## Meeting Overview At 10:32 AM on Tuesday, July 29, 2025, the Whatcom County Board of Health convened in joint session with the Public Health Advisory Board (PHAB) in a hybrid meeting at the County Courthouse. Health Board Chair Jon Scanlon called the meeting to order with all seven council members present: Barry Buchanan, Tyler Byrd, Todd Donovan, Ben Elenbaas, Kaylee Galloway, Jon Scanlon, and Mark Stremler. The meeting also included approximately 15 PHAB members, both in-person and virtual. This joint meeting addressed three key items: updates from the health department's interim director and co-health officers, plus continued discussion about potentially restructuring the Health Board's composition. The session would stretch past its intended noon adjournment, running until 12:13 PM, as passionate debate emerged about governance structures, measles response protocols, and the future direction of public health oversight in Whatcom County. ## Health Department Operations and Budget Challenges Interim Health Director Charlene Ramont delivered sobering news about the department's current state. The Health and Community Services Department, managing a budget exceeding $50 million, is operating without critical leadership positions. "We still do not have a financial services manager, nor do we have a financial services supervisor [or] accounting supervisor," Ramont explained. "This entire year so far has been very, very challenging in terms of the support that we need." Like other county departments, Health and Community Services is working on mid-biennial budget adjustments while simultaneously managing cost reduction scenarios requested by the executive's office in June. The department is receiving additional support from Central Finance to ensure timely submission of budget materials. Despite these challenges, Ramont announced a significant organizational restructuring completed in early July. The changes moved approximately five staff members between divisions to improve efficiency and align resources with emerging needs. Staff focused on healthcare access and mutually beneficial programs were relocated to the Communicable Disease Division for closer coordination with health officers. Another staff member moved to the Community and Organizational Development Division to support the upcoming CHIP (Community Health Improvement Plan) iteration. Three additional staff members were reassigned to work directly under the Office of the Director, supporting system-wide organizational policies and procedures. "Really, what we're trying to do is build infrastructure to increase effectiveness, efficiency and standardized processes," Ramont said, acknowledging that rapid growth over the past five years had outpaced the department's infrastructure development. ## Winter Shelter Challenges and Creative Solutions One of the most striking revelations came regarding winter shelter operations. The department issued a Request for Proposals (RFP) for operating the severe weather shelter but received zero responses. "Unfortunately, did not receive responses. And so we will most likely again, be gearing up to operate a severe weather shelter for this coming winter," Ramont announced. Council Member Elenbaas expressed surprise at the lack of responses, noting the frequent public advocacy for nonprofits to take on such roles. Ann Beck from Community Health and Human Services explained that operating a winter shelter "takes a toll" on organizations, with most providers lasting only about a year before burning out. The county is developing new strategies to address staffing challenges. Instead of relying on existing department staff working overtime shifts, officials plan to hire temporary, full-time employees for approximately six months. "We would be hiring out more staff, more kind of long term, maybe six month employees," Beck explained, noting this approach would avoid paying overtime to current staff while providing better continuity of operations. Deputy Executive Kayla Schott-Bresler emphasized the unsustainability of current practices: "We can't continue to stretch our staff so thin in the operation of the winter shelter. We've had folks, you know, up all night and then coming to work to do their day jobs." She acknowledged this new model will likely be more expensive but stressed the county's commitment to finding a nonprofit partner for future operations. "I just want to be clear, we're not headed [toward a county-run year round shelter]. That's not our intent," she stated firmly. ## Measles Case Investigation: A Deep Dive into Public Health Response The meeting's most extensive presentation came from Co-Health Officers Dr. Amy Harley and Dr. Meg Lelonek, who provided a comprehensive overview of the county's first measles cases in over a decade. Their presentation served multiple purposes: educating the board about measles as a public health threat, demonstrating the complexity of disease investigation, and highlighting the critical importance of trust in public health work. Dr. Harley began with sobering historical context. Before vaccines, measles infected 4 million children annually in the United States, killing about 500. The disease causes high fever, characteristic rash, cough, runny nose, and conjunctivitis. Complications are common and severe: pneumonia, brain infections requiring hospitalization, ear infections, severe diarrhea, and sometimes permanent