Agricultural workers in the American South are caught in a dangerous gap: they face the highest risk of infection from the screwworm outbreak now spreading through livestock, yet they remain largely disconnected from the healthcare system that could treat them.
The parasitic fly has been detected in goats and sheep across three Texas counties in recent weeks, bringing the confirmed animal cases to 16. No human infections have been reported yet, but public health experts warn that farm workers living and working in affected areas are the most vulnerable population if spillover occurs.
Screwworms lay eggs in open wounds as small as tick bites. For workers who spend long hours outdoors, rest without protective barriers, or live in remote housing without air conditioning or screened windows, the risk is substantial. A worker falling asleep during a break could easily become a host.
The barriers keeping farm workers from healthcare run deep. Many work long hours that extend past clinic closing times. They live on-site in rural locations, often lack insurance or savings to pay for services, and face language barriers. For migrant workers and communities of color, the fear of immigration enforcement under the Trump administration creates an additional obstacle to seeking care.
Rebekah Stewart, a clinical educator with the Migrant Clinicians Network, described the challenge starkly: "If they're not in touch with the healthcare system, they're very likely not going to be picked up by any of the surveillance that is being done. It's like a jungle gym, the number of hoops and barriers that a person has to jump over to get from the farm to a healthcare system."
Those delays in care compound the danger. A recent survey found that 84% of clinicians working regularly with immigrant populations reported seeing serious delays in patients seeking healthcare since January 2025. Any worker avoiding medical attention for a wound becomes a potential vector for infection to go undetected and untreated.
The outbreak itself poses a massive economic threat to the livestock industry. Before the screwworm was eradicated from the United States four decades ago, it cost the sector hundreds of millions of dollars. The meat and poultry industry is worth $347.7 billion today. As the fly has crept back north through Central America, the question shifted from whether it would reach the US to when.
Tom Paterson, president of the New Mexico Cattle Growers' Association, said the industry transitioned earlier this year "from describing New World screwworm and what the problems are with it, to advising our cattle producer members about what to do when they get it."
Ranchers are taking precautions. Paterson's operation, which runs off-grid on solar power without air conditioning, keeps protective clothing readily available: long sleeves, long pants, gloves, and hats for workers. Screened doors and windows help keep insects out while allowing airflow in the heat. When Paterson recently worked with cattle for branding, castrating, vaccinating, and ear-tagging, he treated the animals with Dectomax to prevent infection.
The FDA has issued emergency authorizations for anti-parasitic medications for animals, and manufacturers are scaling up production. But for humans, no specific treatment exists beyond manual extraction of fly larvae and off-label use of anti-parasitic drugs.
Public health experts are urging farm employers to partner with migrant health programs so workers have easy access to care close to where they live and work. Stopping the outbreak in animals would also reduce the risk to the workers themselves, since fewer infected livestock means fewer flies in the environment.
Paterson remains cautiously optimistic that aggressive response and cooperation with Mexico and Central America can contain the outbreak and eventually eradicate the fly from US soil again. But for ranchers already dealing with infected herds, the pain is immediate and real.
Author James Rodriguez: "Farm workers are the forgotten frontline in this outbreak, and healthcare gaps that were already shameful are now a public health liability for everyone."
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