In a tiny hamlet of the Canadian subarctic, something was wrong with the fish.

Indigenous elders and university scientists stood over a tarp of dissected walleye on the banks of a channel near Fort Chipewyan, Alberta. The scientists clutched clipboards as they analyzed humpbacks, lesions, discolored scales and outsize livers. An elder, who had long relied on the waterway’s marine life for sustenance, knew simply by first glance: “No good.”

It was five days into their investigation on the freshwater Chenal des Quatre Fourches, in a place everyone just called Cutfish. They had pitched tents among the diamond willow and settled in for a week of dissections — their best chance at understanding the contaminants they believed were plaguing the food supply from one of the largest industrial operations on Earth.

That operation was more than 100 miles upstream, where energy companies, including a subsidiary of Exxon Mobil, were drilling for a viscous form of petroleum called bitumen, using water from the Athabasca River to extract it from deposits that stretch out beneath some 140,000 square kilometers of boreal forest. Massive pools of toxic waste with known carcinogens — their collective volumes estimated at more than half a million Olympic-size swimming pools — sit near the river, and an analysis suggests they are leaking around 11 million liters per day into the groundwater. As oil-company operations have increased, so have bouts of unexplained illness among residents of Fort Chipewyan.

Now, the Canadian government is weighing regulations that could allow the companies to release the oil sands wastewater directly into the river system, so long as they first use filtration systems, microorganisms or other methods to reduce contaminants to safe levels. But scientists say there are no safe levels of exposure to some carcinogenic components — and no proven methods for fully eliminating them.

Environmental experts are worried about implications well beyond Fort Chipewyan, since the Athabasca River runs north through Alberta and the Northwest Territories, ultimately joining a vast river system that empties into the Arctic Ocean. They say pollution from the oil sands could threaten biodiversity and the waterway’s climate-stabilizing properties — and could share contaminants from the mining waste, known as tailings, with the rest of the world.

When the last walleye was examined, elders from the three Indigenous groups in Fort Chipewyan gathered in a tent for an emergency meeting. It wasn’t just the fish, they agreed: The muskrat dens had all but disappeared. The wild tern eggs were contaminated with mercury. Petroleum sheens were collecting around the water caves. And the rate of rare cancers in the hamlet was high. There were fewer than a thousand residents, but lately, there seemed to be a funeral every week, sometimes two.

“I don’t care how many times they treat that contaminated water — it’s going to end up here,” said Alice Martin, a Mikisew Cree elder with feathery gray bangs who was pleading with others to help make a plan to fight the oil companies. “We can’t depend on others to say what is important to us. It’s time. Because we’re going to die out.”

The wind rushed in from the marshlands, and the smell of mint tea wafted from a fire nearby. Ron Campbell, an elder who spent six decades in Fort Chipewyan, cleared his throat.

“For thousands of years, we have lived off this delta,” he said, adjusting his Toronto Blue Jays baseball cap. “It’s in our genetic makeup to hunt, trap, fish, gather. Now the food that kept us alive for thousands of years is killing us. Where do they expect us to go?”

Decades of Worry

From above, the oil sands tailings are a study in explosive growth.

Maps of the region, which was once known for its drinkable streams and vast green expanse, now include landmarks like “Bitumount” and “Tar Island.”

From the ground, it is a literal wasteland. Scarecrows in construction hats line the perimeters of the tailings to keep migratory birds away. An oily film coats the mailboxes, the doorknobs and the windshields of trucks that haul across open pits where pine trees used to be.

Environmental experts have worried for decades about the health impact of the oil sands on wildlife and humans. Tailings ponds contain elevated levels of naphthenic acids — considered carcinogenic in some contexts — as well as benzene and polycyclic aromatic hydrocarbons that have been known to disrupt hormone and immune function. The waste also contains lead, mercury and arsenic, all three of which rank among the World Health Organization’s 10 chemicals of public concern. Thousands of waterfowl, gulls and other animals have been found dead at the sites.

People living near the sites have long reported headaches, congestion, bloody noses, rashes, even fainting. But little research has examined the true health impacts. According to one analysis, only three out of 87 peer-reviewed articles on the health effects of resource extraction in Canada have examined communities exposed to emissions from oil sands.