eye scarring. "Death occurs in one to three out of 1,000 reported cases," Harley noted. The virus's transmission characteristics make it particularly challenging to control. "It's contagious four days before the characteristic rash appears, so you might spread it before you even know you have it," Harley explained. The virus can survive in the air for up to two hours after an infected person leaves a space, with 90% of susceptible people becoming infected upon exposure. Despite the vaccine's remarkable success — reducing U.S. cases by over 99% — 2025 has seen concerning resurgence nationwide. The United States has recorded 13,119 cases this year, with 13% hospitalized and three deaths. Washington State has confirmed 10 cases across three counties, with Whatcom County contributing two cases to that total. Local vaccination rates present concerning vulnerabilities. While 86% of kindergarteners in Whatcom County are fully vaccinated with two doses of MMR vaccine, this falls short of the 95% threshold needed for herd immunity. More troubling, rates vary dramatically by school district, ranging from 79% to 94%. "So some communities, particularly many ones that are quite vulnerable, have quite low rates at 79%," Dr. Lelonek noted. ## The Lynden Case: When Everything Goes Right, It's Still Complex Dr. Lelonek's detailed account of the measles investigation revealed both the sophistication of public health response and the fragility of the system. The case began with a phone call around 9 PM on June 18th from a provider at Family Care Network in Lynden. "I think I have a person who has measles here in my clinic. What do I do?" the provider asked. Despite being only two months into her role as co-health officer, Dr. Lelonek was able to mobilize quickly because of existing relationships and preparation. "Thankfully, this provider was really astute. We've been preparing for this," she said. The provider had attended training, followed proper isolation protocols, used appropriate personal protective equipment, and closed the room for the required two-hour period after the patient left. However, initial cooperation proved challenging. "One hurdle that we came to during this time was... a little bit of lack of trust, so the household that was involved really didn't want to speak with us at first," Dr. Lelonek explained. "It's not completely surprising if the government or health care calls, not everybody wants to answer their phone." The breakthrough came through trusted relationships. The patient's primary care provider, though not working at the time, agreed to contact the family. This trusted intermediary was able to facilitate communication between the health department and the household, ultimately enabling the collection of a nasopharyngeal swab for testing at 7 PM on June 19th. The investigation's scope was remarkable even for a "best-case scenario." The team identified 33 contacts from a single exposure location, conducted daily monitoring of two susceptible individuals for 21 days, facilitated MMR vaccination for three people within the 72-hour window, processed approximately 10 additional samples from other providers with concerns about febrile rash illnesses, and coordinated hospital protocols for one exposed contact. ## The True Cost of Public Health Response Dr. Lelonek's presentation included detailed cost analysis that stunned many attendees. The investigation consumed approximately 320 hours of staff time at an estimated cost of $24,000. "This is a really conservative estimate," she emphasized, noting the calculation excluded interruptions to other staff, state epidemiologist consultation time, and testing costs at the Washington State Public Health Laboratory. To provide perspective, she noted that a single dose of MMR vaccine costs $106 cash-pay at local pharmacies, with most people receiving it free through insurance or state programs. The stark comparison — $106 for prevention versus $24,000 for investigation of a single case — illustrated the economic argument for vaccination. Comparisons with other jurisdictions revealed Whatcom County's response was both efficient and fortunate. Most measles cases generate 150 to 250 contacts; Whatcom had 33. Clark County's 2019 outbreak involving 72 cases cost $2.3 million in public health response alone, with total estimated community costs reaching $3.4 million when including lost productivity and healthcare expenses. "I was really shocked two months into the job, how complex and expensive this investigation was for one case," Dr. Lelonek reflected. She emphasized that the investigation's success depended entirely on trusted relationships — with healthcare providers, community members, and local organizations. "I think there were a couple times where I think things could have gone really differently during this investigation, particularly when we were trying to make that initial contact." ## Community Access and Equity Concerns The discussion revealed ongoing challenges in ensuring equitable access to immunization services. PHAB member Sue Rogers, an outreach nurse working with migrant farmworker families, highlighted persistent barriers: "It's super hard for them to get into the clinics... I think that's super important too, is to do whatever we can to get those clinics in those areas where the kids are under immunized." The department's immunization team works with schools to provide school-based