The Brief

Tens of thousands of doses of a new RSV shot will be shipped to pediatricians and hospitals throughout the country, as a months-long nationwide shortage collides with an increasing number of cases.

The long-acting monoclonal antibody is administered as an injection to infants to protect them from severe illness caused by the respiratory syncytial virus — or RSV infections, which are the leading cause of hospitalization among babies.

The additional 77,000 doses “will be distributed immediately” through the Vaccines for Children Program and commercial channels, according to the Centers for Disease Control and Prevention.

“That’s a good first step, but there are about 10,000 babies born in the U.S. each day, so this will cover us for a week,” said Orange County pediatrician Eric Ball.

“I have about 30 doses,” he added. “Right now we have to ration and we're turning people away because we just can't get the shot.”

The shot is a monoclonal antibody treatment, not a traditional vaccine. The lab-grown proteins supplement a baby’s underdeveloped immune system and give them immunity for about five months, long enough for them to get through their first respiratory virus season when they're at highest risk for complications.

Nirsevimab is approved for all infants up to 8 months old, and for some older babies and toddlers considered at higher risk due to RSV. The American Academy of Pediatrics recommends that every baby whose mother did not get the RSV vaccine while pregnant receive nirsevimab in the first week of life.

In clinical trials, the shot reduced RSV hospitalizations and health care visits in infants by almost 80%.

Doctors hoped the immunization would be a game changer in pediatrics. Ball said it’s devastating for babies to contract RSV and can affect survivors' lungs for years to come.

“They get fluid in their lungs, and the hardest thing about RSV is there's no effective treatment,” Ball said. “You just have to kind of support them and wait it out. So a lot of these babies are in the hospital for a week or more on oxygen until their body can fight it off and they get better on their own, and some don’t make it.”

The new shot for babies and toddlers became available in September. By mid-October, demand for nirsevimab had already outstripped supply, according to the pharmaceutical company Sanofi.

In response, the CDC issued guidance in October advising pediatricians to allocate the limited supply of doses by focusing on the infants at highest risk of RSV complications: babies under 6 months old and those with underlying medical conditions.

That leaves pediatricians to decide who gets the shot — and who doesn’t.

“We're seeing a lot of RSV right now. I had a [patient] admitted to the hospital just last week,” Ball said. “I fear for what's going to happen this winter. It's hard for us to have these babies who get sick or admitted to the hospital with something that theoretically could have been prevented.”

Different vaccine supplies for different insurance

There are two parallel vaccine systems in the United States. Children with commercial health insurance, such as through their parent’s employer, receive vaccines through the commercial market. Children with government insurance, such as Medi-Cal, get shots through the federally funded Vaccines for Children program, which provides vaccines to half of all children in the U.S.

Ball said his practice has never received RSV shots through the Vaccines for Children program, meaning none of his patients on Medi-Cal have been immunized.

“And they are the most vulnerable,” Ball said. “It’s just horrible.”

The shot comes with a hefty price tag of $495 per dose, making it the most expensive standard childhood shot.

Due to a quirk in the Affordable Care Act, commercial insurance plans can wait up to a year before they are required to cover it.

That leaves parents whose insurance won’t cover it with a gut-wrenching decision: Do they pay hundreds of dollars for an expensive immunization that will protect their child during the RSV season or take the risk their child may get sick and end up in the hospital?

“It's a terrible decision and dilemma that we're putting our families through,” Ball said. "If an insurance company is not going to pay for it, we're putting the burden of that cost onto a family with a newborn baby. And it leads to inequities in our health care system, where only rich people can protect their babies."

Pediatricians say the high cost of the shot slows down the dissemination of the medication, along with the many bureaucratic obstacles in Medicaid's system for vaccine distribution to children.

RSV shot for pregnant people

Another shot that also protects babies is available for a specific window during pregnancy, and it’s readily available.

Pregnant people between 32 and 36 weeks can get immunized and the protection is transferred to their baby in utero, negating the need for the child to get the shot as a newborn. It has an added bonus of protecting the pregnant person from RSV infection.

“If you're pregnant and you're in that range, get that now so that you don't have to go through this rigmarole of having to get insurance authorization or shopping around to find a place that has the RSV immunization,” Ball said.

“It's much easier for the pregnant people to get vaccinated than to do the babies.” he said.

The federal financial aid process opened this past week for students applying to college for next year. But for many California students, a source of state financial help remains untapped.

In 2022, the state launched the California Kids Investment and Development Savings Program, also known as CalKIDS, and began creating investment accounts for more than 6 million children in the state to use for higher education.

