Pediatric pandemic preparedness for a vulnerable Gulf of Mexico

Abstract

The geographic region of North America encircling the Gulf of Mexico includes parts of five U.S. southern coastal states – South Texas, Louisiana, Mississippi, Alabama, and West Florida; multiple Mexican states extending to the Yucatan Peninsula; and western Cuba. Together, South Texas and the Gulf Coast comprise one of America’s greatest areas of distress. A 2023 consensus study report from the National Academies of Science, Engineering, and Medicine (NASEM) identified multiple social and environmental determinants that disproportionately affect the health of U.S. Gulf of Mexico populations. They include extreme poverty, systemic racism, and lack of access to education and employment, together with oil and chemical spills and other forms of environmental pollution, and the deadly effects of climate change—fast-rising temperatures, searing heat, and hurricanes, historic floods, and other catastrophic weather events.¹ Regarding the 65 million people (and almost 15 million children) living in U.S. Gulf Coastal states, I previously wrote with Rep. Sheila Jackson Lee (who served in the U.S. Congress representing low-income neighborhoods of Houston, Texas for decades before she lost her battle from cancer this summer) on the depth and breadth of their deprivations: “Approximately 10 million people live below the poverty line on the US Gulf Coast, while more than one-third of people from US counties living in ‘persistent poverty’ are in Gulf Coast states”.² This region also suffers from the highest child poverty rates in the U.S., led by Louisiana and Mississippi where more than one-quarter of children under 18 live in poverty, with Alabama not far behind;³ 20% of Texas children also live below the poverty line, but this figure climbs to roughly one in three children in South Texas. Former Vice President Al Gore, the founder and chair of the Climate Reality Project, has detailed how poor and marginalized communities are disproportionately affected by pollution and climate change.

Superimposed on these 21st-century forces is the specter of pandemic threats. In 2023, the U.S. Congress established a PREVENT Pandemics Act with a new Office of Pandemic Preparedness and Response Policy to advise the President on preparedness and coordinate “public health threats that have pandemic potential, or may cause significant disruption…and threats from COVID-19, Mpox, polio, avian and human influenza, and RSV”.⁴ But beyond these big profile and transmissible viral diseases, for those living in the Gulf of Mexico there is also the more specific risk of parasitic and vector-borne diseases, each illness closely linked to climate change operating in concert with key social determinants such as poverty, inadequate housing, and lack of access to water, sanitation, and hygiene (WASH). For example, human hookworm and other soil-transmitted helminth infections are still prevalent in Alabama and Mississippi;⁵ autochthonous Chagas disease transmission is significant in Texas and possibly other Gulf Coast states; and in 2023 locally acquired vivax malaria cases were diagnosed in Sarasota County in West Florida and Cameron County in South Texas.⁶ Vector-borne viral illnesses are also accelerating, especially those linked to Aedes mosquito transmission, including dengue, chikungunya, and Zika. Together climate change and expanding urban populations are projected to expand the geographic distribution of Aedes mosquitoes across the Gulf Coast and Southern U.S., and dengue could gain a permanent foothold.⁷ This year, the World Health Organization announced that dengue has reached alarming proportions in the Americas.