By AMANDA SEITZ, Associated Press

WASHINGTON (AP) — As measles outbreaks popped up across the U.S. this winter, pediatricians waited for the nation’s public health agency to send a routine, but important, letter that outlines how they could help stop the spread of the illness.

It wasn’t until last week — after the number of cases grew to more than 700, and a second young child in Texas had died from a measles infection — that the Centers for Disease Control and Prevention finally issued its correspondence.

The delay of that letter may seem minor. But it is one in a string of missteps that more than a dozen doctors, nurses and public health officials interviewed by The Associated Press identified in the Trump administration’s response to the outbreak.

Health secretary Robert F. Kennedy Jr.’s efforts to contain an epidemic in a tight-knit, religious community in West Texas have run counter to established public health strategies deployed to end past epidemics.

“What we are lacking now is one, clear strong voice — from the federal to the state to the local — saying that the vaccine is the only thing that will prevent measles,” said Patricia Stinchfield, a nurse and infectious disease expert who helped stop a 2017 measles outbreak in Minnesota’s Somali community.

An ‘extremely unusual’ approach to the outbreak

Behind the scenes, Kennedy has not been regularly briefed in person on the outbreak by his own infectious disease experts at the CDC at least through March 21, according to Kevin Griffis, a career staffer who worked as the agency’s communications director until he resigned that day.

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Even after the measles claimed its first young Texas victim in late February, Kennedy had still not been briefed by CDC staff, Griffis said. His account was confirmed by a second former federal health official, who resigned at the end of February.

A spokesperson for Kennedy did not answer specific written questions about how he had been briefed or his communications with CDC staff.

The spokesperson said the CDC activated an Atlanta-based response in early February to provide overall guidance on measles testing and vaccination strategy. An on-the-ground team was deployed to West Texas throughout most of March and withdrawn on April 1.

It was a “joint decision” between state and federal officials to send the team home, CDC spokesman Jason McDonald said. Another team of seven was dispatched back to the region this week.

In previous administrations, health secretaries held weekly briefings with CDC staff, lasting between 25 and 30 minutes, during infectious disease outbreaks, both former HHS officials said. Kennedy, instead, received updates on paper or through email, Griffis said.

“That is extremely unusual,” said Griffis, who sat in on such briefings with the previous health secretary and said that none were held for Kennedy during his first month on the job. “I’ve never seen that before.”

In another irregularity, the American Academy of Pediatrics, the nation’s largest network of pediatricians, has not been tapped to work with the CDC on the outbreak, according to the organization’s officials. Historically, the CDC and AAP have convened for monthly or biweekly briefings during outbreaks to share updates, which include details about what doctors are seeing and questions they’re fielding from parents in exam rooms. The officials spoke on the condition of anonymity to freely discuss the health department’s response.

The only updates provided widely to pediatricians by the CDC have come from a health alert network update sent on March 7, a week after the first U.S. measles death in a decade, and the letter sent to providers last week, which, according to the pediatric academy officials, was late in the outbreak.

Kennedy praised the CDC on Tuesday during an event in Indianapolis, saying it “had done a very good job controlling the measles outbreak.”

Kennedy endorses vaccines, but still raises safety doubts

Kennedy’s inconsistent and unclear message on the measles vaccines has also made the outbreaks difficult to contain, experts say.

He has occasionally endorsed the measles, mumps and rubella vaccine as “effective,” but also continues to raise safety concerns about the shots in other statements. In a CBS interview last week, he claimed the vaccines were “not safety tested.”

That approach has been the biggest flaw of the government’s response, said Dr. Carlos del Rio, the president of the Infectious Disease Society of America.

“Imagine if the captain of the Titanic had told you that you need to be careful about lifeboats and think about other opportunities,” del Rio said.

Trials were conducted on thousands of children before the vaccine was approved for use in the 1960s. The federal government has since used medical records to continue to monitor for side effects from use in millions of people since.