In the early 2000s, Dr. John O’Connor, a family doctor working downstream in Fort Chipewyan, noticed unusually high rates of certain rare cancers in the hamlet, as well as high numbers of both autoimmune disorders and miscarriages. He consulted doctors in nearby Fort McMurray and, in 2005, alerted federal health authorities, but said he hadn’t received a response. After a radio journalist heard rumors about health issues in Fort Chipewyan and convinced Dr. O’Connor to participate in a segment, the College of Physicians and Surgeons of Alberta began investigating — not the cause of the sicknesses, but Dr. O’Connor himself. Health Canada had accused him of causing “undue alarm.”

Researchers from the Alberta Cancer Board who followed up on his concerns eventually agreed that the overall cancer rate was higher than expected, but said this might be attributable to increased detection or to chance. Their report suggested “closer monitoring of cancer occurrence in upcoming years.”

In 2014, two First Nations collaborated with scientists to publish their own study, which found elevated levels of contaminants in muskrat, moose and duck. It also found that a fifth of all respondents to a survey in Fort Chipewyan had suffered from cancer. But with a population so small — and cancers with long latency periods — it was difficult to establish any causal relationship.

Last year, a letter from Alberta’s chief medical office of health to Allan Adam, the chief of the Athabasca Chipewyan First Nation, acknowledged that “the rates of all cancers combined in the Fort Chipewyan area were statistically significantly higher than those in the rest of Alberta.” Over three decades, the rate of non-Hodgkin’s lymphoma had been more than two and a half times what would be expected for the hamlet. Cervical cancer had occurred at four times the expected rate. The rate of a rare bile duct cancer in men had been more than nine times the expectation. And for other biliary tract cancers, the rate was 13 times what was expected.

But then came the familiar disclaimer: “The small population size of the Fort Chipewyan community limits the ability to interpret results.”

After years of pleas, the Canadian government finally announced in August 2024 that it would commission a 10-year study to examine the health impacts of the oil sands on Fort Chipewyan. But the work has not begun, and it has not specified a methodology or suggested any interventions to protect residents in the interim.

Oil companies are legally responsible for cleaning up their tailings and restoring the landscape, but even after more than 50 years of mining, those efforts have hardly begun here. There is little pressure from the province of Alberta — sometimes called the Texas of Canada — a petrostate that relies heavily on energy royalties for its budget. In a recent report, the auditor general of Alberta found the estimated cost to clean up the oil sands to be more than 51 billion Canadian dollars. The funds that regulators have collected from companies thus far amounted to only 1.8 billion Canadian dollars as of September.

In response to an inquiry from The New York Times, the Alberta Energy Regulator sent a long statement describing the regulatory process.

“The Alberta Energy Regulator provides for the efficient, safe, orderly and environmentally responsible development of energy and mineral resources in Alberta, and holds companies accountable through life cycle oversight, compliance and enforcement,” the statement said.

A yearslong probe by an environmental group found “consistent evidence of seepage” from Syncrude and Suncor tailings ponds into groundwater that was near tributaries to the Athabasca River. There are also occasional large-scale spills, such as in 2022, when industrial wastewater escaped from four locations belonging to Imperial, a partly-owned subsidiary of Exxon Mobil. But the Athabasca Chipewyan First Nation said they had not been alerted until nine months later, when the government announced it was investigating another “uncontrolled release.” Imperial estimated the second spill to be 2,000 liters. That figure later grew to 5.3 million.

Life in Fort Chip

People like Calvin Waquan are determined not to let anxiety destroy tradition. Mr. Waquan, a member of the Mikisew Cree First Nation, teaches his 8-year-old daughter to braid sweetgrass and takes his 12-year-old son to hunt moose and duck. But whenever an acute tailings spill upstream goes public, they must throw away all the meat in their freezer and replace it with processed foods for the winter.

At the local gas station that Mr. Waquan manages, nicknamed Chief’s Corner, he has begun displaying dozens of the community’s death notices behind his cash register, each with a neighbor’s smiling face.

There is Claire Cardinal, whose husband said she had undergone more than 200 rounds of chemotherapy before her death; her husband is a double lung transplant survivor himself and still wears her ashes in a locket around his neck. And there’s Warren John Simpson, whose aunt said his bile duct cancer had essentially starved him to death; she cooked him a last simple broth and held his hand as he died. There were various relatives of John Henry Marcel, who finally encouraged his children to move their young families away from Fort Chipewyan after his own battle with prostate cancer. Mr. Marcel lives alone and can’t afford to move, so he sits in an armchair near their photographs on the mantel each night. “This is how I see them,” he said.

