A Crisis Rooted in Neglect

In February 2025, a disease most Americans believed belonged to the 19th century quietly began spreading through the suburbs and urban neighborhoods of eastern Kansas. Tuberculosis—ancient, airborne, and deadly—was back. And not in a faraway war-torn country or among unhoused populations in overcrowded city shelters, but in elementary schools, clinics, grocery stores, and family homes.

The Kansas Department of Health and Environment (KDHE) confirmed 67 active cases of tuberculosis by early May, with another 79 identified as latent infections—individuals who are infected but not yet symptomatic (KDHE, 2025). The outbreak primarily affects Wyandotte and Johnson counties, areas that span both underserved urban pockets and wealthy suburbs. Two people are already dead.

This is not merely an outbreak. It is one of the largest clusters of tuberculosis seen in the United States in decades. Kansas officials, keen to avoid panic, were slow to escalate the response. The state’s top health officer publicly stated the risk to the general public remains low—while quietly partnering with the Centers for Disease Control and Prevention (CDC) to ramp up contact tracing and containment efforts.

But make no mistake: this crisis was preventable. It is not the product of mutation, immigration, or poverty alone. It is the culmination of years of policy decisions, ideological warfare against public health, and an electorate more concerned with symbolic freedoms than material consequences. Thomas Frank asked, “What’s the Matter with Kansas?” in 2004. In 2025, we have an answer: deliberate neglect cloaked in populist defiance.

In 2021, Kansas began stripping public health officials of the authority to enforce health mandates. That year, in response to the backlash against COVID-19 restrictions, the Kansas Legislature passed laws weakening the power of county and state health departments to enforce quarantines, mandate testing, or close businesses in emergencies (Kansas Reflector, 2021). By 2022, many local officials had resigned, citing threats and burnout. By 2023, Kansas had one of the weakest public health enforcement systems in the nation.

So when tuberculosis began spreading in early 2025, officials were left without the tools to respond with urgency. And worse: they were left without public trust.

The people of Kansas, primed for years to view public health as government overreach, responded not with concern—but with skepticism. Misinformation flourished on social media. Parents refused TB testing for their children. Some suggested this was another hoax meant to justify future lockdowns. Others, emboldened by political rhetoric, demanded schools remain open and testing remain optional.

All the while, children sat in classrooms with infected peers. Families shared air with symptomatic relatives. And doctors, wary of pushing too hard, hesitated to report early cases or press for mandatory treatment.

Kansas is not alone in its vulnerability, but it is unique in how thoroughly it gutted its safeguards—and how quickly that unraveling has led to real human cost. Tuberculosis did not return to Kansas because of bad luck. It returned because Kansas invited it.

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Health Policy and Legislative Sabotage

In Kansas, the tuberculosis outbreak of 2025 did not emerge in a vacuum. It emerged in the wreckage of a calculated campaign against public health authority—one that began long before the first cough was traced to an elementary school hallway in Wyandotte County. The current health emergency is not just a viral resurgence. It is the political consequence of decisions made in Topeka, on talk radio, and at campaign rallies where freedom was defined not as collective safety but as resistance to science.

After the COVID-19 pandemic, Republican lawmakers in Kansas led efforts to dismantle nearly every health protection protocol that had been put in place. House Bill 2280, passed in 2021, stripped local health officers of the power to order quarantines or require vaccinations during outbreaks. These powers were transferred to elected county commissions—bodies with no medical expertise and frequent political motivations (Kansas Reflector, 2021). The result was immediate confusion. Health professionals could no longer act swiftly, and every outbreak became a political debate.

In February 2025, as TB cases climbed, local authorities were powerless to impose isolation. Under the revised law, even the state’s health secretary had limited reach. No orders could be enforced without approval from political appointees, often driven by reelection concerns rather than epidemiological models.