clinics, but Rogers' comments underscored that structural barriers remain for vulnerable populations. The conversation touched on language barriers as well, with Dr. Lelonek noting they had contacts who were non-English speaking during the investigation, including one case requiring an interpreter for a less common language that "took an extreme amount of time and hours for us to be able to work with this particular case." PHAB member Rachel McGarrity raised broader questions about safety and privacy that affect trust in healthcare systems: "How are we enhancing the safety, the security and privacy of people seeking health care and protecting them in an effort to build that trust?" She emphasized that community advocates need to stand on "sure footing saying, coming to this clinic isn't going to expose you to other scary things like questions about your paperwork status." ## Health Board Structure Debate: Governance in Transition The meeting's final hour was devoted to ongoing discussions about potentially restructuring the Health Board itself. Chair Jon Scanlon presented four options developed by a working group that has been studying this issue for nearly a year. The current model consists of all seven county council members serving as the Health Board, with a 21-member Public Health Advisory Board providing community input. This structure was established following COVID-19 pandemic experiences and subsequent state law changes requiring enhanced public health advisory boards. Option One proposes a 10-member board: three council members, two elected officials from cities (one from Bellingham, one from small cities), two tribal representatives (one each from Lummi Nation and Nooksack Tribe), and three community members representing categories outlined in state law. Option Two would create a 14-member board with five council members, maintaining the same city and tribal representation but adding two additional community members. Option Three envisions an 18-member board keeping all seven council members while adding equal representation from cities, tribes, and community members. The fourth option maintains the status quo. Council Member Stremler expressed skepticism about the need for change: "I haven't really heard or seen any of that. And then, like I said, from the cities I haven't heard from them, a concern for moving in in in a new direction... what's what's broken now?" Council Member Donovan responded by referencing the Burke consultant report commissioned by the council to assess the county's COVID-19 response. "They... [made] a recommendation there that we should consider diversifying what our Board of Health is and looking at some of the models that other counties have done." He noted that other counties with mixed elected/non-elected boards report better implementation and more community buy-in. Scanlon emphasized lessons learned from pandemic-era collaboration: "One of the things was bringing people together and having that cross jurisdictional work through Whatcom unified command... one idea that came out from both statewide studies and in our local study of that model is you shouldn't just have that during crisis. You can have that ongoing." ## The Complexity of Change and Volunteer Fatigue PHAB member Leah Wayman, participating virtually, made an impassioned plea about volunteer capacity: "We are all volunteers... every time we have the conversation around oh and more of XYZ, remember that you're asking volunteers to spend more time on this, and that we are community members trying to serve our community." Her comments highlighted tension between thoroughness and volunteer burnout. The working group has been meeting for nearly a year, with PHAB volunteers contributing substantial unpaid time to research and analysis. "We are in our second work group, and coming up on a year for this conversation, and we are all volunteers," Wayman noted. Council Member Galloway acknowledged this tension while expressing her continued uncertainty: "I hear your frustrations... I'm just like... do we try to keep this body of work moving, or do we just stop?" She identified herself as currently opposed to change but willing to continue learning: "I guess from my vantage point, I am trying to figure out how to get to a yes on this, but right now I'm still a no, and I'm not sure Council has the votes to pass a new model." Sterling Chick, a long-serving PHAB member, provided historical perspective: "I'm the, along with Leah, I'm the oldest pihab member. I was back in the day when we were a nimble group, a small group." He described how state legislation created eight massive new tasks for the advisory board that are "nearly impossible" to accomplish with 21 members, particularly given the size constraints. ## Future Directions and Unresolved Questions The meeting concluded with agreement to continue the working group's efforts, focusing particularly on the 10-member board option that seemed to generate the most interest among council members. Scanlon committed to additional outreach to the small cities caucus and tribal leaders to gauge their interest and secure formal support. Council Member Buchanan requested specific analysis of how a 10-member board would function compared to current operations, particularly regarding the relationship with PHAB. Several council members emphasized they would need letters of support from all cities and tribes before moving