CDC testing cuts leave Idaho more exposed

Less than two years ago, a skunk scratched a man on his shin at a rural Idaho property. He did not think much of it. Weeks later he was dead of rabies, and a Michigan man who had received one of his kidneys was dead, too, the fourth time in nearly half a century that the United States had confirmed rabies transmission through an organ transplant.

The multistate investigation that followed spanned seven states, traced 370 possible contacts and intercepted a fourth infected corneal graft headed to a Missouri patient before it could be implanted.

That investigation succeeded in part because federal laboratory experts confirmed the diagnosis quickly, allowing public health officials to act. The specialized rabies testing that made that possible came from the Centers for Disease Control and Prevention.

Now the CDC has paused that testing, and Idaho, a state that ranked last in the nation for physicians per capita in 2025, finds itself navigating the gap with fewer resources than almost anywhere else in the country.

Reduced testing pushes the shortage

On April 1, the CDC posted a list of more than two dozen diagnostic tests that have become temporarily unavailable, including those for rabies and monkeypox. A government spokesman described the move as a routine quality review.

Outside experts said it was something they had never seen at this scale. The poxvirus and rabies labs lost roughly half their staff through layoffs, retirements and the nonrenewal of temporary positions, according to the National Public Health Coalition, a group of former and current CDC workers. Overall, CDC staffing has fallen by an estimated 20 to 25%.

For most states, that gap is a serious problem. For Idaho, it arrives on top of conditions that were already cause for concern.

Idaho’s workforce crisis

Idaho’s health care workforce crisis did not begin with the CDC announcement. It has been building for years, documented in biennial reports and repeated with growing urgency by hospital administrators, state epidemiologists and public health researchers.

The state ranks 50th in the nation for physicians per capita, with 227 physicians per 100,000 residents in 2025. That figure sits well below the national average of 248, and the gap widens significantly in rural counties, where most of Idaho’s geography lies.

Forty-three of Idaho’s 44 counties carry a federal Health Professional Shortage Area designation. Even adding 1,400 doctors overnight would only bring Idaho up to the national average.

The nursing picture is built from similar arithmetic. The Idaho Center for Nursing’s 2024 Nurse Workforce Report, a comprehensive biennial analysis drawing on license databases, employer surveys and school enrollment data, counted 22,845 registered nurses in Idaho as of June 2024.

Remove the 2,487 advanced practice nurses who do not typically fill standard RN positions, and the working pool drops to 20,358. Remove the 1,399 nurses who are already at or past retirement age and the adjusted workforce count falls to 18,959, a net gain of only 309 nurses over two years despite Idaho being among the fastest-growing states in the nation.

The state is ranked as the second-fastest growing in the U.S. and saw an increase of 1.4% in the population in 2025, according to U.S. Census data. Idaho surpassed 2 million residents in July of that year. The data shows the state has increased by 10.4% since 2020, with nearly 200,000 settling here in the past six years.

Using that adjusted count, Idaho is short 1,867 registered nurses from what it needs to meet baseline health care demand.

Monthly nursing vacancies across the state held between 750 and 1,000 open positions through 2022 to 2024, according to the report, with the Idaho Department of Labor identifying registered nurses as a top job need statewide.

Long-term care facilities have been hit especially hard. The report found that the majority of Idaho chief nursing officers have been in their roles for only two to four years, and in long-term care, the average CNO tenure is one year or less, a measure of how difficult it has become to build stable institutional leadership, let alone respond to a public health emergency.

The pipeline has its own ceiling. Every Idaho nursing school reported more qualified applicants than it could accept, and the barrier appears to be faculty. Nursing school salaries cannot compete with hospital wages, so nurses who are academically prepared to teach remain on the floor rather than in the classroom.

Travel nurses, who filled critical gaps during the pandemic, have largely moved on. Agencies have fewer available for placement, and those who remain seek postings in California, Oregon, Washington and Arizona, all states that pay more and recruit harder.

Idaho’s rate of registered nurses per 1,000 residents fell to 7.06 in 2024, down from 9.97 in 2022, even as the national historical benchmark sits at 10.6. Rural Idaho gained 520 nurses since 2022, reversing a prior trend, but critical access hospitals and long-term care facilities in those communities continue to struggle with vacancies the new numbers have not filled.

Into this landscape, the CDC now has reduced federal laboratory capacity, precisely in the areas of infectious disease detection and response that depend on the kind of specialized expertise and institutional knowledge that small, understaffed state systems cannot easily replicate.

What it all means for Idaho

David Dodd, chairman and CEO of GeoVax, a biotechnology company developing an alternative domestically manufactured mpox vaccine, said the compounding effect on states like Idaho is not difficult to trace.

“In states with limited health care capacity, reduced testing or delayed detection becomes more consequential,” Dodd said. “When you have fewer health care workers, you need stronger front-end prevention.”

The Idaho rabies case started with a chain of events in late 2024 and early 2025 that unfolded quietly at first. It started with a scratch, a death attributed to other causes, a kidney shipped to a transplant center in Ohio. Weeks passed before anyone suspected rabies, and when they did, the investigation required CDC’s specialized laboratory capacity to confirm the diagnosis, expand contact tracing across multiple states and stop the corneal graft headed to Missouri.