Health secretaries have typically delivered a clear message urging the public to get vaccinated during outbreaks, said Dr. Anne Schuchat, a former deputy director at the CDC who retired after 33 years at the agency in 2021.

President Donald Trump and his first-term health secretary, Alex Azar, urged people to get shots during news conferences in 2019, when measles ripped through Brooklyn and infected more than 1,200 nationwide.

“You don’t necessarily need the secretary of health to attend a funeral, OK, but you don’t want to have mixed messages on vaccines,” Schuchat said. “Someone in a federal building in Washington can do a lot of harm from the way that they are messaging.”

Texas Gov. Greg Abbott also quiet on vaccines

Local leaders have largely been left alone to urge the public to take up vaccinations.

Texas Gov. Greg Abbott, a Republican, has not urged the public to get vaccinated, either. He has not held any news conferences about the outbreak and posted just once on social media about measles since January. Any statements about the illnesses, which have also put 56 people in the hospital at some point, have been left to his aides.

Abbott’s office did not respond to questions about his response to the outbreak.

Governors in other states have responded more forcefully to the growing measles case count. Hawaii Gov. Josh Green, a Democrat and a doctor, made front page news last week after urging Hawaiians to take up vaccines when the state recorded its first measles case in a year.

Ahead of a busy travel week for the Easter holiday, Nebraska Gov. Jim Pillen, a Republican, unequivocally called on people to vaccinate themselves and their children. There are no known measles cases in Nebraska, but an outbreak is active in neighboring Kansas.

“If you’re not vaccinated, you’re going to get measles,” Pillen said last week.

Those types of statements are important for the public to hear leaders say from the top down, said Dr. Oxiris Barbot, who was New York City’s health commissioner during the 2019 measles outbreak.

Barbot worked with local rabbis, as well as doctors and nurses in the Jewish community, to send messages that encouraged vaccine uptake. Calls from Trump and Azar, who urged the public to vaccinate, helped her make the case, too.

When national leaders distance themselves from that message, she said it “starts to erode the effectiveness of people who are trying to convey those messages at the local level.”

Associated Press writers Paul Weber in Austin, Texas, Devi Shastri in Milwaukee and Margery Beck in Omaha contributed to this report.

By CHRISTOPHER BODEEN, Associated Press

TAIPEI, Taiwan (AP) — China appointed a new trade negotiator Wednesday in the midst of its tariff fight with the U.S.

The government said Li Chenggang replaces Wang Shouwen, who participated in negotiations for the 2020 trade deal between the China and the U.S.

The world’s two largest economies have been steadily increasing tariffs on each other’s goods. China faces 145% taxes on exports to the U.S., while dozens of other countries were given a 90-day reprieve for most duties.

Earlier on Wednesday, China announced its economy expanded at a 5.4% annual pace in January-March, supported by strong exports. Analysts are forecasting that the world’s second largest economy will slow significantly in coming months, however, as tariffs on U.S. imports from China take effect.

Exports were a strong factor in China’s 5% annual growth rate in 2024, and the official target for this year is also about 5%.

Beijing has hit back at the U.S. with 125% tariffs on American exports, while also stressing its determination to keep its own markets open to trade and investment.

In the near term, the tariffs will put pressure on China’s economy, but they won’t derail long-run growth, Sheng Laiyun, a spokesperson for the National Bureau of Statistics, told reporters earlier.

It wasn’t clear why China was changing negotiators but the move comes as Chinese officials say the country has multiple options to respond to U.S. actions, including relying more on its own vast market of 1.4 billion consumers, and on Europe and countries in the global south. But as China’s domestic consumption continues to languish, it will be difficult to replace the U.S. consumer.

China also imposed more export controls on rare earths, which include materials used in high-tech products, aerospace manufacturing and the defense sector.

Prior to his new appointment, Li spent about 4 1/2 years as China’s ambassador to the World Trade Organization, the body that governs global commerce and to which Beijing has appealed in its tariff dispute with the U.S.