forward, recognizing that the success of any expanded board depends entirely on active participation from those entities. PHAB member Sue Rogers made a compelling case for including diverse geographic representation: "Having more rural representation or representation from our small cities... could make a world of difference. Those were the people in those communities were on the front line during the flood. Having their voices represented in this space feels really integral to the future of Whatcom County." She also noted that Bellingham's approaching population of 100,000 could trigger options for the city to establish its own health jurisdiction, making current planning even more crucial for long-term regional coordination. ## Systemic Challenges and Public Trust Throughout the meeting, themes of trust, capacity, and coordination emerged repeatedly. Dr. Lelonek's measles presentation demonstrated how trusted relationships enabled successful disease control, while the Health Board structure discussion revealed ongoing struggles to balance democratic representation with technical expertise. The winter shelter situation illustrated persistent challenges in building sustainable community partnerships, while budget constraints and staffing shortages revealed the ongoing stress on public health infrastructure. Sally Mickley's public comment provided alternative perspective, questioning the focus on measles when other health issues like tuberculosis cause more deaths, and advocating for broader prevention approaches including vitamin D supplementation. Her comments about vaccine injury compensation and transparency reflected ongoing community skepticism that public health officials must navigate. As the meeting adjourned at 12:13 PM, it was clear that Whatcom County's public health system stands at a crossroads. Whether addressing immediate challenges like winter shelter operations or long-term governance questions about Health Board composition, officials must balance technical expertise with community trust, emergency response capacity with democratic representation, and immediate needs with sustainable infrastructure. The meeting exemplified both the complexity of modern public health governance and the ongoing evolution of local democracy in response to 21st-century challenges. With measles cases highlighting the need for rapid, coordinated response and governance discussions revealing the difficulty of balancing multiple stakeholder interests, Whatcom County continues working toward more effective, equitable, and trusted public health systems.

### Meeting Overview The Whatcom County Council met jointly with the Public Health Advisory Board on July 29, 2025, serving in their role as the Board of Health. The meeting focused on public health updates, including a detailed presentation about the county's response to its first measles case in over a decade, and continued discussion about potentially expanding the Health Board to include representatives from cities, tribes, and community members. ### Key Terms and Concepts **Board of Health:** The governing body responsible for public health policy in a jurisdiction. In Whatcom County, the seven County Council members serve as the Board of Health, though state law now allows for expansion to include other representatives. **Public Health Advisory Board (PHAB):** A 21-member volunteer advisory body that provides community input on health matters. Created to meet state requirements when maintaining a council-only Board of Health. **Measles Contact Tracing:** The intensive process of identifying, monitoring, and potentially quarantining everyone who may have been exposed to a confirmed measles case to prevent outbreak spread. **MMR Vaccine:** The measles, mumps, and rubella vaccine that provides protection against these three diseases. Requires two doses for full protection. **Herd Immunity Threshold:** The vaccination rate (95% for measles) needed in a population to prevent disease outbreaks from spreading. **Incident Command Structure:** An emergency management system used to coordinate complex responses like disease outbreaks, borrowed from emergency services. **LEAD Program:** Law Enforcement Assisted Diversion program that diverts people from the criminal justice system into community-based services. **Mid-Biennial Budget Adjustments:** Changes made to the county's two-year budget at the midpoint to address changing needs or revenues. ### Key People at This Meeting | Name | Role / Affiliation | |---|---| | Jon Scanlon | Council Chair, Health Board Chair | | Charlene Ramont | Interim Health Director | | Dr. Amy Harley | Co-Health Officer | | Dr. Meg Lelonek | Co-Health Officer | | Kayla Schott-Bresler | Deputy County Executive | | Christine Espina | PHAB Vice Chair | | Tyler Byrd | Council Member District 1 | | Kaylee Galloway | Council Member District 2 | | Todd Donovan | Council Member District 3 | | Barry Buchanan | Council Member District 4 | | Ben Elenbaas | Council Member District 5 | | Mark Stremler | Council Member District 6 | ### Background Context This meeting occurred during a period of significant change for Whatcom County's public health infrastructure. Recent state law changes allow counties to expand their Boards of Health beyond just elected officials to include cities, tribes, and community members. The county has been studying this option for over a year, prompted by recommendations from