This devolution of authority wasn’t accidental—it was the outcome of years of rhetorical framing. Public health was no longer seen as a collective good but as an arm of government control. In 2020 and 2021, Kansas officials proudly touted their resistance to mask mandates and lockdowns, even as hospitals in Wichita and Kansas City overflowed with COVID patients. In campaign ads, candidates promised to “protect your rights” from doctors and scientists. In legislative halls, they boasted of “freeing Kansans from tyranny.”

The irony is suffocating: in their effort to protect freedom, legislators undermined the very tools needed to protect life. And as TB quietly spread through school gyms and workplace cafeterias, those same lawmakers were nowhere to be found.

Even now, the legislative response has been sluggish and cosmetic. A “task force” was announced in April 2025, too late to contain the initial wave. No emergency health orders were authorized. No funding for expanded testing was released. Instead, the state issued vague assurances that “the situation is under control”—despite CDC officials privately warning Kansas health leaders that without aggressive intervention, this outbreak could spread to nearby states (Associated Press, 2025).

And yet, the broader Kansas public remains largely unaware or disengaged. In a state where public health messaging has been drowned out by anti-vax influencers and political radio, it’s not surprising. One local news outlet reported that a majority of Kansans polled in late April 2025 were unaware there even was a tuberculosis outbreak at all.

There is a deep tragedy in this — not only because lives are at stake, but because the damage is self-inflicted. Kansas has excellent hospitals, skilled doctors, and experienced epidemiologists. But in this ideological landscape, those resources are shackled. What use are medical experts if their warnings are ignored? What use are outbreak response protocols if they require political approval to activate?

The tuberculosis outbreak is the result of legislative sabotage: an experiment in libertarian governance taken to its logical conclusion. A public stripped of protections, officials stripped of power, and diseases given free rein. It is not a natural disaster. It is a manmade failure.

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Institutional Failure and Professional Irresponsibility

Public health emergencies demand rapid, unified responses. In Kansas, the tuberculosis outbreak of 2025 was instead met with infighting, institutional paralysis, and a stunning failure of professional responsibility. It wasn’t just the laws that failed Kansans—it was also the bureaucracies and medical systems that hesitated, squabbled, and downplayed early signs of a crisis.

In the early days of the outbreak, health officials from the Kansas Department of Health and Environment (KDHE) and the Unified Government Public Health Department (UGPHD) of Wyandotte County clashed over who was responsible for initiating community-wide testing and public notification. According to internal emails obtained by the Kansas News Service, state and local officials were more concerned with public perception than with public safety (KCUR, 2025). Each side pointed fingers over delays in testing, confusion about reporting protocols, and a lack of communication with schools and clinics.

By the time formal testing began in some schools, multiple students had already been exposed for weeks.

In Wyandotte County, which recorded the majority of early cases, school nurses reported difficulty accessing proper diagnostic materials and said they received conflicting instructions about whether parental consent was needed to test asymptomatic children. These delays proved costly: latent TB, if untreated, progresses silently. By the time a student begins to cough, they’ve likely already infected others.

This was not just a logistical failure—it was a moral one. Doctors and nurses on the frontlines of the outbreak admitted privately, according to leaked correspondence, that they had hesitated to alert public health authorities to suspected TB cases for fear of triggering “another COVID-like panic” or attracting unwanted political scrutiny. In Kansas, where even minor mitigation efforts became media spectacles in recent years, health professionals have been conditioned to second-guess their obligations.

“There’s been a culture of fear instilled in our medical community,” one anonymous physician in Johnson County told The Kansas City Star. “We’re being taught not to rock the boat, even when the boat is sinking.”

Some pediatricians, fearing backlash from anti-mandate parents, chose not to proactively screen children who had potentially been exposed, citing “lack of clarity” from the state. Others admitted they weren’t trained to recognize TB in its early stages because it had been nearly eradicated in the U.S. and dropped from many continuing education curricula.

Meanwhile, hospitals struggled to identify and isolate infected individuals due to the slow adoption of CDC-recommended protocols. At least one major hospital in the Kansas City metro area was found to have treated multiple TB patients in general waiting areas before they were correctly diagnosed, according to an internal hospital report reviewed by the Associated Press.