Mr. Waquan said he had buried five family members, three of whom had cancer, since moving back to the hamlet about 11 years ago and tossing sand onto the graves of too many others for him to count. In private, his fears are growing: Mr. Waquan recently noticed blood in his stool. He is waiting for a colonoscopy to reveal whether he could be next.

“Cancer is a big word — everyone is afraid to say it,” he said. “But we are raising our families in the industry’s toilet bowl.”

An Uneasy Truce

Far up the river, Chief Adam was donning his headdress beside representatives of the oil industry.

It was the fifth annual cultural festival for the First Nations, but many of its sponsors and organizers were energy companies. Visitors were learning Dene language vocabulary and moose-hide-tanning techniques courtesy of Suncor. A gift shop of local Indigenous art was sponsored by the industry giant Canadian Natural Resources. The event’s main stage was presented by Imperial, the company that had hidden its 2022 spill.

Chief Adam strode past posters that had been plastered throughout the grounds: “We are thankful for these borrowed lands,” they read, “and the lessons of resilience they offer us.”

Indigenous leaders like Chief Adam are in a challenging position. On one hand, they are the drivers behind efforts to protect their land and health. They have filed lawsuits and traveled to Ottawa to protest companies’ plans.

But these same leaders are balancing the realities of a complex economic relationship. Hundreds of members of the Athabasca Chipewyan First Nation work in the oil sands, commuting from Fort Chipewyan for weeklong shifts or moving to the burgeoning neighborhoods near the operations, where they earn salaries multiple times that of any job available in their hamlet. And just as worries about the health impacts have grown, so have the number of new youth centers and community projects in the Indigenous communities, each of them branded with an oil company sponsorship.

“As chiefs, we have to think seven generations ahead,” Chief Adam said, watching his 8-year-old grandson practice a traditional tribal hand game. Before he came into office, the First Nation had a more than $300,000 deficit and no way out, he said. Now it has more than a dozen companies that provide contracting services to the industry, including equipment management and catering. Most of his funding now comes from the oil sands, he said.

“How do I walk away from all that?”

The Future of Fort Chip

The formal release of the tailings ponds into the Athabasca River seems, to many, all but imminent. Indigenous groups have met with federal officials through a working group to come up with alternatives to the river-dumping approach, such as drying the waste into stackable pucks, though that option would be costly.

A draft of federal rules that would set standards for wastewater treatment and release is expected later this year, and final recommendations could head to the country’s minister of environment and climate change soon after.

But Alberta is already deep into the planning process. A steering committee in the province recently recommended that the government “expedite” the development of standards, saying that continuing to accumulate the toxic substances where they are now “is not sustainable” and “creates environmental and financial liabilities.” The premier of Alberta also mandated in October that the then minister of environment and protected areas “accelerate” the finalized strategy.

Mike Mercredi, a councilor for the Athabasca Chipewyan First Nation, has shouted in the faces of regulators, accused them of “regulated murder” and held up glasses of water from the river, daring them to drink it. But on a recent morning, as he stood at the top of Monument Hill, near Cutfish, he admitted that he felt there was little left to do but wait.

He rolled juniper seeds between his palms, then smoothed his ponytail and the caribou-skin sheath on his waistband. To his right was the Lake Athabasca dock he jumped off as a child — long before it was reported to be contaminated and became off limits to his daughter.

“This view used to be restful for me, you know — a place for thinking,” he said, watching the sun dance across the ripples of the lake. “Now I know too much.”

On his way home, Mr. Mercredi parked his pickup truck outside the town’s jam-packed cemetery and wove carefully between the plots, surveying the names of loved ones on all the headstones.

“We could all move elsewhere and just be funeral operators, for how often we bury,” he said.

He stood for a while, then turned quickly to leave. “It never gets easier,” he added.

Blacki Migliozzi contributed reporting.

Dressing for St. Patrick’s Day and actually looks chic? It’s a hard job. There’s a fine line between festive and cheesy billboard – you’re probably only about 12% Irish anyway.