a consultant's review of their COVID-19 response. Meanwhile, the health department faces ongoing challenges including vacant leadership positions, a complex 50+ million dollar budget without adequate financial staff, and the need to plan for another county-operated winter shelter after receiving no responses to their RFP for nonprofit operators. The measles case discussed represents the first in Whatcom County in over a decade, highlighting both the success of vaccination programs and the ongoing vulnerability of under-immunized communities. ### What Happened — The Short Version Interim Health Director Charlene Ramont updated the board on departmental restructuring, budget challenges, and the successful securing of LEAD program funding. The department moved five staff members between divisions to improve efficiency and is preparing to operate another winter shelter after no nonprofits responded to their RFP. Dr. Amy Harley and Dr. Meg Lelonek presented a detailed account of the county's response to two confirmed measles cases in June. They explained the intensive 320-hour, $24,000 investigation that involved tracking 33 contacts and implementing a full incident command structure. The presentation emphasized how vaccination prevents not just disease but also the enormous cost and disruption of outbreak response. Chair Scanlon continued discussion about potentially expanding the Health Board, presenting three models with 10, 14, or 18 members that would include city and tribal representatives. While some council members showed interest in the 10-member model, others remained skeptical about the need for change, and no final decision was made. ### What to Watch Next - The work group will continue developing more detailed proposals for Health Board expansion, with particular focus on the 10-member model and its relationship to PHAB - Council will receive the county's mid-biennial budget adjustments, likely including health department requests - Planning for winter shelter operations will continue, with the county preparing for a more expensive staffing model - The next joint Health Board/PHAB meeting is scheduled for late September 2025 ---

**Q:** What was the total cost of investigating Whatcom County's measles case? **A:** Approximately $24,000, representing 320 hours of staff time for just two cases in one household. **Q:** Who is the current interim health director? **A:** Charlene Ramont serves as Interim Director of Whatcom Health and Community Services. **Q:** What percentage of Whatcom County kindergarteners are fully vaccinated for measles? **A:** 86% of kindergarteners have two doses of MMR vaccine, which is below the 95% herd immunity threshold. **Q:** How many people were exposed in the county's measles case? **A:** 33 people were identified as contacts at one exposure location, with two people requiring daily symptom monitoring. **Q:** What happened when the county issued an RFP for winter shelter operations? **A:** Zero organizations responded, forcing the county to plan operating the shelter again with hired staff rather than stretching existing employees. **Q:** How long can measles virus survive in the air after an infected person leaves a room? **A:** Up to two hours, making it extremely contagious and difficult to contain. **Q:** What is the current size of PHAB? **A:** 21 members, which many participants noted creates challenges for efficient decision-making and meaningful participation. **Q:** Which Whatcom County program recently won a national achievement award? **A:** The Whatcom County Veterans Program earned recognition from the National Association of Counties. **Q:** What are the three Health Board expansion models under consideration? **A:** 10-member board (3 council, 2 cities, 2 tribes, 3 community), 14-member board, or 18-member board keeping all council members. **Q:** How many confirmed measles cases has Washington state had this year? **A:** 10 confirmed cases across three counties, with no outbreaks (defined as more than three related cases). **Q:** What percentage of people exposed to measles will become infected if they're not immune? **A:** 90% of non-immune people exposed to measles will become infected. **Q:** How many contracts does the health department currently manage? **A:** Over 300 fully executed contracts, previously managed by just one staff person. **Q:** What is the incubation period for measles? **A:** People can develop symptoms up to 21 days after exposure, and they're contagious for four days before the rash appears. **Q:** Which council members expressed the most skepticism about Health Board expansion? **A:** Mark Stremler and Ben Elenbaas voiced the strongest concerns about the need for change. **Q:** How many staff did the health department recently move between divisions? **A:** Five staff members were moved to improve efficiency and create better organizational infrastructure. **Q:** What cash price did they cite for an MMR vaccine? **A:** $106 at a local Bellingham pharmacy with a GoodRx coupon, though most people receive it free through insurance. **Q:** How many deaths occur per 1,000 measles cases? **A:** One to three deaths per 1,000 reported cases, with higher hospitalization rates and serious complications. **Q:** What major funding was secured for the LEAD diversion program? **A:** Ongoing funding for the remainder of 2025, after months of uncertainty about the program's future. ---