Hospital staff who treated the Idaho man had initially attributed his symptoms to chronic comorbidities.

Dodd described what he sees as a four-part cascade when that kind of federal support is unavailable or delayed. Confidence in what clinicians are observing breaks first. Decision timing breaks second as public health officials wait for laboratory confirmation before notifying partners, tracing contacts or deploying preventive treatment.

Communication breaks third, as agencies across state lines struggle to coordinate without a shared understanding of what they’re facing. The fourth break is strategic as policymakers underestimate threats they cannot see clearly and delay the preparedness decisions that could blunt the next outbreak.

“The cascade can begin quickly,” Dodd said, “even if the visible consequences take longer to emerge.”

The cascading effect

Against that backdrop, Idaho’s Legislature passed the Idaho Medical Freedom Act in early 2025. Gov. Brad Little signed it in April. The law, described by legal analysts as the first of its kind in the nation, prohibits government entities, businesses, schools and colleges from requiring any medical intervention, including vaccines, as a condition of access, employment or services.

An amendment carved out a narrow exception allowing exclusion of visibly ill people during declared outbreaks. However, infectious disease experts note that many diseases spread most efficiently before symptoms appear.

The timing of the law coincided with vaccination data that was already alarming public health officials. Idaho’s MMR vaccination rate among kindergartners was approximately 78% in the 2024-2025 school year, the lowest of any state in the country and well below the 95% threshold considered necessary for measles herd immunity.

In some Idaho counties, fewer than 40% of kindergartners had received all required vaccines. Three confirmed measles cases appeared in Idaho in August 2025, the first in some of those counties in more than three decades.

Idaho already had the highest rate of kindergarten vaccine exemptions in the nation before the Medical Freedom Act passed. Legal analysts said the new law could erode vaccination rates further by weakening the mechanisms schools and employers have historically used to encourage immunization.

Dodd said that reduced vaccination coverage and reduced federal testing capacity are not separate problems.

“Lower coverage means less community resilience,” he said. “Reduced federal testing capacity means less visibility and potentially slower response. Put those together and the system becomes more fragile.”

He was careful to note the distinction between mpox and measles transmission (they do not move through populations the same way) but said the underlying preparedness principle holds regardless of the pathogen. Fewer protections upstream make surveillance and response downstream more important, not less.

When Idaho’s upstream protections are weakening at multiple points simultaneously, the downstream systems must be exceptionally strong to compensate. Idaho’s downstream systems are not strong, he said.

Mpox adds a new danger

The mpox picture adds urgency to the broader concern.

The virus, once called monkeypox and renamed in 2022 by the World Health Organization, circulated primarily through close contact in its first major U.S. outbreak. A newer variant, Clade 1, transmits more casually and carries a significantly higher fatality rate. A hybrid of the two variants was detected in New York City earlier this year.

Globally, vaccine supply has not kept pace with demand. A single manufacturer based in Denmark holds a near-monopoly on the modified Ankara vaccine preferred for mpox prevention. Last year, that company produced every dose it could and still fell far short of documented global need.

In parts of Africa, where Clade 1 has been most active, the unmet demand represents a persistent pocket of viral circulation, and in a world of commercial air travel, those pockets do not stay local.

The 2026 FIFA World Cup begins June 11 in North America, projecting millions of international visitors into U.S. airports, tourist destinations and host cities. Idaho will not host matches, but its tourism infrastructure will not be insulated from the expanded human traffic.

“Public health officials should be using mass gathering season as a trigger to heighten situational awareness,” Dodd said, “and review isolation, referral and reporting protocols now rather than later.”

GeoVax acquired rights from the National Institutes of Health to a separate MVA strain and has spent four years developing what it hopes will become a second source of global mpox vaccine supply. The company plans to begin a clinical trial in the second half of 2025 through the European Medicines Agency, which has granted expedited review given the existing need. Dodd said the U.S. strategic national stockpile has also indicated interest in purchasing product if clinical results support approval.

“This is not just a commercial opportunity,” Dodd said. “It’s a public health and national security priority.”

What Idaho can do now

What Idaho public health officials can do in the near term, Dodd said, is not wait for the federal picture to gain clarity.

Some larger state laboratories like those in New York and California have indicated capacity to absorb portions of the federal testing gap. Establishing those partnerships and protocols now, before a suspected case arrives, is the kind of preparedness planning that becomes exponentially harder once an outbreak is underway, Dodd stressed.

Refreshing communication chains among hospitals, infectious disease specialists, local health districts and the state laboratory costs nothing but time.

Dodd also said that clinical awareness matters more in a thin system and that recognizing an unusual presentation early can be as important as having immediate confirmatory testing.

In the Idaho rabies case, hospital staff initially missed the diagnosis because they did not know to look for it. Better clinician education about unusual presentations, better coordination before a crisis rather than during one, better protocols for when to call the state lab and when to call for federal support are the investments that lean systems can still make, he said.

Idaho has demonstrated, painfully and recently, what happens when those systems are not in place when they are needed, Dodd said.

“You can’t test your way out of a supply problem,” he said. “But you also can’t respond to what you cannot confirm you are seeing.”