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According to a spokesperson for Health and Human Services, Dr. Vinay Prasad, a polarizing figure at the Food and Drug Administration who oversaw vaccines, left the agency in late April.

As the agency’s chief scientific and medical officer, Dr. Prasad has broad authority over vaccines, medicines and gene therapies. He made several controversial decisions, including removing working scientists from some vaccine approvals and cracking down on a biotech company linked to the deaths of two teenagers.

In one of the most publicized moves, Dr. Prasad decided to accept Moderna’s application for a new mRNA flu vaccine, prompting uproar from companies and some experts who complained that he too often pushed back targets for studies that had been approved by the agency. Within a few days, Dr. Marty Makary, the agency’s commissioner, reversed the decision after the company agreed to conduct another study.

And in recent months he had made a series of rejections for rare disease treatments, increasingly angering patients who had few options and biotech companies investing in developing cures.

Many of these decisions were made without warning. He shied away from public meetings of advisory committees on the drugs under investigation and rejected calls for more transparency. Dr. Prasad has criticized these forums and said that the pharmaceutical industry has manipulated public opinion.

During his short tenure at the FDA, Dr. Prasad was a professional scientist with political agendas that sometimes involved threats against employees who might leak information. He publicly called on agency employees who disagreed with him to resign.

He was fired last summer after right-wing influencer Laura Loomer led an attack against him by citing positive comments he had made about Democrats in the past. At the urging of Dr. Makary and Secretary of Health Robert F. Kennedy Jr., he was soon brought back.

The Wall Street Journal first reported his planned departure on Friday. Dr. Prasad declined to comment.

In an email to FDA employees on Friday, Dr. Makary Dr. Prasad for his efforts to identify promising drugs for rapid review and enable drug approvals after companies conduct one large trial instead of two.

He also praised Dr. Prasad’s work on a new Covid vaccine framework that recommends giving the jab only to people aged 65 and over or those with an underlying medical condition.

“These reforms represented a tremendous amount of work accomplished in a remarkably short period of time,” wrote Dr. Makary. “These are substantial, lasting changes that will shape the agency’s approach for years to come and will stand as part of Vinay’s enduring legacy here.”

Leaders in the biotech and investment community had long urged the White House to oust him.

However, Diana Zuckerman, a close FDA observer and president of the nonprofit National Center for Health Research, said Dr. Prasad’s decision to leave was a loss for independent researchers who “had hoped he would help strengthen the FDA’s public health mission.”

“FDA’s ‘flexible’ standards for approving products that have not been proven effective result in an unsustainable health care system,” she said, pointing to the cost of failed therapies to Medicare and patients.

Before joining the agency, Dr. Prasad academic at the University of California, San Francisco. He was known for criticizing the FDA, saying its drug review officials were too lenient in granting approvals.

He has also been described as anti-Covid after complaining on podcasts and on his YouTube channel about public health measures that he said were inadequately based on medical evidence.

In an article in the New England Journal of Medicine, he and Dr. Dr. Prasad later claimed in a memo to staff that a small number of children had died after receiving the Covid vaccine, but no further report was released due to internal disagreements over the cases.

After a second teenager died last summer from liver complications as part of treatment for Duchenne muscular dystrophy, Dr. Prasad called on the manufacturer Sarepta to stop selling the drug. The company fought back and the agency decided to withhold the drug from older children who were more likely to be harmed by it.

The episode was soon followed by social media posts from Ms. Loomer detailing previous statements made by Dr. Prasad was quoted endorsing Senator Bernie Sanders, the independent from Vermont, and lambasting President Trump.

The Department of Health held a background briefing on Thursday about the latest controversial decision against treating Huntington’s disease.

A senior administration official identifying himself as an oncologist at the University of California, San Francisco, defended his decision to reject a request to review UniQure’s drug, which had reported success in a small trial of Huntington’s disease patients.

The official, who spoke on condition that his name not be used, called it a “failed therapy” and detailed discussions between the company and the FDA, which the company later denied.

The official said he misses his clinic, his teaching and his ability to speak freely. Dr. Prasad is an oncologist on leave from UCSF

On Friday, Rep. Jake Auchincloss, a Massachusetts Democrat, said on social media that Dr. Prasad was the official and that he disclosed trade secrets about UniQure’s treatment without legal authorization. A Health and Human Services official said everything discussed in the call was disclosed by the company and that it was reasonable for the agency to look into the matter.

