### Meeting Overview The Whatcom County Council, acting as the Health Board, met jointly with the Public Health Advisory Board (PHAB) on April 1, 2025, to discuss measles outbreak concerns, the health director recruitment process, and a major recommendation to expand the Health Board's membership structure based on nine months of working group research. ### Key Terms and Concepts **Public Health Advisory Board (PHAB):** A 21-member advisory body that provides community input to the County Council when it acts as the health board, currently required by state law because Whatcom County's health board consists only of elected officials. **Health Board:** The governing body with authority over public health matters, currently consisting of all seven Whatcom County Council members, with broad powers including the ability to impose health regulations and quarantines. **MMR Vaccine:** The measles, mumps, and rubella vaccine that is 97% effective when both doses are completed, required for school entry in Washington State. **RCW 70.05.035:** State law passed in 2021 requiring local health boards to include diverse membership (health professionals, tribal representatives, community members) unless they have an existing community health advisory board like PHAB. **Health Officer:** The medical professional who serves as the chief public health official for the county, currently Dr. Amy Harley in a job-sharing arrangement with Dr. Megan Laylana starting April 14th. **Grandfathering:** The legal provision that allowed Whatcom County to keep its current all-council health board structure because PHAB already existed, but if changed now, there would be no going back to the current structure. ### Key People at This Meeting | Name | Role / Affiliation | |---|---| | Jon Scanlon | Health Board Chair, County Council Member | | Amy Harley | Health Officer | | Charlene Ramont | Interim Health Director | | Kayla Schott-Bresler | Deputy County Executive | | Kelli Carroll | PHAB Chair | | Dr. Christine Espina | PHAB Member, working group participant | | Ben Elenbaas | Council Member, vocal skeptic of expansion | | Todd Donovan | Council Member, working group participant | ### Background Context Whatcom County is one of only six remaining Washington counties where the county council serves as the entire health board, a structure that's become increasingly rare since 2021 state law changes. The current system works because PHAB exists to provide community expertise, but critics argue it lacks direct representation from cities, tribes, and health professionals when making binding public health decisions. Meanwhile, a measles outbreak in Texas has reached nearly 500 cases nationally, raising concerns about Whatcom County's below-average vaccination rates of 87% among kindergartners—short of the 95% needed for community immunity. The debate over health board structure reflects broader tensions about democratic accountability versus technical expertise, with some council members concerned about giving voting power to unelected appointees on a body that can restrict individual freedoms during health emergencies. The working group's recommendation would fundamentally change local governance by bringing in mayors, tribal representatives, and health professionals as voting members rather than advisors. ### What Happened — The Short Version Dr. Harley warned about rising measles cases nationally and Whatcom County's vulnerability due to vaccination rates below the 95% threshold for herd immunity. Deputy Executive Schott-Bresler outlined a multi-month national search process for a new health director, requiring formal participation from both the Health Board and PHAB in candidate interviews and recommendations. The main event was the working group's presentation of their recommendation to expand the Health Board to include mayors, tribal representatives, and health professionals—a change that would be permanent if adopted. After extensive discussion about accountability, representation, and process concerns, the Health Board voted 6-1 to form a new working group to develop implementation options, with Councilmember Elenbaas casting the sole dissenting vote. The new group will include Council members Donovan, Scanlon, and Elenbaas, plus up to four PHAB members to be selected at their April 17th meeting. ### What to Watch Next - PHAB will select up to four members for the new working group at their April 17th meeting - The working group will study legal requirements, review other counties' approaches, and potentially recommend community forums for public input - April 10th lobbying trip to Olympia to advocate for public health funding - Health department presentations on April 15th (community health division update) and April 29th (fentanyl program evaluation) ---

**Q:** What percentage of measles cases in the current national outbreak are unvaccinated or have unknown vaccination status? **A:** 97% of cases are unvaccinated or have unknown vaccination status, with two deaths reported including one school-age child. **Q:** What is Whatcom County's current kindergarten MMR vaccination rate compared to the recommended threshold? **A:** 87% on average (ranging from 82-93% by district), which is below the 95% herd immunity threshold needed to prevent outbreaks. **Q:** Who is Whatcom County's new interim health director? **A:** Charlene Ramont, who was officially appointed at the previous council meeting to provide stability during the leadership transition. **Q:** What was the vote count on forming a new working group to study health board expansion? **A:** The motion passed 6-1, with Council members Buchanan, Byrd, Donovan, Galloway, Scanlon, and Stremler voting yes, and Elenbaas voting no. **Q:** Which three County Council members were selected for the new working group? **A:** Todd Donovan, Jon Scanlon, and Ben Elenbaas were nominated and approved unanimously to serve on the working group. **Q:** What is the key difference between the current health board structure and the proposed expansion? **A:** Currently all seven county council members serve as the health board; the expansion would add mayors, tribal representatives, and health professionals as voting members. **Q:** Why can't Whatcom County go back to its current structure if it expands the health board? **A:** Due to state law changes, once a county moves away from an all-council health board structure, it cannot return to that model. **Q:** What role does PHAB currently play in the health board system? **A:** PHAB serves as a 21-member advisory body that provides community input and expertise to the County Council when it acts as the health board. **Q:** How effective is the complete MMR vaccine series against measles? **A:** The two-dose MMR vaccine series is 97% effective, with the first dose being 93% effective. **Q:** When will PHAB select its members for the new working group? **A:** At their next meeting on April 17th, where they will elect up to four PHAB members to join the joint working group. **Q:** What upcoming presentations will the health department give to the County Council? **A:** April 15th: community health division update and Healthy Children's Fund evaluation; April 29th: fentanyl program evaluation and update. **Q:** What is the timeline for the health director recruitment process? **A:** Several months total, including one month for job description refinement, one month posting period, and 1-2 months for the multi-step interview process. **Q:** Which counties did the working group interview about their expanded health board experiences? **A:** Clark, Snohomish, Thurston, King, Kitsap, and the Chelan-Douglas joint health district. **Q:** What is RCW 70.05.035 and why does it matter? **A:** The 2021 state law requiring local health boards to include diverse membership categories, which Whatcom County currently meets only because PHAB exists. **Q:** Who makes the final decision on appointing the new health director? **A:** The County Executive conducts final interviews and makes recommendations, but the County Council must confirm the appointment. ---