a program that has helped keep record numbers of Americans insured since the pandemic – and therefore that the issue could not be delayed.

The result is a standoff that blends fiscal and policy disagreements – a hallmark of contemporary budget politics.

As experts in health law, we see this issue as simple but consequential from a legal standpoint. Congress authorized the enhanced subsidies in 2021, originally to cushion the economic fallout from COVID-19 for families, and extended them through 2025 in the Inflation Reduction Act.

Without new legislation, the subsidies revert to pre-2021 levels on Jan. 1, 2026 – which would lead to a jump in the cost of health insurance and would make coverage unaffordable for millions of Americans.

Enhanced subsidies explained

Most Americans under age 65 get insurance through their employers, which the federal government subsidizes by making it tax-free. Medicare, the program for older Americans, and Medicaid, the program that mainly serves low-income Americans, are heavily supported by subsidies too.

But as of 2025, about 1 in 6 people under age 65 do not have access to this coverage, including many small-business owners and tradespeople, as well as part-time workers and those in the gig economy. For them, unsubsidized health insurance can be prohibitively expensive.

To address this affordability problem, the ACA provided for households earning between 100% and 400% of the federal poverty level to receive subsidies for purchasing policies on the ACA marketplace, effectively lowering premiums. The original law limited subsidies only to those making under 400% of the federal poverty level, which is, for a family of four in 2025, around US$128,000 per year. A family making $129,000 a year, however, would have to pay full price.

The American Rescue Plan temporarily made two major changes in 2021:

• It removed the 400%-of-poverty eligibility ceiling, extending help to many middle-income families.

• It capped the maximum household contribution at 8.5% of income for everyone, ensuring affordability regardless of income.

If these reforms expire in 2026, the Internal Revenue Service must revert to the older, less generous formula.

What the subsidies accomplished

The enhanced subsidies drove ACA marketplace participation to historic highs – more than 24 million people selected plans for 2025, up from about 11 million in 2020. The Department of Health and Human Services found disproportionate enrollment gains among Black and Latino Americans, helping to reduce racial disparities in coverage.

For many low-income enrollees, mid-level plans – called silver plans in the ACA marketplace – effectively became free. Middle-income families who previously earned just above the cutoff gained meaningful relief, sometimes saving thousands of dollars a year.

What happens if subsidies expire?

Analysts broadly agree that returning to the pre-2021 rules would mean large cost increases and coverage losses. On average, the premiums that Americans will pay for ACA marketplace plans would more than double. The Kaiser Family Foundation estimates that average annual out-of-pocket premiums for an individual would jump from about $888 in 2025 to $1,900 in 2026.

With these increases, millions of Americans will lose their health insurance coverage. The Urban Institute, a think tank, projects that 7.3 million fewer people would receive subsidized marketplace coverage and 4.8 million more would become uninsured.

This is highly consequential, as research shows that insurance coverage saves lives by ensuring access to care. Knocking nearly 5 million people off insurance may cause as many as 500 additional deaths per year.

Losses would disproportionately impact low- and middle-income families. Free premium plans would disappear. Those making below 250% of the federal poverty level could see their net premiums rise more than fourfold, while those between 250% and 400% would see their premiums double. What’s more, rural Americans, already under pressure from the state of the economy, face higher risks.

The fiscal and policy trade-offs

On the flip side, making the enhanced credits permanent would add about US$350 billion to federal deficits between 2026 and 2035, according to the Congressional Budget Office’s estimates. Proponents argue that the cost is justified by reduced medical debt, fewer uninsured, greater household stability and ultimately saving lives. Short-term savings from cutting the subsidies would also lead to higher health care costs, longer-term. But critics worry it’s a broad and expensive way to support affordability, benefiting some higher-income households that could otherwise afford coverage, even though it would cost more than 8.5% of their income.

Another concern is how the subsidies affect price competition. Under the ACA, the government pays most of the difference between what a household is expected to contribute and the actual cost of a standard benchmark plan. That means if health insurance companies raise their premiums, those who receive subsidies don’t feel the effect of the premium increases, because the federal subsidy simply grows to cover it. That means companies have fewer reasons to compete on price.

Legal and administrative constraints

Because the subsidies are written into the tax code, only Congress can extend them or make them permanent. The question of whether to renew them was already debated strenuously when Congress passed the big tax and spending package that President Donald Trump signed into law on July 4, 2025. By omitting the subsidies, the bill effectively raised health care costs for millions of middle-income Americans. States that run their own marketplaces may add some aid, but few can match the scale of federal support.

Administrative timing matters too. The IRS, health insurers and the online marketplace all need to know how the subsidy amounts will be calculated – in other words, which income limits and premium caps Congress wants to use. These figures determine how much financial help people get when they sign up for coverage. Late or temporary fixes can create confusion for both consumers and administrators.

Options before Congress

Lawmakers have several options, each with different trade-offs.

A permanent extension would provide stability for consumers and insurers – but at the cost of higher long-term federal spending. A short-term renewal of one to four years could soften the immediate jump in premiums while giving Congress time to reassess the policy, but it would continue the cycle of temporary fixes.

Alternatively, a targeted approach might preserve the larger subsidies for lower-income households but gradually reduce assistance for higher earners so that they aren’t guaranteed a cap of 8.5% of their income for insurance. This would make the policy more fiscally restrained but less universal.