In a social media post on Friday evening, Dr. Makary that Dr. Prasad would resume work in California and that a successor would be announced before his departure.

Gas prices in the United States averaged $3.41 a gallon on Saturday, a day after crude oil prices rose to levels not seen since 2023 as the fallout from US-Israeli attacks on Iran continued.

This increase means that the price of gasoline has increased by 14 percent in the past week, according to the AAA Motor Club. Prices recorded on Saturday were the highest for gasoline since 2024.

The sudden rise in energy costs – everything from kerosene to diesel for trucks and tractors is more expensive – is due to crude oil deliveries from the Persian Gulf. The tankers that normally transport oil from the region are not sailing, cutting off the world from about a fifth of its oil supply.

This has led to a rise in oil prices worldwide. As of Friday, U.S. crude benchmark West Texas Intermediate had risen more than 35 percent this week to settle at $90.90 a barrel, with much of that increase coming on Friday alone. The last time crude oil traded at these levels, U.S. gasoline prices were above $3.80 a gallon, AAA data shows.

There are already big differences in the amount of the fares. Although oil prices account for the largest share of gasoline costs at about 60 percent, taxes, refining margins and distribution costs can further increase prices. Drivers in California, for example, paid an average of $5.08 per gallon on Saturday, the highest in the country, while those in Kansas paid the lowest at $2.90.

Prices at the pump could stabilize once oil channels reopen, but the impact on American wallets could linger beyond that point.

“Even if it’s a short-term price increase and we’re back to where we were in two to three months, you’re still putting a significant strain on people’s budgets and having a significant impact on the economy,” said Wayne Winegarden, an economist at the Pacific Research Institute, a think tank. “This will have long-term effects.”

In an interview with Reuters on Thursday, President Trump indicated that military action in Iran was a priority for him and that he was willing to tolerate a rise in prices. “They’ll go down very quickly when this is over, and when they go up, they go up, but that’s far more important than gas prices going up a little bit,” he said.

Energy experts generally say presidents have little control over oil prices, but the United States has its strategic petroleum reserve with storage capacity of 714 million barrels to draw on in the event of shortages. In 2022, as gas prices soared following Russia’s invasion of Ukraine, President Joseph R. Biden Jr. released millions of barrels from inventories to offset commodity prices.

However, if any impact were to be felt, it would likely be temporary and the reserve was not intended to provide an economic cushion.

If the United States is “stricken and we don’t have supplies and the military or the government needs oil, then that’s the purpose of the Strategic Petroleum Reserve for emergencies of that nature,” Winegarden said. “If its purpose is to improve market trends, it is simply not sufficient for the task.”

“Matt Kaplan and one of my friends at Netflix called me and said, “Hey, that’s you.” We will be filming in South Korea at the same time as us. Would you like to come back? XO, Kitty?,’” Noah told deadline in 2025. “And I said, ‘Yeah, anything for Anna.’ I think Anna is just wonderful and hard-working and super talented, just a professional, and she deserves the world.”

Still, it was a little unsettling to return to a character he hadn’t played in several years.

“It’s a daunting thing to go back to Peter and open that box,” Noah admitted. “You don’t want to disappoint or let anyone down. The character is what it is. But actually it worked. How could I say no?”

Season three of XO, kitty Premieres on Netflix April 2nd. To take a look at more shows coming to the small screen this year, read on.

Prescriptions of acetaminophen for pregnant women fell in emergency rooms across the country after President Trump claimed at a White House briefing in September that the painkiller could cause autism, researchers reported Thursday.

The new peer-reviewed analysis, published as a research letter in the British medical journal The Lancet, examined nearly 90,000 emergency department visits by pregnant women over an 11-week period following the White House briefing.

The study found that prescriptions of acetaminophen — the active ingredient in Tylenol — fell by 10 percent before eventually appearing to rebound.

In comparison, researchers observed no change in acetaminophen prescriptions among more than 850,000 women who were not pregnant and went to the emergency room during the same period.

Medical groups, including the American College of Obstetricians and Gynecologists, have defended acetaminophen at recommended doses as the safest option for treating fever in pregnant women. Untreated fever itself is linked to an increased risk of neurological disorders in babies.

