Public Health division flags falling immunization rates, autopsy workload and calls for maternal and domestic‑violence funding

Kirby Krueger, director of disease control and forensic pathology at the Department of Health and Human Services, and other public‑health leaders briefed the Senate Appropriations Human Resources subcommittee on March 1 about program priorities and budget requests for the Public Health Division.

Krueger described the forensic pathology workload and contracting arrangement with the University of North Dakota (UND). The department’s Bismarck forensic office performed 188 autopsies in 2023 and 122 in 2024; UND handled the remainder under contract. Krueger said the state’s coverage is divided geographically by contract: certain western and south‑central counties routinely send cases to Bismarck, other counties send to UND. He told the committee the Bismarck forensic examiner position is currently part time (Doctor William Mazzello works two days a week) and that a single full‑time pathologist would not be sufficient to meet the state’s current autopsy volume.

On immunizations, Krueger and Molly Howell, immunization director, presented statewide trends and county‑level variation. They said MMR coverage among kindergarteners has declined since the early 2020s and that the state’s exemption rate for kindergarten immunizations has risen toward about 7 percent statewide, with local pockets much higher. Howell noted that measles remains highly contagious and that two doses of MMR achieve about 97 percent effectiveness, while a single dose is roughly 93 percent effective. Committee members asked whether prior spikes (for example in the 1970s) provide a useful model; Howell explained historical program changes (single‑dose to two‑dose recommendation and the start of school immunization requirements) but said modern pockets of under‑vaccination are what create outbreak risk now.

Public‑health leaders highlighted federal funding constraints for immunization operations and the difference between vaccine procurement (federal Vaccines for Children entitlements) and operational supports such as reminder/recall systems and outreach, which rely on federal grants that have flattened.

Kim Mertz, section director for Healthy and Safe Communities, outlined program areas across maternal and child health, WIC, newborn screening, school dental programs (SealND), a poison‑control hotline (contract with Hennepin County), domestic‑violence and sexual‑assault services, and chronic‑disease initiatives including tobacco prevention. Mertz summarized several budget asks included in the executive recommendation: a $2.0 million package to expand maternal and child health services, $2.25 million proposed for domestic‑violence services in the governor’s recommendation (the House provided about $2.1 million, with an additional Community Health Trust Fund shift in some lines), and a $2.2 million request to expand coordinated immunization access including RSV antibody and Hep B access for infants.

Mertz and staff described other program statistics and needs: the WIC program served more than 16,000 participants in the prior year; newborn‑screening covers roughly 34 conditions and screens about 11,000 infants yearly; the SealND school sealant program screened thousands of students and applied preventive sealants; the poison hotline handled more than 6,000 calls in 2023. They also summarized the domestic‑violence network’s caseload: in 2023, programs served 6,131 new victims of domestic violence statewide and the sexual‑assault programs reported 1,288 new primary victims (data collected by the state coalition).

On workforce and recruitment, Mertz described loan‑repayment programs administered by the Primary Care Office. The department reported a combined loan‑repayment funding pool (state and federal) in the executive recommendation; Natalie Young, primary care director, said the programs prioritize rural and shortage areas (dentists awarded through the program are required to provide at least $20,000 a year in Medicaid services) and that federal loan‑repayment contracts have steep penalties for default, which limits defaults in practice.

Committee members asked for follow‑up: where county immunization rates are lowest (Shelidan, Wells and Williams counties were flagged as examples), requests for data on defaults and completions for loan‑repayment participants, contract details for the UND autopsy agreement, and clarity about how Community Health Trust Fund dollars were shifted to general fund in the House version of the bill. The committee did not take a vote; staff and agency leaders agreed to provide follow‑up documentation and to return with additional detail.