Some legislators have also proposed offsetting the cost of ACA subsidies by pairing an extension with savings elsewhere in the health system. Those savings could come from trimming what the government pays insurers to lower patients’ out-of-pocket costs or by reducing Medicare payments to doctors.

Each of these options reflects a different balance among affordability, fiscal responsibility and administrative simplicity. Together, they highlight how difficult it is to design a policy that meets all three goals at once.

A structural challenge

The problem isn’t just political – it’s built into how time-limited programs like the enhanced ACA subsidies are designed. The subsidies have always reflected partisan divides, but their temporary nature makes those divides even sharper. Lawmakers limited them to a few years to keep costs down, but that choice now means Congress has to reopen the same debate every year.

When deadlines for renewing programs collide with larger funding fights, important benefits can lapse, not because lawmakers chose to end them but because the fights over broader spending leave little room for resolution.

In the end, it’s up to Congress to decide not only whether these subsidies continue, but whether big social policies like this should be settled through last-minute budget showdowns. For now, getting the government running and keeping health insurance affordable are part of the same fight.

Wendy Netter Epstein is a member of the Illinois Health Benefits Exchange Advisory Committee.

Christopher Robertson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Health insurance subsidy standoff pits affordable care for millions against federal budget constraints – https://theconversation.com/health-insurance-subsidy-standoff-pits-affordable-care-for-millions-against-federal-budget-constraints-266851

Source: The Conversation – USA – By Aimee Pugh Bernard, Associate Professor of Immunology and Microbiology, University of Colorado Anschutz Medical Campus

Every day, your immune system performs a delicate balancing act, defending you from thousands of pathogens that cause disease while sparing your body’s own healthy cells. This careful equilibrium is so seamless that most people don’t think about it until something goes wrong.

Autoimmune diseases such as Type 1 diabetes, lupus and rheumatoid arthritis are stark reminders of what happens when the immune system mistakes your own cells as threats it needs to attack. But how does your immune system distinguish between “self” and “nonself”?

The 2025 Nobel Prize in physiology or medicine honors three scientists – Shimon Sakaguchi, Mary Brunkow and Fred Ramsdell – whose groundbreaking discoveries revealed how your immune system maintains this delicate balance. Their work on two key components of immune tolerance – regulatory T cells and the FOXP3 gene – transformed how researchers like me understand the immune system, opening new doors for treating autoimmune diseases and cancer.

How immune tolerance works

While the immune system is designed to recognize and eliminate foreign invaders such as viruses and bacteria, it must also avoid attacking the body’s own tissues. This concept is called self-tolerance.

For decades, scientists thought self-tolerance was primarily established in the parts of the body that make immune cells, such as the thymus for T cells and the bone marrow for B cells. There, newly created immune cells that attack “self” are eliminated during development through a process called central tolerance.

However, some of these self-reactive immune cells escape this process of elimination and are released into the rest of the body. Sakaguchi’s 1995 discovery of a new class of immune cells, called regulatory T cells, or Tregs, revealed another layer of protection: peripheral tolerance. These cells act as security guards of the immune system, patrolling the body and suppressing rogue immune responses that could lead to autoimmunity.

While Sakaguchi identified the cells, Brunkow and Ramsdell in 2001 uncovered the molecular key that controls them. They found that mutations in a gene called FOXP3 caused a fatal autoimmune disorder in mice. They later showed that similar mutations in humans lead to immune dysregulation and a rare and severe autoimmune disease called IPEX syndrome, short for immunodysregulation polyendocrinopathy enteropathy X-linked syndrome. This disease results from missing or malfunctioning regulatory T cells.

In 2003, Sakaguchi confirmed that FOXP3 is essential for the development of regulatory T cells. FOXP3 codes for a type of protein called a transcription factor, meaning it helps turn on the genes necessary for regulatory T cells to develop and function. Without this protein, these cells either don’t form or fail to suppress harmful immune responses.

Harnessing the immune system for medicine

Regulatory T cells can be heroes or villains, depending on the context. When regulatory T cells don’t work, it can lead to disease. A breakdown in immune tolerance can result in autoimmune diseases, where the immune system attacks healthy tissues. Conversely, in cancer, regulatory T cells can be too effective in suppressing immune responses that might otherwise destroy tumors.

Understanding how FOXP3 and regulatory T cells work launched a new era in immunotherapies that harness the immune system to treat autoimmune diseases and cancer. For autoimmune diseases such as rheumatoid arthritis and Type 1 diabetes, researchers are exploring ways to boost the function of Tregs. For cancer, the goal is to inhibit Tregs, allowing the immune system to target tumors more aggressively.

Beyond disease treatment, this research may also improve organ transplantation, where immune tolerance is crucial to prevent rejection. Scientists are exploring how to engineer or expand Tregs to help the body accept transplanted tissues over the long term.

Continuing to unlock the secrets of immune regulation can help lead to a future where the immune system can be precisely tuned like a thermostat – whether to turn it down in autoimmunity or rev it up against cancer.

The 2025 Nobel Prize reminds us that science, at its best, doesn’t just explain the world – it changes lives.

Aimee Pugh Bernard is affiliated with Immunize Colorado as a volunteer and unpaid board member.

– ref. How does your immune system stay balanced? A Nobel Prize-winning answer – https://theconversation.com/how-does-your-immune-system-stay-balanced-a-nobel-prize-winning-answer-266842