During the unusual White House briefing, the president – flanked by top health officials – urged pregnant women to avoid the painkiller and claimed it could cause autism in children. “Don’t take Tylenol. Don’t take it. Fight like hell not to take it,” Trump said.

This claim is not supported by the data. While scientists have been researching a possible connection between acetaminophen and autism for years, studies have so far produced inconclusive results. The largest studies using data from Scandinavian countries that attempted to account for genetic factors showed no association.

Andrew Nixon, a spokesman for the Department of Health, said the government’s message was “another example of its commitment to telling the truth about public health.”

The new research found the decline resulted in 22.5 fewer acetaminophen orders per 1,000 emergency department visits by pregnant women. The researchers found no increase in prescriptions of riskier pain-relieving alternatives such as opioids.

By the end of the study period in December, paracetamol prescriptions to pregnant women had returned to levels seen at the beginning of the summer.

But the number of prescriptions may still have been lower than would otherwise have been the case because acetaminophen use typically increases during cold and flu season, Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and co-author of the new study.

More data is needed to better understand the full scope of the changes, he added. (Dr. Faust writes a widely read newsletter criticizing the Trump administration and federal health officials.)

Even if the decline in prescriptions was temporary, the study showed that public announcements had a significant impact in the short term, Dr. said. Aaron Kesselheim, a professor of medicine at Harvard Medical School who was not involved in the study.

Updated

March 5, 2026, 11:27 p.m. ET

“Even if it’s the case that people move on and the news cycle moves on and people forget, these short-term spikes and dips represent many, many people,” Dr. Kesselheim.

He also warned that the snapshot was incomplete because many people take paracetamol at home, a use that is much harder to measure.

Prescriptions account for only a small portion of acetaminophen taken in the United States. Most often, people buy the drug over the counter and take it without medical supervision.

It is not clear to what extent the decline in prescriptions immediately after the press conference was due to women refusing acetaminophen or to their doctors choosing not to prescribe it.

“Ten percent isn’t a big change, but you don’t want patients who are at risk of preeclampsia or a febrile illness to go without treatment,” Dr. Nathaniel DeNicola, environmental advisor to the American College of Obstetricians and Gynecologists.

The new study chimed with his own experiences as an obstetrician who faced a wave of anxious patients in the immediate weeks after the White House briefing. The concerns quickly disappeared, he said.

“Patients have been very willing to take their doctor’s advice. And our advice has never really changed: We use Tylenol as needed, in the lowest amount and for the shortest duration,” said Dr. DeNicola.

Dr. DeNicola also noted that the new study showed that pregnant women were cautiously prescribed acetaminophen in the first place. Less than a quarter of pregnant women presenting to the emergency room had already been prescribed the painkiller before the White House announcement.

The new study also analyzed outpatient prescription data for Leucovorin, a B vitamin-based drug that has long been used to treat chemotherapy symptoms. Dr. Food and Drug Administration Commissioner Marty Makary announced at the press conference that the agency had approved Leucovorin for the treatment of autism.

This move flipped the script for the drug approval process. Typically, a pharmaceutical company carefully studies a drug and then submits this data as part of a formal application for drug approval.

For Leucovorin, the agency said it reviewed the relevant research and made the decision to recommend the drug alone.

The Lancet study also analyzed prescription data from more than 8 million doctor visits for children ages 5 to 17 and showed that outpatient leucovorin prescriptions increased 71 percent during the 11-week study period.

Although the absolute numbers are still small, representing an increase of around 17 prescriptions per 100,000 children, the immediate impact of the announcement is undeniable, said Dr. Audrey Brumback, a pediatric neurologist at the University of Texas at Austin.

“I had a few weeks there where every single patient asked about it,” said Dr. Brumback. “There are now around one to two patients per week.”

Small studies, including one that was recently retracted, suggest that the drug may improve communication skills in children with a condition called cerebral folate deficiency, in which low levels of folate in the spinal fluid can lead to deficits in motor and language development.

But this condition is rare. In an attempt to help families with their questions about Leucovorin, Dr. Brumback instead offered to conduct genetic testing to better understand what might have contributed to her altered brain development.

But the FDA’s September decision has put pressure on doctors to prescribe the drug.

“The announcement put Leucovorin on families’ radars and they started asking about it,” said Dr. Brumback. As long as families request it, “doctors will continue to prescribe it.”

