My Turn: Lyme disease is now a rural aging crisis

I write this after another trip to the emergency room at Franklin Medical Center for Lyme disease — my third bout in three years. Lyme disease is not a condition that should routinely end in emergency room care. Early identification, rapid access to primary care, public awareness, and coordinated surveillance should prevent many cases from escalating to that point. Yet in rural western Massachusetts, too often the emergency room becomes the default entry point into care

Sarah Rahal’s reporting on Massachusetts’ worsening tick season, “A Tick Time Bomb,” Boston Globe, April 2026, was timely and important. But one critical point remains largely absent from the public discussion: individual vigilance is not a sufficient response to what has become a structural public health problem

Massachusetts reported 9,715 Lyme disease cases in 2023, nearly double any previous year on record. Franklin County and other parts of western Massachusetts consistently experience some of the highest rates of Lyme disease and tick-borne illness in the commonwealth. CDC data also show that incidence among adults ages 75 to 79 has risen sharply in recent years. Older adults are particularly vulnerable because Lyme symptoms are often mistaken for aging, arthritis, fatigue, or cognitive decline, delaying diagnosis and treatment.

And yet, despite the commonwealth’s extensive discussion of “rural health transformation,” the state’s Rural Health Transformation Program appears effectively silent on tick-borne disease as a strategic priority. The plan emphasizes interoperability systems, workforce pipelines, facility modernization, EMS integration, digital health infrastructure, and capital investment. The plan contains no significant targeted strategy for tick-borne disease despite western Massachusetts carrying some of the highest rates in the state.

This omission matters because Lyme disease is not simply an individual behavioral issue. Tick checks and repellents help, but they cannot replace long-term surveillance, environmental management, clinician training, public education targeted toward older adults, or sustained rural public health investment. Even Mass General Brigham recently established a dedicated Tick-Borne Disease Access Clinic precisely because delayed access and fragmented care remain significant problems

Western Massachusetts carries some of the commonwealth’s oldest populations and among its highest disability concentrations. In counties where aging-in-place is already fragile, repeated tick-borne illness becomes not just a medical issue but a rural aging and disability issue.