Senate confirms Erica Schwartz as CDC director; cyclospora reaches 47 states; the best and worst states for health care — Morning Medical Update Weekly Recap

Senate confirms Erica Schwartz as CDC director

The 51-44 vote ends a yearlong vacancy and restores the director's sign-off on the vaccine recommendations that drive commercial coverage.

The Senate voted 51-44 on Aug. 5 to confirm Erica Schwartz, M.D., J.D., M.P.H., as director of the U.S. Centers for Disease Control and Prevention (CDC), giving the agency its first Senate-confirmed leader in nearly a year. Sen. Tim Kaine (D-Virginia) was the lone Democrat to vote in favor, as he was when the Senate Health, Education, Labor and Pensions (HELP) Committee advanced her nomination July 30. Schwartz is a physician and a lawyer, a retired rear admiral in the U.S. Public Health Service Commissioned Corps who served as chief medical officer of the U.S. Coast Guard and then as deputy surgeon general in the first Trump administration. She is President Donald Trump's third nominee for the job in two years.

For primary care practices, the consequence runs through the immunization schedule. The CDC director accepts or rejects recommendations from the Advisory Committee on Immunization Practices (ACIP), and under Section 2713 of the Public Health Service Act, adoption by the director is what triggers the requirement that non-grandfathered commercial plans cover a vaccine without cost sharing. The same adoption determines availability through the Vaccines for Children program. With no confirmed director in place, HHS Secretary Robert F. Kennedy Jr. had been signing ACIP recommendations himself, and in January he rewrote the childhood schedule to recommend fewer universal shots. A federal judge stayed that change in March, along with Kennedy's ACIP appointments and the recommendations that panel had issued.

At her July 15 confirmation hearing, Schwartz told the committee "I believe in vaccines" and said she does believe mRNA technology is safe and effective, pledging to "never betray the science" and to bring "radical transparency" to the agency. She declined to say what she would do if Kennedy directed otherwise. Her predecessor, Susan Monarez, Ph.D., was confirmed a year ago and fired 29 days later after refusing to preemptively approve recommendations from Kennedy's reconstituted vaccine panel. Committee Chairman Bill Cassidy, M.D., (R-Louisiana) accused her of evading the question, then reversed a week later after HHS revised the CDC's vaccines and autism webpage. Schwartz also told the committee, "I am all in on the Make America Healthy Again agenda."

Cyclospora outbreak reaches 47 states as CDC confirms first deaths

The largest recorded U.S. outbreak has produced 10,468 confirmed cases and 517 hospitalizations, and a routine stool panel will not detect the parasite.

The CDC's weekly surveillance update, published Aug. 4, counted 10,468 laboratory-confirmed domestically acquired cases of cyclosporiasis since May 1, along with 517 hospitalizations and two deaths, the first the agency has recorded in the United States from the parasite. Cases have been reported in 47 states, with only Delaware, Hawaii and Montana unaffected, and the CDC says it is aware of more than 12,255 additional cases that are not yet laboratory-confirmed, putting the running total above 22,000. The agency estimates a six-week lag between illness onset and case reporting, so national counts trail state figures.

Both deaths were in Michigan, the center of the outbreak with more than 11,000 cases of its own. Michigan health officials said both patients had significant underlying conditions that may have been affected by the illness and the dehydration that accompanies it. John Guzewich, who worked on foodborne disease outbreaks at the U.S. Food and Drug Administration (FDA) from 1997 to 2011, told The New York Times he was not aware of any other instance in which the CDC had reported U.S. deaths linked to the parasite, calling it unprecedented.

The CDC added six states to the lettuce-linked outbreak this week, bringing it from nine to 15, according to The Washington Post, citing people familiar with the investigation. Arkansas, Iowa, Missouri, Nebraska, New Hampshire and North Carolina join Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania and West Virginia. Taylor Farms recalled iceberg lettuce sourced from central Mexico on July 17, in a withdrawal covering product distributed to 27 states between June 29 and July 16, and most cases have been traced to lettuce served at Taco Bell.

Stephen Ostroff, M.D., a former acting FDA commissioner, told NBC News that the additional states do not necessarily mean the outbreak is still spreading, because the incubation window on the recalled product closed weeks ago and the new cases are largely older illnesses clearing the reporting pipeline. The FDA investigation has not identified a second source.

Related content: A primary care physician's guide to cyclosporiasis, with Molly O'Shea, M.D. and Cyclosporiasis outbreak: 13 things primary care physicians need to know right now

New Hampshire tops WalletHub's ranking of the best states for health care

Alaska finished last overall, and Texas placed 48th while ranking dead last in the country on both insured adults and insured children.

WalletHub's 2026 ranking graded all 50 states and the District of Columbia across 44 measures of cost, access and outcomes, each dimension weighted equally, using data collected as of June 29. New Hampshire finished first with a score of 68.63, helped by the lowest average monthly insurance premium in the country at about $469 and the second-lowest out-of-pocket medical spending. Minnesota and Iowa completed the top three. At the bottom, Alaska ranked 51st, Mississippi 50th, Georgia 49th, Texas 48th and West Virginia 47th.

The ranking measures what patients encounter rather than where it is advantageous to practice; WalletHub publishes a separate best and worst states for doctors list, released in March, which Montana topped. Several underlying metrics still bear on practice economics. Texas ranked 51st on both the share of insured adults aged 19 to 64 and the share of insured children, while Massachusetts ranked first on both. Nevada has the fewest physicians per capita of any state. The spread on average monthly premiums runs roughly two to one between New Hampshire and West Virginia, and California retains about five times as many of its medical residents after training as the District of Columbia does.

Related content: The 10 best states for health care in 2026 and The 10 worst states for health care in 2026