Read: Why are STDs on the rise if Americans are having less sex?

Local health departments play a crucial role in preventing the spread of STDs. Preventing congenital syphilis requires testing pregnant women for syphilis the first time they see their doctor. Then, health-department employees have to follow up with them to be sure they get treated—with as many as three doses of an antibiotic.

But since the 2008 recession, the municipal-health-department workforce has shrunk by almost a quarter, says Adriane Casalotti, the chief of government and public affairs at the National Association of County and City Health Officials. That makes it harder for officials to follow pregnant women to be sure they’re getting their antibiotic doses, or to reach out to doctors and community leaders to raise awareness about the rise of syphilis. And the overall lack of funding means many health departments can’t pay for all the tests and medications they need to catch other types of STDs.

With tax revenue low during the recession, states and municipalities were looking for programs to cut, Casalotti and others say, and in the late Aughts, STD prevention seemed like a reasonable area for savings. Certain STDs had been declining in the 1990s, and in 2000 syphilis was close to being eliminated. STDs simply weren’t seen as much of a threat. And to the extent that they were, it was easy to blame the victims. “There’s a lot of assumptions that these are adults and they should be making better choices, and if they did, there wouldn’t be the spread of STDs,” Casalotti says.

Read: The overblown stigma of genital herpes

But after the recession ended, state and local funding for STD programs never came back. Federal funding for syphilis, gonorrhea, and chlamydia prevention has also remained far below the level that public-health advocates have requested, as my colleague Russell Berman and I reported in 2016. “We’re doing less with less,” Bill Smith, the executive director of the National Coalition of STD Directors, told us then. “The public’s health is in danger.” Three years later, the consequences of doing less are becoming even more clear.

Public-health advocates say policy makers are essentially asleep at the wheel as STDs creep up slowly and claim more lives. “There’s a lack of public, provider, and policy-maker knowledge about what’s happening in STDs, and many consider these to be infections of a bygone era,” Matthew Prior, the communications director of the National Coalition of STD Directors, told me via email. “Like, who gets syphilis anymore?” Last year, 486 school buses’ worth of people did.