Kentucky must investigate its woeful response to deadly hep A outbreak

Courier Journal
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Forty-three people are dead.

More than 4,000 people sickened.

And state officials didn’t do enough to stop it.

Now, as the commonwealth faces the largest and deadliest hepatitis A outbreak in the nation, we Kentuckians deserve answers.

The Cabinet for Health and Family Services must investigate the state’s grossly inadequate response to this crisis. It must determine what happened, why it happened and who is to blame. And it must take immediate action to stop the current crisis and develop protocols to ensure that it never happens again.

The investigation should start with this question: Why was the urgent advice of a veteran public health doctor and former infectious disease chief ignored when a deadly hepatitis A outbreak began spreading through impoverished Eastern Kentucky last spring?

As detailed in a Courier Journal investigation that published last week, In May of 2018, knowing lives were at stake, Dr. Robert Brawley recommended a swift and aggressive attack that included spending $6 million for 150,000 vaccines, $4 million for temporary staff and declaring a state of emergency to possibly get federal assistance.

His pleas were ignored, the Courier Journal revealed.

Instead, Dr. Jeffrey Howard, the 31-year-old acting commissioner of the Department for Public Health, who at the time had only recently been named to his first official state job, supported a $3 million state response — less than a third of what Brawley recommended.

Howard also declined to declare an emergency, even though rampant drug addiction in Appalachia was fueling the fast-growing outbreak.

Ultimately, under Howard's leadership, the state sent just $2.2 million to 48 counties and area development districts, with most receiving $40,000 — enough to buy about 1,000 vaccines.

Little to no additional staff were added in counties to more quickly find and vaccinate drug users and homeless people, who largely were spreading the disease.

The result?

Kentucky’s deadly outbreak grew, spreading into 103 of the state’s 120 counties.

And killing more people.

More:How hepatitis A spread across Kentucky and grew into the nation's largest outbreak

Howard later admitted that declaring an emergency might have bolstered the case for moving money from elsewhere in the Cabinet for Health and Family Services, "but we never got to the point where we needed to do that."

Really? How many people have to get sick and die before we reach that critical point?

The family of former Eastern Kentucky coal miner James Ramey would like to know. Hepatitis A killed him on Nov. 28, 2018, just over a year after the state declared an outbreak.

His sister believes he would still be alive had the state done more earlier to educate and vaccinate people in Appalachia.

Howard said his office offered to pay for nursing staff to administer the vaccines but had no takers.

Really? Then why is it that some county health department directors said they didn't even know they could get money for staff?

"Essentially, the message from my office was, 'We’ll do whatever we can to help try to support you guys with the resources we have,'" Howard told Courier Journal reporters Laura Ungar and Chris Kenning.

But the state didn't do everything it could. What we needed was swift, decisive, experienced and aggressive leadership.

Instead, more people — some of the state’s most vulnerable — continued to get sick and die.

Of a preventable disease.

Kentucky could have easily looked to other states for guidance.

San Diego County in California spent more than $12 million fighting its 2017 outbreak.

Michigan sought money from the state legislature. 

Indiana deployed “strike teams” of state health workers to various counties. 

Tennessee earmarked $3 million after just 25 cases.

Kentucky took none of these actions.

More:Kentucky's 'too low and too slow' response to the nation's worst hepatitis A outbreak

State Sen. Morgan McGarvey, D-Louisville, says he may file a resolution directing the  Cabinet for Health and Family Services to examine why we've had such a poor response to the hepatitis A outbreak.

It’s the right step to take.

Doug Hogan, executive director of public affairs for the Cabinet of Health and Family Services, said he’s more than willing to discuss the hepatitis A response at any upcoming hearing or individually with legislators.

Good. Because he has a lot of explaining to do.

Every Kentucky lawmaker should be as outraged about the state’s shameful response as the families whose loved ones have died.

They should demand answers — and an immediate plan to stop the outbreak.

Forty-three people are dead. 


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