The Riverside County Executive Office, following consultations with the District Attorney’s Office, Sheriff’s Department and other agencies, submitted a formal request for the board to consider implementing a set of regulations aimed at deterring sales and marketing of kratom derivatives, mainly to minors.

“I had never heard of kratom before this came to us earlier this year,” county Chief Executive Officer Jeff Van Wagenen told the board ahead of its unanimous vote. “Kratom is becoming more widely used. Is there an opportunity to act now before it becomes more widely abused? We’ve tried to identify the most dangerous aspect of this … ‘gateway drug.’ This is an opportunity to limit the exposure of folks to it.”

The main emphasis is on so-called “7-OH” products, which contain alkaloids produced using biosynthetic methods. The 7-OH derivatives are based on kratom leaf or kratom leaf extracts originating from a tropical plant native to Southeast Asia, officials said. Their properties have pain-relieving influences similar to morphine and heroin.

“The 7-OH concentrated synthetic products are often promoted as dietary supplements,” Sacramento-based California Narcotics Officers’ Association Legislative Advocate Ryan Sherman told the board. “These products come in various forms, like concentrated liquid extract, and can significantly increase adverse potential life-threatening effects, especially when 7-OH is combined with alcohol and sedatives. Unknown concentrations of these synthetics bear an increased risk of unintentional overdose. There is no approved medical use.”

In July, the U.S. Food & Drug Administration requested that the DEA formally review kratom derivatives and consider placing them on the federal list of controlled substances, which would result in stringent regulations. The DEA is still in the review stage.

“Highly concentrated and synthetic kratom-based products — marketed in the form of powders, capsules, gummies and `energy shots’ — have proliferated in the U.S,” the Executive Office said in a statement. “These products are commonly sold online, in smoke shops and at convenience stores, often with no quality control or labeling standards.”

The state Legislature is in the process of sorting out possible statewide restrictions on 7-OH sales, after a similar proposal in the previous legislative session died in the state Senate. In the meantime, localities have taken regulatory steps of their own.

The Orange County Board of Supervisors approved a measure in August, following related actions in the cities of Jurupa Valley, Newport Beach, Oceanside, San Diego and Solano Beach, all of which now have ordinances in place that prohibit some 7-OH marketing and sales.

The proposed Riverside County regulatory scheme, which requires a second public hearing in the next two weeks before it can be formally approved, would bar the sale of any kratom-based products that contain more than 2% of alkaloids to anyone under 21 years old. The county would further outlaw any marketing of the derivatives to youths via advertisements or brand packaging.

Violations would result in potential misdemeanor criminal charges and fines.

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According to the Department of Health, the cuts will save $1.8 billion annually and — combined with previous downsizing — reduce the employee headcount from 82,000 to 62,000 full-time employees.

Under a restructuring plan, the number of health department divisions will drop from 28 divisions to 15 — including a new Administration for a Healthy America, or AHA. The number of regional offices will drop from 10 to five.

“We aren’t just reducing bureaucratic sprawl,” the Health secretary said in a statement. “We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic. This Department will do more — a lot more — at a lower cost to the taxpayer.”

Many in the national and global health community have been steeling themselves for dramatic change since Kennedy, an opponent of some vaccines and an advocate of stronger food safety, took office vowing radical reform.

The primary target of Kennedy’s cuts is the Food and Drug Administration, which works to ensure the safety and efficacy of foods, drugs, medical devices, tobacco and other regulated products. It will cut its workforce by 3,500 full-time employees — a reduction that a health department fact sheet said “will not affect drug, medical device, or food reviewers, nor will it impact inspectors.”

The Centers for Disease Control and Prevention, a vast $9-billion agency that works to prevent chronic diseases, fight infectious disease outbreaks and make vaccine recommendations, will also cut 2,400 employees.

Dr. Tom Frieden, the former CDC director who now works as president and CEO of the nonprofit health organization Resolve to Save Lives, said Kennedy’s plans were unlikely to result in greater efficiency.

“Breaking up the agency by sending the experts in non-communicable diseases to another new agency isn’t efficient, it just creates new bureaucracy,” Frieden said in a statement to The Times. “Infectious diseases do not occur in a vacuum, and factors including pre-existing chronic diseases play critical roles in understanding and controlling infectious diseases.”

The CDC, Frieden said, has been the “flagship of public health for generations” as it pursued its “core mission of saving lives and protecting people from health threats of all kinds.”

“No other part of the federal government has the depth and breadth tracking, understanding and supporting communities and providers to stop our leading killers,” Frieden said. “CDC has contributed to saving millions of lives — not just from infectious diseases but also from cancer, heart attack, stroke and other leading causes of death of Americans; better road safety; and prevention of injury and drug overdose.”

The National Institutes of Health, the primary federal government agency for conducting and supporting medical research, will cut 1,200 employees.

A former NIH official and Trump administration critic said the reductions would have far-reaching consequences.