He was also deputy permanent representative to the Chinese delegation to the U.N. office in Geneva and other international organizations in Switzerland.

Perhaps more so than his predecessor Wang, Li’s experience at the Commerce Ministry and his participation in negotiating China’s accession to the WTO more than 20 years ago stand him in good steed as China continues to refuse to cave in to U.S. demands, said Tu Xinquan, director of the China Institute for WTO Studies at the University of International Business and Economics.

Still, a bevy of higher-ranking leaders from President Xi Jinping on down is likely to chart the course, with Li representing their case in any talks with the U.S., Tu said, adding that Li is considered pro-free trade.

“There might be another style of negotiations. Li Chenggang is an open-minded person and supports free trade,” Tu said.

Xi, meanwhile, was making the case for China as a source of “stability and certainty” in global free trade as he tours Southeast Asia this week — implying that China is a more reliable trade partner than the U.S.

After first visiting Vietnam, he arrived in Kuala Lumpur, Malaysia’s capital, later Tuesday, for a three-day visit and will end his tour with a stop in Cambodia. In Malaysia, Xi is expected to discuss a free trade agreement between China and 10-member Association of Southeast Asian Nation, one of several funds and agreements China has led as a means of sidestepping organizations and mechanisms dominated by the U.S. and the West.

Asked about the possibility of talks with the U.S., Chinese Foreign Ministry spokesperson Lin Jian said the U.S. had begun the tariff spat and China was only “taking necessary countermeasures to defend its legitimate rights and interests and international fairness and justice.”

“If the U.S. truly wants to resolve the issue through dialogue and negotiation, it should stop using maximum pressure and stop threats and blackmail. For any dialogue to happen, it must be based on equality, respect and mutual benefit,” Lin said at a daily briefing.

By MICHELLE GUMEDE, Associated Press

JOHANNESBURG (AP) — An American pastor who was kidnapped last week by armed and masked men during a sermon in the Eastern Cape province of South Africa was rescued on Tuesday after three of his abductors engaged in gunfire with officials and were killed, police reported Wednesday.

The 45-year-old American citizen, Josh Sullivan from Tennessee, has been based in the Motherwell township branch of the Fellowship Baptist church since 2018 alongside his wife and two children.

The missionary was abruptly abducted on Thursday evening when four men broke into the Fellowship Baptist church in Motherwell. They stole two cellphones from members of the congregation before seizing Sullivan from the pulpit and bundling him out of the building. His truck was found abandoned a few hours later.

A multi-agency task force, including the Anti-Gang Unit and the Serious Organised Crime unit, took over the investigation. On Tuesday night they approached the location where they suspected Sullivan was being held, a house in KwaMagxaki, Gqeberha about 20 minutes’ drive from the Baptist church.

According to police, a shootout began when suspects in a car parked outside the house tried to escape and began firing at them. Three unidentified suspects were killed, police said.

“The victim was found inside the same vehicle from which the suspects had launched their attack,” Lieutenant Colonel Avele Fumba said in a statement. “Miraculously unharmed, he was immediately assessed by medical personnel and is currently in an excellent condition.”

The number of kidnappings in South Africa has risen by 264% over the past decade, police data showed.

According to the Institute of Security Studies, a think tank specializing in Africa, kidnapping has become a key tactic in armed robberies and carjackings. In its latest Africa report, the ISS notes that less than 5% of kidnappings in South Africa involve ransom demands.

Since his release, Sullivan, who describes himself as “a church-planting missionary” on his personal website, has been reunited with his wife Meagan and their two children.

A man named Tom Hatley, whom Sullivan describes on his personal blog as his childhood and training pastor, posted a picture of Sullivan and his family on Facebook. Explaining that he had received “the go ahead to let it be known”, Hatley said, “Josh has been released.”

“Thank you for your support and prayers. Please do not stop praying for The Sullivans,” his post read.

