Public health director outlines state priorities as MMR coverage falls to 89%; officials warn of measles and pertussis risks

Bismarck — Dirk Wilkie, interim commissioner of the North Dakota Department of Health and Human Services and executive director of public health, presented the department’s 2024–2029 State Health Improvement Plan (SHIP) to the House Appropriations Subcommittee, Human Services/Human Resources and emphasized four priorities for the next five years: strengthening workforce, cultivating wellness and childhood opportunity, expanding access and connection to health services, and building community resilience.

Wilkie said the SHIP was developed from extensive data analysis and stakeholder input. “We reached out to over 125 focus groups and stakeholders,” Wilkie said, and he credited North Dakota State University’s Center for Social Research for helping finalize the report. The plan, Wilkie said, is one of the documents required by public health accreditation and will guide division work through 2029.

Decline in childhood immunization: Wilkie highlighted a decline in childhood MMR (measles, mumps and rubella) immunization. “In 2019 to 2020, our MMR vaccine was at 94.2% of children immunized. Right now, we sit at 89% of children immunized,” Wilkie said, noting the public-health goal for community immunity is 95%. He added the department has observed an increase in exemption rates from about 3% in 2019–2020 to roughly 7% now.

Disease control concerns: Kirby Kruger, director of disease control and forensic pathology, told the committee the department has tools to prevent spread when a measles case is identified, including targeted vaccination of susceptible contacts. “If we can identify susceptible individuals who haven't been vaccinated and get them vaccinated soon after their contact with that measles case, we can prevent the measles case,” Kruger said.

Kruger described a rise in pertussis (whooping cough) in 2024, reporting a preliminary total of 148 cases this year and saying that number is up “significantly” from about seven or eight cases in 2023; he said he would double-check historical counts. Kruger also said tuberculosis activity this year was within a typical annual range (about eight to 12 active cases per normal year) but that some cases had drug-resistant strains, which complicates treatment.

Emerging respiratory threats: the committee discussed avian influenza (H5N1). Kruger cautioned that influenza A viruses can change by mutation or by reassortment when human and avian strains infect the same person, creating the potential for human‑to‑human spread. He called this a “concern” and noted national surveillance is watching these developments.

Other department activity and metrics: Wilkie reviewed other public-health operations and outcomes: WIC served 16,225 participants in 2023 (including 4,727 infants) and 16,601 participants in 2024 (including 4,877 infants). The department’s Emergency Preparedness and Response unit conducted 378 missions to provide long‑term‑care or hospital gap staffing, 91 patient-transport coordination missions and more than 1,300 courier missions for medical cash and lab specimens around the state.

Regulatory and enforcement pressures: Wilkie warned the department’s work has become more complaint-driven since the pandemic, reducing its ability to do proactive surveys. He reported allegations to the department rose 274% and complaints rose 170% in the health facilities area; through the period cited the department recorded 815 allegations and 523 complaints across 115 facilities. Food and lodging enforcement actions rose 850% in the past biennium, with nearly half of that increase attributed to mobile home parks; that enforcement work produced about 120 warnings and 15 legal actions.

Audit findings and corrective actions: Wilkie said the department had three findings in the 2022 single audit (two related to COVID relief funding and one to WIC). He said the department implemented additional procedures and internal controls and completed corrective actions by June 30, 2023.

Medical marijuana program: Jason Wall of the Medical Marijuana Program told the committee the program is funded by fees and is operated under a continuing appropriation outside the base budget. Wall said the department is not funding clinical studies of higher-THC products and that confidentiality limits the amount of program data the department can share. Wall described the current statutory or rule-based limit as a 30‑day supply equal to 6,000 milligrams of THC (equating to a 200 mg-per-day average). He told the committee adverse-event reporting is available to law enforcement and medical professionals and that the program has received minimal adverse-event reports in recent years.

Legislative questions and concerns: Rep. Murphy raised concerns about the 200 mg daily figure and potential state liability and drug interactions; Murphy asked whether the state would fund clinical studies. Wall replied the department is not currently funding such studies and noted federal scheduling and confidentiality constraints complicate research. Kruger and Wilkie both recommended continued focus on prevention, data-driven work, and stakeholder engagement.

Wilkie closed by asking the committee to study the Community Health Trust Fund (tobacco settlement dollars) as a possible funding source for health-related programs. He also said the department would present detailed section-level testimony at subsequent subcommittee meetings.