“You can’t cut that many people without drastically having to scale back the work that NIH and HHS are doing,” said Nate Brought, who resigned last month from his position as director of NIH’s Executive Secretariat. “It’s just not possible.”

Brought said he worried that research on the LGBT community and AIDS would be completely cut and studies on cancer and childhood disease would falter.

“We’ve already seen them cut back on HIV and AIDS assistance and, to some extent, research, and now I would not be surprised to see most of that go away as well,” he said. “Cancer research I think is a huge one… Anything that touches on any childhood disease being cut is going to obviously be a huge problem. I don’t think Americans are about children dying to meet their political goals.”

In an address posted to the social media platform X on Thursday, Kennedy painted a dark, apocalyptic picture of the U.S health department, noting that as its budget and staff increased, all that money has failed to improve the health of Americans.

“In fact, the rate of chronic disease and cancer increased dramatically as our department has grown,” he said. “Our lifespan has dropped. So Americans now live six years shorter than Europeans. We have the sickest nation in the world, and we have the highest rate of chronic disease. The US ranks last among 40 developed nations in terms of health, but we spend two to three times more per capita than those nations.”

Kennedy called his department an “inefficient” and “sprawling bureaucracy” that had seen rates of cancer and chronic disease increase as its budget had increased.

“When I arrived, I found that over half of our employees don’t even come to work,” Kennedy said. “HHS has more than 100 communications offices and more than 40 IT departments and dozens of procurement offices and nine HR departments. In many cases, they don’t even talk to each other. They’re mainly operating in their silos.”

During the Biden administration, Kennedy said the health department budget had increased by 38% as staffing increased by 17%.

“But all that money has failed to improve the health of Americans,” he said.

Dorit Reiss, a professor of law at UC San Francisco who specializes in public health, questioned the premise that the nation’s health agencies were overstaffed.

“If anything, the FDA and CDC are understaffed, they don’t have as many people as they need to combat the many challenges we’re facing,” she said, and noted that the nation was in the middle of a measles outbreak. “This isn’t a good time to cut the organization that’s at the front line of fighting it.”

The new Administration for a Healthy America — which according to a fact sheet will “more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans” — will have multiple divisions including, Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce.

Kennedy admitted that his overhaul of the department would be a “painful period” for the agency. But he said he wanted all employees to rally together “behind a simple, bold mission.”

“I want every HHS employee to wake up every morning asking themselves, ‘What can I do to restore American health today?’ I want to empower everyone in the HHS family to have a sense of purpose and pride and a sense of personal agency and responsibility to this larger goal. We’re going to save taxpayers nearly $2 billion a year, and we’re going to return HHS to its original commitment to public health.”

Brought however, said that the government had never been less efficient than it was now under the Trump administration.

“At this point, morale is at an all-time low, productivity is at an all-time low, and then you’re going to throw something like this on top of it,” he said.

“People who are constantly being told that they’re about to be fired, that their jobs are in danger,” he added, “are not doing their best work, as efficiently and as well as they are capable of and as they were before.”

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New data from the California Department of Public Health show that last year, 96.2% of California students in transitional kindergarten and kindergarten were vaccinated against measles, mumps and rubella in the 2023-24 school year, down from 96.5% the year before. And 93.7% of kindergarten students were up to date on all their immunizations, down from 94.1% in the same period the previous year. Data on vaccination rates for first-grade students, which are usually higher, were not yet available.

California’s childhood vaccination rates are still higher than in the U.S. overall. But public health experts say the declining immunization rate creates two main risks: that measles could spread here amid the deadly outbreak that began in Texas, and that the immunization rate could continue to fall.

The COVID-19 pandemic worsened trust in public health institutions, experts say, and there’s growing concern that deep political discord, along with widespread disinformation online, will only make it harder to reverse the downward trend.

A 95% vaccination rate, sometimes called “herd immunity,” is generally considered the gold standard of disease prevention. That threshold not only prevents infections from ripping through a community, but also protects those who are not able to get vaccinated because they are pregnant, immunocompromised or have other serious health issues.

“Measles is so infectious,” said Dr. Chad Vercio, division chief of general pediatrics at Loma Linda University Children’s Health in San Bernardino County, where about 93.5% of kindergarten students were immunized against measles last year.

When fewer people are vaccinated against the disease, he said, “the likelihood that someone who’s not been vaccinated gets infected becomes so much higher.”

Measles is most often associated with a high fever and rash, but more severe cases can cause pneumonia or encephalitis. The disease kills about one to three people for every 1,000 infected and leads to hospitalization in 1 in 5 cases, Vercio said.

California’s vaccine laws, which were tightened in the wake of the 2014-15 measles outbreak at Disneyland, make it difficult for parents to send children to school without a series of standard childhood vaccines, including the shots known as DTaP, short for diphtheria, tetanus, and pertussis; and MMR, short for measles, mumps and rubella.

Still, the state’s childhood immunization rates have been falling for the better part of a decade.