Babies born on or after July 1, 2022, can get up to $175 in their accounts, while low-income public school students can claim up to $1500.

In Los Angeles County, about 1.1 million public school students are eligible for the accounts, but fewer than 20% of kids have claimed them, said Cassandra DiBenedetto, executive director of California’s ScholarShare Investment Board. The claim rate is even less for babies — about 11%.

“The money itself, it has a long trajectory. So you have these newborns, and there's not a sense of urgency among some parents; they know the account's there, it’s been created. Parents are busy,” DiBenedetto said.

There is no deadline to claim the money, which is already growing in the investment accounts. (You do have to use the money by age 26). But DiBenedetto says kids are more likely to see themselves as college-bound if they have it — and will be able to watch the account grow over time.

“ You talk to second-and third graders who are like, ‘I'm gonna go to UC Santa Barbara,’ ‘I'm gonna go to Cal Berkeley,’” she said.

The state is working with the Los Angeles Unified School District and other school districts to get students signed up.

The city’s top financial adviser is recommending that the Los Angeles City Council deny a police department request to procure 300 additional vehicles for the 2028 Olympics and Paralympics.

The report, submitted to the council Monday by City Administrative Officer Matt Szabo, found that the L.A. Police Department would have enough vehicles to temporarily expand its fleet during the Games without the additional cars.

LAPD officials had previously requested around $31 million, arguing the additional officers deployed for the Games will need additional vehicles for their police work.

But Szabo disagreed in his report, finding instead that the department would soon have a large enough fleet.

“Given the current available vehicles and new vehicle procurements which have already been funded, it is not recommended to authorize the procurement of any additional police vehicles for the 2028 Games deployment,” Szabo wrote.

An LAPD spokesperson declined to comment on the city administrative officer’s report. Previously, the department has emphasized that its request seeks only to temporarily expand its fleet, with plans to retire old vehicles after the Games.

The police department has offered different estimates of how many additional vehicles it will need to patrol the Olympics. Two months after the LAPD asked for an additional 300 vehicles, the department released another report estimating an even higher need: 576 police vehicles.

Either way, Szabo’s report found that more than 1,100 police vehicles not yet in use by the department were funded in the past three budget cycles. He said those should be sufficient for the Olympics.

When you sit down at Birria Pa La Cruda in El Sereno, you might be expecting one thing. What you'll leave talking about is something else entirely, and it's just as good.

Take the mushroom quesataco. It starts with a tortilla brushed with avocado oil and griddled until lightly crisp, then layered with a thin skirt of cheese and a smooth smear of refried red kidney beans. On top goes a heap of shimeji mushrooms braised in a house-made salsa verde, mild, nutty and savory with a bright finish.

It's a slight departure for chef Carlos Jaquez, who spent seven years building a reputation for the birria de res at his popular pop-up. Now, at his new brick-and-mortar just blocks from where he got his start, he's serving his much-loved birria alongside several vegetable-focused dishes — including this one.

You get the sense that Jaquez has been refining each one for years through his pop-up, his work as a private chef and his high-end dining background at Otium and Bestia.

Homegrown talent

Jaquez grew up in El Sereno and launched Birria Pa La Cruda (which means “for the hangover” in Spanish) as a Sunday pop-up in 2019. Over the years, he's drawn on everything from his family's cooking to his Indigenous roots, to the bounty of local produce, building a repertoire that showcases the full range of his influences. His new place, on Alhambra Road near Cal State L.A., is his chance to prove it.

Carlos Jaquez, chef and owner of Birria Pa La Cruda, draws on the El Sereno community where he grew up and a wide range of culinary influences.

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Eric Valle

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Courtesy Birria Pa La Cruda

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"I don't wanna just be the birria guy," Jaquez said. "If people know me for just the birria, then I'm sure that one day when I cook something else they'll be like, 'Wow, he can cook other stuff too.'"

The menu

The mushroom quesataco may be exquisite, but Jaquez's birria de res hardly takes a back seat. For example: the mulita. Two corn tortillas are dipped in spiced 12-hour braising liquid, and the beef he uses is cooked in a pot lined with charred blue agave leaves that Jaquez harvests from the El Sereno hills. The meat is piled on thick, then topped with cheese, resulting in a juicy, well-seasoned bite where all the flavors and textures meld together. It's a mouthful, but the mulita shows backbone, never falling apart bite after bite.

The sweet potato tamal, topped with date-almond mole and sesame seeds, served with red amaranth leaves and pickled vegetables.