Global Academy of South Carolina, a public charter school, is housed in a gleaming modern building on a sprawling campus, a 10-minute drive from bustling downtown Spartanburg. The staff has Ukrainian and Russian-speaking teachers, showing that many of the approximately 600 students belong to a thriving Slavic community whose life revolves around the evangelical churches in surrounding Spartanburg County.

But on Oct. 8, the South Carolina Department of Health made an ominous announcement: Global Academy was one of two schools in Spartanburg County where measles had been diagnosed. Only 21 percent of students were vaccinated, one of the worst rates for a public school in the state.

As of Tuesday, the Spartanburg County outbreak had grown to 990 cases, mostly among unvaccinated children, accounting for the vast majority of current cases in the United States. Two children experienced a serious complication, measles encephalitis, inflammation and swelling of the brain.

Spartanburg, on the North Carolina border, is now the site of the largest measles outbreak since 2000, when the virus was declared eradicated in the United States.

People were exposed not just in niche communities, but also where the public goes every day – Costco, Best Buy, Publix, Food Lion, Goodwill, Burger King, Walmart, Target, the library, a museum and the post office.

“This is not normal,” said Dr. Linda Bell, the state epidemiologist, at a press conference in February. “This is unprecedented.”

Measles was defeated more than 25 years ago due to high vaccination rates among school children. But in Spartanburg, those rules have been weakened by vaccine skepticism and the state’s religious exemption, which have left vaccination rates dangerously low.

Many parents want to have the right to make their own decisions about their children’s medical treatment. But the latest contagion shows what happens when this safety net designed to keep children safe is cut.

“We have allowed measles to regain a foothold in this country, which is very unfortunate,” said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention who now leads the global health organization Resolve to Save Lives.

The exceptions

States have long required vaccinations before children can attend daycare or school. However, 46 states grant exemptions for religious or personal beliefs, according to KFF, a nonprofit health policy research organization.

South Carolina has allowed parents to use religious exemptions since at least 1980. To qualify, they simply need to certify that the vaccinations “conflict with my religious beliefs.”

Until recently, the number of exceptions was relatively small.

But anti-vaccination activism grew during the pandemic, with parents protesting what they saw as enforced regulations surrounding the Covid vaccine. More and more parents demanded religious exemptions.

In Spartanburg County, the share of students with religious exemptions more than doubled to 9.6 percent from 4.5 percent in the 2021-2022 school year.

Today, 89 percent of Spartanburg students have childhood vaccinations, including for measles, well below the 95 percent vaccination required to prevent the spread of the virus.

According to the CDC, kindergarten vaccination rates nationwide fell to 91 percent in the 2024-2025 school year from 95 percent in 2019-2020

Nationwide, the percentage fell from 95 percent to 93 percent over the same period.

Dr. Bell, the state epidemiologist, said at a recent weekly news conference that “exceptions played a big role” in the outbreak.

Health experts say what’s happening in South Carolina could be a harbinger for other states.

Across the country, there were 50 outbreaks and 2,281 cases with three deaths in 2025 — a significant increase from 2024, according to the CDC

There have already been 10 new outbreaks and 1,136 cases this year, including in Spartanburg.

State Senator Margie Bright Matthews, a Democrat, has sponsored a bill to eliminate the religious exemption. But she faces an uphill battle in the Republican-controlled state legislature.

“I immediately started getting emails from a lot of people telling me how dare I violate parental rights,” she said. “My bill does not violate any parental rights. It protects children.”

Henry McMaster, the state’s Republican governor, has acknowledged that measles is dangerous but supports the parental exemption. “We want to make sure people have all the information they need,” he told reporters last month while attending a tourism conference.

At the national level, anti-vaxxers close to Secretary of Health and Human Services Robert F. Kennedy are trying to repeal state laws that for decades have required children to be vaccinated against measles, polio and other diseases before entering day care or kindergarten.

The dynamic is going in the wrong direction, said Dr. Dan Jernigan, who resigned in August as director of the National Center for Emerging and Zoonotic Infectious Diseases, part of the CDC, in protest

“There are some people who want to get rid of the baseline,” he said, “on a purely voluntary basis.”