“Also, PLEASE respect The Sullivans privacy and their parents. A lot of folks love The Sullivans, and they love you back, but give them some time.”

By ELAINE KURTENBACH, Associated Press Business Writer

BANGKOK (AP) — World shares were mostly lower Wednesday as stocks of Nvidia and other technology companies were walloped by tighter U.S. controls on exports of advanced computer chips used for artificial intelligence.

The future for the S&P 500 was down 0.8% while that for the Dow Jones Industrial Average lost 0.3%.

Chip maker Nvidia’s shares fell 5.9% in premarket trading after it said the U.S. had imposed stricter controls on its exports of one of its computer chips designed for use in artificial intelligence. Rival chip maker AMD’s shares dropped 6.7%.

Trade war concerns also were revived by a Trump administration announcement of an investigation into imports of critical minerals such as rare earths, which are used in smart phones, electric vehicles and many other products.

In early European trading, Britain’s FTSE 100 lost 0.3% to 8,224.51 after the government said inflation in the U.K. fell for the second month running in March largely as a result of lower gas prices.

Germany’s DAX fell 0.7% to 21,139.72, while the CAC 40 in Paris gave up 0.5% to 7,299.72.

Stocks in China led Asian declines after Beijing reported the world’s second largest economy grew at a strong 5.4% annual rate in the first quarter of the year, helped by strong industrial production, retail sales and exports. But in quarterly terms, growth slowed to 1.2% in January-March from 1.6% in the final quarter of 2024.

Hong Kong’s Hang Seng dropped 1.9% to 21,056.98, while the Shanghai Composite index regained lost ground, adding 0.3% to 3,276.00.

Private sector economists have been downgrading their forecasts after President Donald Trump recently pushed his tariffs on most imports from China to 145%, while China raised its duties on imports from the U.S. to 125%.

Analysts at ANZ Research said activity in the current quarter is already weakening.

“Our view is that the tariff shock is caused by the unpredictability rather than the tariff itself. President Trump’s announcements have affected business sentiment and activity,” Raymond Yeung and other ANZ researchers said in a report after the China data was released.

In Tokyo, the Nikkei 225 index shed 1% to 33,920.40, pulled lower by big tech companies like chip testing equipment maker Advantest, whose shares dropped 6.6% and Disco Corp. which plunged 8%.

South Korea’s Kospi fell 1.2% to 2,447.43, while in Australia, the S&P/ASX 200 edged less than 0.1% lower to 7,758.90.

India’s Sensex rose 0.4% and Bangkok’s SET climbed 0.9%.

On Tuesday, U.S. stocks drifted, with the S&P 500 slipping 0.2% and the Dow down 0.4%. The Nasdaq composite edged less than 0.1% lower.

Uncertainty over President Donald Trump’s tariffs kept investors watching to see what comes next.

The U.S. bond market appeared to calm after its sudden and sharp moves last week shook confidence in the status of U.S. government bonds as a safe haven against risks.

The yield on the 10-year Treasury was steady at 4.33%, down from 4.38% late Monday and 4.48% at the end of last week. A week earlier it had been at just 4.01%. Yields usually drop when investors are jittery, so this week’s moves have offered reassurance.

The value of the U.S. dollar also steadied after tumbling last week, raising more worries that Trump’s trade war also may be undermining its status as a safe-haven investment.

Palantir Technologies climbed 6.2% for a second day of gains after NATO said it would use the company’s artificial-intelligence capabilities in its allied command operations.

In other dealings early Wednesday, U.S. benchmark crude oil bounced back from early losses, gaining 45 cents to $61.78 per barrel, while Brent crude, the international standard, picked up 49 cents to $65.16 per barrel.

Trump’s tariffs have raised expectations that economies will slow, denting demand for oil and other resources.

The U.S. dollar fell to 142.71 Japanese yen from 143.24 yen. The euro rose to $1.1369 from $1.1283.