At the institutional level, Kansas’ fragmented healthcare delivery system—spread across county lines, with limited central oversight—meant there was no clear plan in place for disease containment. Hospitals operated independently, school districts made their own decisions about closures, and county commissioners—many with no medical background—overruled health department recommendations.

The result: not just a failed response, but a dangerously inconsistent one. In some districts, children were sent home for potential exposure. In others, school remained in session despite known cases. One district provided N95 masks to its teachers. Another offered nothing more than a letter home. In one extreme case, a teacher in Olathe was placed on unpaid leave after refusing to work in a classroom with an untested student population.

The absence of a unified voice—and a culture that punishes professionals for doing the right thing—allowed a once-rare disease to regain a foothold in modern America. And those most affected were the very individuals the system is meant to protect: children.

If there is any lesson in this phase of the crisis, it’s that institutions are only as strong as the people willing to use them. In Kansas, those people hesitated. And their hesitation has left dozens infected and hundreds more at risk.

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The Role of Parents, Misinformation, and Community Apathy

If public officials weakened the legal tools to fight disease, and health professionals hesitated to act, it was the broader public—especially parents—whose indifference or defiance accelerated the spread. Kansas’ tuberculosis outbreak is not simply a failure of institutions. It is a reflection of community apathy, ideological rigidity, and willful ignorance, all of which have converged in the worst possible place: the schoolhouse.

After COVID-19, Kansas became a breeding ground for vaccine skepticism and anti-public health sentiment. School board meetings turned into battlegrounds. Parents protested mask mandates, quarantine rules, and vaccine campaigns—not as safety measures, but as attacks on liberty. By 2023, several districts had stopped requiring routine childhood vaccinations altogether unless parents proactively opted in, a reversal of long-standing public health best practices.

Then came House Bill 2294.

Passed in 2024, HB2294 allowed parents to opt out of all vaccinations for schoolchildren, including tuberculosis screening and treatment, simply by citing “sincerely held religious beliefs.” The bill’s passage was cheered by lawmakers who claimed they were protecting Kansan families from government overreach. But in practice, the law opened the door to abuse and exploitation. Parents who simply distrusted modern medicine or read conspiracy theories on Facebook could now avoid protecting their children—and others—with no scientific justification.

As tuberculosis spread in early 2025, many families chose to decline testing. In Johnson County, a school district reported that nearly 25% of families refused TB tests for their children despite documented exposures, citing “personal liberty” or distrust in public health (KMBC News, 2025). Several parents formed social media groups to organize opposition to school-based testing and began circulating false information about the disease: that it was “just a bad cold,” that positive test results would lead to government surveillance, or that antibiotics were more dangerous than TB itself.

The irony is chilling. Kansas parents, long conditioned to see themselves as protectors of freedom and defenders of the family unit, are now actively endangering their own children—and others’—by rejecting the very tools that could stop a deadly airborne disease. One mother in Overland Park, interviewed anonymously, admitted she refused testing even after her daughter developed a persistent cough. “I didn’t want her getting labeled or quarantined,” she said. “That’s not the kind of attention we need.”

Meanwhile, public messaging was virtually nonexistent. State agencies, wary of political backlash, issued only tepid press releases that framed the outbreak as “contained” and “under surveillance.” Local health departments, already overwhelmed, lacked the resources or political cover to mount aggressive information campaigns. Misinformation filled the vacuum.

Churches, which could have played a pivotal role in shaping community understanding, were largely silent. In some cases, religious leaders outright discouraged cooperation with health authorities. At a congregation in Leavenworth County, a pastor warned that TB testing was “a pretext for more government tracking.” Few voices of reason were amplified.

This mass withdrawal from collective responsibility had predictable consequences. In a society where airborne illnesses rely on proximity and passivity to spread, apathy becomes a form of complicity. Every parent who opted out, every school board that downplayed risks, every neighbor who said, “That’s not my problem,” contributed to the chain of infection that now spans multiple counties.