Vercio said he and other local pediatricians have seen a “significant” increase in vaccine hesitancy since the start of the pandemic, including parents who refuse to discuss immunizations with their doctors after encountering misinformation online about vaccines, including the debunked connection between vaccines and autism.

Last year, nearly two-thirds of California’s counties reported immunization rates for all childhood diseases below 95%, with 14 counties falling below 90%, according to the health department data. The immunization rate for measles was higher, but 16 counties — or more than 1 in 4 — still reported a rate below 95%.

The lowest immunization rates were in northern California. In Glenn and El Dorado counties, fewer than 80% of kindergarten and transitional kindergarten students were fully vaccinated, and fewer than 81% against measles. Sutter County reported the lowest vaccination rate overall at 73%, and 75.8% for measles.

Southern California has generally fared better. Of the nearly 130,000 kindergarten students in Los Angeles County, more than 97% received two or more doses of the MMR shot last year, the data show. And Orange County reported a 97.4% immunization rate for its nearly 44,000 kindergarten students.

But San Diego County, which has the second-largest number of kindergarten students after L.A. County, saw its immunization rate slip just below the 95% herd immunity benchmark to 94.8%.

In Kern County, the measles immunization rate among more than 19,000 kindergarten students was just shy of 91%, a drop of more than 1 percentage point from the year before, the data show. About 87.4% of kindergarten students had received all their required shots.

Michelle Corson, a spokeswoman for the Kern County Public Health department, said in a statement that a “mistrust of healthcare providers and systems, along with the spread of vaccine misinformation” has contributed to vaccine hesitancy.

She said some residents also face other barriers in accessing healthcare, including lack of insurance or transportation challenges. Corson said the county has run back-to-school vaccination drives and has a mobile health clinic that travels to more rural areas of the county to provide shots.

In Santa Cruz County, 91.8% of kindergarten students were vaccinated against measles last year, a rate that has declined from 94.1% two years earlier, state data show.

“We’re vulnerable,” said Dr. Lisa Hernandez, the county’s public health officer. Scenic Santa Cruz has a “baseline vulnerability” to infectious diseases such as measles, she said, because a relatively high number of people travel through the county to take vacations and to visit the University of California campus.

Many counties with relatively low vaccination rates have a higher share of students enrolled in independent study or home-school programs that do not involve classroom instruction or who receive special education services at school even if they’re not fully vaccinated.

Kern County said 9% of kindergarten students were enrolled in such programs. In El Dorado County, nearly 20% of students were, while in tiny Sutter County, which has the state’s lowest vaccination rate overall, that share surged to nearly 1 in 4 of the county’s kindergarten students.

Heather Orchard, an immunization specialist and public health nurse with El Dorado County Public Health, said despite the rural county’s low vaccination rates, the risk of a measles outbreak is less likely than in larger, more populated counties.

“I feel like our risk is low in El Dorado County,” she said. But, she said, the county is still working on making vaccines available and sharing that information with families who are sending students to school.

California first tightened its childhood vaccination laws a decade ago after a measles outbreak at Disneyland, which spread to 131 people in California, highlighting the risk of a disease that was once thought eliminated. California has reported five measles cases in 2025.

In 2015, state lawmakers approved Senate Bill 277, which eliminated parents’ ability to cite their personal or religious beliefs as a reason for skipping childhood vaccinations that were required for school. That law led to a 5 percentage point increase in the state’s vaccination rate, data show.

Four years later, amid allegations that a handful of doctors were issuing bogus medical exemptions for unvaccinated children, legislators passed SB 276, giving the state more authority to scrutinize those exemptions. Those collective efforts reduced personal belief exemptions to zero and medical exemptions to less than 1% statewide.

But since then, the vaccination rate for all childhood immunizations and for the two-dose measles shot have declined, state data show.

Former state Sen. Richard Pan (D-Sacramento), a pediatrician who wrote both of California’s vaccine laws, said his efforts have made schools safer for vulnerable kids, even while acknowledging that immunization rates remain low in certain regions.

“From a policy point of view, we’ve done what we can,” Pan said. “And I feel that we’ve done well.”

But public health experts are preparing for childhood immunization rates to continue declining in the current political climate and as the anti-vaccine movement becomes more mainstream.

“Now it has started to become much more of this kind of red state, blue state thing,” said Richard Carpiano, a public policy professor at the UC Riverside who has studied vaccine hesitancy.

Carpiano and other experts said there’s general concern that the Trump administration’s decision to pull funding for public health efforts and medical research will only worsen health disparities across the country. He noted that instead of encouraging families to vaccinate their children during this recent measles outbreak, Robert F. Kennedy, Jr., Trump’s U.S. Department of Health and Human Services secretary, promoted vitamin A and cod liver oil as effective treatments.

“We’re going backwards. And we’re creating all these different types of vulnerabilities,” Carpiano said. “The lighter fluid has just been thrown all over these little sparks about freedom and personal choice and parental rights.”

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