Vulnerable from the start

Because measles is highly contagious and opportunistic, it initially spreads in groups with low vaccination rates. Close-knit communities are particularly at risk, and Spartanburg has a large Slavic Protestant population.

The state does not collect data about the patient’s country of origin, said Dr. Bell. But she added: “We know that some schools with a high proportion of children from Ukrainian or Russian-speaking families are affected.”

Global Academy, the public charter school with a focus on Slavic languages, was notable for its exceptionally low percentage of vaccinated students. (The director, Mark Robertson, referred all questions about this article to the state health department.)

But there are many others that don’t come close to the 95 percent goal. Fairforest Elementary had a vaccination rate of 82 percent. At the Campobello Gramling public school the rate is 80 percent. At the private school Westgate Christian the rate is 47 percent. The schools did not respond to requests for comment.

In total, 75 of 93 Spartanburg County schools on the state list — including public and private schools — do not have vaccination rates of at least 95 percent, according to the state health department.

The state’s updates indicate that churches were also severely affected.

On November 19, the state health department told the Way of Truth Evangelical Church that a measles patient had visited the church twice in early November. On December 9, the department reported 16 new cases related to Way of Truth.

Viktor Radion, the pastor, sat in a church conference room before a Sunday service in late February to talk about the outbreak. With the help of a translator, he said, mostly in Russian, that the church, with about 260 members, was no more responsible for spreading the infection than any other place and that it had cooperated fully with the health department.

The church neither “prohibits nor promotes” vaccinations, he said, adding that the decision rests “on the conscience of every citizen.”

The hard fight

There is evidence that the outbreak was scary enough — and the government response was effective enough — that people got vaccinated. More than 16,800 doses of measles-mumps-rubella vaccine were administered statewide in January 2026, an increase of more than 40 percent compared to January 2025. In Spartanburg County, vaccinations increased 162 percent in January 2026 compared to January 2025.

Every push means a hard-fought victory. “Doctors need to somehow talk to skeptical parents without alienating them,” said Dr. Joshua Brownlee, assistant professor of pediatrics at the University of South Carolina School of Medicine, Greenville.

“You can’t wag your fingers too much,” he said. “You have to listen.”

The state has offered free vaccinations in health vehicles and parked them at a community center and churches. But the acceptance was disappointing.

From October to mid-February, the vans distributed 71 doses of the measles vaccine, 22 of which were to children, the state said.

But people may get their vaccine behind closed doors, through doctors and pharmacies, Dr. Jernigan, who resigned from the CDC

Health authorities, he said, need to provide some relief.

They need to make sure people “know how to get the vaccine without having to show up and stand in front of a camera,” Dr. Jernigan. “You try to meet people where they are, which is part of your work in public health.”

The measles vaccine is usually given in two doses when a child turns 1 year old and before they start kindergarten.

But the state health department has encouraged doctors to add a dose for babies ages 6 to 11 months who live or visit the outbreak area.

However, many parents want to do the opposite: delay vaccination or extend the time between doses because they think this will protect their child’s immune system.

“I’m not against vaccinations,” said Olga Grabovsky, whose husband is a partner at Prostor, a popular Eastern European grocery store in Spartanburg. Her two older children had received vaccinations, she said. But with the youngest, she said, “I’ve read a little more about it” and might delay it after talking to her doctor.

“I will decide what is right for my family,” she said. “I have that right.”

Some doctors say: Better late than never. Dr. Natalie Bikulege-Baum, a pediatrician in nearby Greenville, said, “Ultimately, if we can get a child vaccinated this way, then let’s do it.”

Sometimes real-life experience convinces parents. On a recent Friday, a blue and yellow van offered free vaccinations in the parking lot of Zion Hill Baptist Church in Inman, a semi-rural neighborhood of small wooden houses.

Over the course of four hours, a parent showed up. Tracy Hobbs brought her five-year-old twins, a boy and a girl, to be vaccinated.

Ms Hobbs had her eldest child, now seven, fully vaccinated as a baby. But after the child was diagnosed with autism at age two, she blamed the vaccine — and herself for allowing it.

She decided not to vaccinate her twins. But when it turned out they were also autistic, she said she did more research and read “Mom Google.”

Now she’s vaccinating her children, she said, not just for her but for “all the children around you.”

Georgia Gee and Kirsten Noyes contributed to the research.