Children, especially in public schools, are bearing the brunt. While private and charter institutions quietly moved to isolate or even exclude untested students, many public schools were powerless to act under current state law. Teachers with health concerns were told to use their own sick days. Immunocompromised students were told to stay home, essentially removing the most vulnerable from the classroom while leaving the exposed behind.

As Thomas Frank observed in What’s the Matter with Kansas?, the state’s political culture is defined by people voting against their own material interests. In 2025, this phenomenon has metastasized. It’s no longer just a matter of economic self-sabotage. It is now a full-blown public health crisis—a parent-led rebellion against basic science, with children caught in the middle.

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What This Outbreak Reveals About America’s Future

Kansas is not an outlier. It is a warning. The tuberculosis outbreak of 2025 is a stark illustration of what happens when a nation that once led the world in public health quietly abandons its commitment to collective care. It didn’t happen all at once. It happened through a thousand legislative cuts, a thousand acts of parental defiance, and a thousand professionals looking the other way.

If there is one question this moment forces us to ask, it’s this: what kind of society do we want to be?

We’ve long accepted, even romanticized, the notion of American ruggedness—of distrust in big government, of individual liberty above all else. Thomas Frank chronicled how Kansas, once a bastion of populist progressivism, became a laboratory for ideological extremism disguised as Midwestern values. Two decades later, that same ideological shift has metastasized into something far more tangible: not just lost wages or underfunded schools, but lost lives. Children are coughing blood in classrooms while their parents rail against antibiotics. Elderly residents are dying silently while lawmakers argue that freedom means never closing a playground.

In the absence of a coordinated federal mandate, states like Kansas are left to manage outbreaks themselves. But with hollowed-out public health departments and partisan commissions blocking every move, “management” becomes a euphemism for waiting. Waiting for someone else to act. Waiting for the virus to burn out. Waiting for another tragedy to shift public opinion. But tuberculosis doesn’t wait. It spreads.

This outbreak tells us that the public health framework of the United States is fragile—and in many places, intentionally dismantled. It tells us that medical expertise, without political authority or community trust, is powerless. And it tells us that when communities retreat into ideological corners, even the most basic acts of care—testing, treating, isolating—become politicized.

It’s not that the public doesn’t care about children. It’s that the very idea of public good has been weaponized. As recently as April 2025, Kansas state legislators were still pushing bills to limit the sharing of medical records between schools and health departments. They did so in the name of privacy, but the effect was predictable: more delays, more confusion, more children sitting in classrooms while latent infections went unchecked (Kansas Legislature Tracker, 2025). No one wanted the responsibility, only the rhetoric.

What makes this moment particularly damning is that it didn’t have to happen. TB is treatable. Contact tracing is effective. Masks, ventilation, antibiotics—all readily available. Yet in Kansas, the tools sat idle while the narrative ran wild. Freedom was redefined not as protection from harm, but as protection from facts.

The media bears some responsibility as well. National outlets paid the outbreak little attention until it was one of the largest in recent U.S. history. Local journalists struggled to cover the story amid threats, layoffs, and a growing mistrust in news itself. In a state where headlines are seen as political weapons, few dared to name the truth: this was a preventable failure.

There is still time to reverse course. But it will require Kansas—and other states like it—to confront uncomfortable truths. That freedom without responsibility is just negligence. That skepticism of government is healthy until it endangers your neighbor. That “parental rights” must never come at the expense of public safety. And that diseases don’t care who you voted for.

America’s health care system was once a model of innovation and compassion. In 2025, it is fractured—riven by partisanship, fear, and a culture that valorizes the individual even as it abandons the community. The Kansas TB outbreak is not just a regional issue. It is a case study in what happens when ideology trumps infrastructure, when science is ignored, and when our most vulnerable—children—are sacrificed to a fantasy of freedom.

And so, we return to Frank’s question: What’s the matter with Kansas?

Everything that’s the matter with America.