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Eric Valle

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Courstesy Birria Pa La Cruda

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Where the birria is a constant, the tamal is expected to change with the seasons. Right now, it's sweet potato and organic yellow corn masa steamed in a banana leaf, then topped with a rich mole made from California-grown dates and almonds. It's entirely vegan, though Jaquez doesn't advertise it that way. It's served alongside pickled carrots and a small salad of amaranth leaves grown just outside the space and dressed in a confit garlic vinaigrette.

Amaranth was a staple for Indigenous peoples in Mexico long before the Spanish arrived. Jaquez, who attended Anahuacalmecac, an Indigenous-focused charter school in El Sereno where students learn Nahuatl from third grade through high school, wanted it on the plate.

"We were eating amaranth and tamales and maybe even combining them thousands and thousands of years ago," he said. "Serving that on a menu today is a reflection of the resilience of our roots."

California love

Jaquez believes the caliber of his cooking comes from using local ingredients, whether it’s tortillas and masa milled in Boyle Heights by Kernel of Truth or heirloom tomatoes from Valdivia Farms in Carlsbad.

Chef Carlos Jaquez's birria de res is braised for 8 to 12 hours before it's served.

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Eric Valle

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Courtesy Birria Pa La Cruda

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"Its uniqueness comes from the locality and the quality of the ingredients that we're afforded because we're in L.A. and California," he said.

So, is it a taqueria or a restaurant?

"I don't know," Jaquez said. "It's Birria Pa La Cruda."

California’s district attorneys and the state attorney general will now have the ability to sue individual businesses that they believe are engaging in anticompetitive conduct.

But for some of its biggest proponents, it’s a hollow victory.

Gov. Gavin Newsom on Wednesday signed Assembly Bill 1776, known as the Compete Act, bringing an end to one of the most hard-fought political battles of the year. Unions and consumer rights groups supported the bill, but the state’s influential Chamber of Commerce fiercely opposed it and won several concessions to water it down.

Assemblymember Cecilia-Aguiar Curry, a powerful Davis Democrat, introduced the bill to modernize the century-old Cartwright Act, which regulates only anticompetitive conduct by two or more businesses. Many progressive Democrats, concerned about corporate consolidation of business in industries such as healthcare, ticket sales and retail, signed on as co-authors.

Newsom signed the bill along with six other small business-friendly bills on the constitutional deadline for signing legislation.

“We’re taking on predatory practices that drive up costs and shut entrepreneurs out — making sure California’s economy works for everyone, not just the biggest and best-connected,” he wrote in a release announcing his approval.

However, his signing message on AB 1776 was more circumspect.

“While I align myself with a stated goal of targeting anti-competitive conduct that harms consumers, workers, and businesses alike, we must be careful not to set the bar too low — dragging legitimate, superior business practices and products into the ambit of anti-competitive behavior,” he wrote.

He added that he expects judges and prosecutors to interpret and apply the law “in ways that penalize clear wrongdoing, without creating needless uncertainty.”

Lee Hepner, senior legal counsel at the American Economic Liberties Project, a former sponsor of the bill, wrote in a post on X that Newsom’s signing message made Hepner pessimistic that the law would be effective.

“I foresee politicized antitrust litigation budgets, partisan allegations of weaponized enforcement, novel legal defenses that find new basis in the legislative history of this bill, and public officials caving to the concentrated private power that antitrust laws are supposed to put in check,” he wrote.

The group had helped craft the legislation for years, but changed its position when Aguiar-Curry removed a “private right of action” provision that would have allowed any individual or business to sue a company they allege is harming them through anticompetitive tactics.

Other supporters included the California Federation of Labor Unions and TechEquity Action, a progressive advocacy group that lobbies for regulation of the tech industry.

Labor Federation President Lorena Gonzalez said in a statement that the new law “gets us one step closer to building a more affordable economy for working people.”

The bill grew out of a three-year review by the California Law Revision Commission, which the Legislature had asked to study changes to the 1907 Cartwright Act.

The private right of action was one of the biggest sticking points for CalChamber, which argued it would “expose businesses of all sizes to a wave of frivolous lawsuits.” The group launched a multimillion-dollar ad campaign over the summer to push to weaken the proposed law. Tech companies such as Meta and Google also spent hundreds of thousands of dollars to lobby legislators on AB 1776 and other issues.

Although Aguiar-Curry said she was disappointed the private right of action was gutted in the last weeks of the legislative session, she pressed on, and lawmakers passed the bill in the last days.

“California now has stronger tools to protect our small businesses, workers, and consumers and to make sure our markets work for everyone,” she said in Wednesday’s release.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.