By Amy Maxmen
Some private schools have been compelled to close their doors due to a rapidly escalating measles outbreak in West Texas. Local health departments, already overstressed, are now pausing other crucial initiatives as they scramble to limit the spread of this highly contagious virus. As of February 21, the Texas health department has confirmed 90 measles cases, leading to 16 hospitalizations. The majority of those infected are under the age of 18, and officials have raised concerns about nine additional reported measles cases in New Mexico that may be linked to the outbreak’s epicenter in Gaines County, Texas. Investigations are ongoing to verify these connections.
Health officials express concern that they may be overlooking cases. Undetected infections pose significant risks to communities, as health professionals cannot effectively contain transmission if they cannot identify those who are infected. “This is the tip of the iceberg,” commented Rekha Lakshmanan, chief strategy officer for The Immunization Partnership in Houston, a nonprofit advocating for vaccine access. “I think this is going to get a lot worse before it gets better.”
An unspecified number of parents might not be taking their sick children to clinics where they could receive testing, according to Katherine Wells, the public health director in Lubbock, Texas. “If your kids are responding to fever reducers and you’re keeping hydrated, some parents may choose to keep them at home,” she noted.
Most unvaccinated individuals are likely to contract measles if exposed to the airborne virus, which can linger indoors for up to two hours. Additionally, infected individuals can spread the virus prior to showing symptoms. Approximately one in five people with measles will require hospitalization, one in ten children may develop ear infections resulting in permanent hearing loss, and roughly one in 1,000 children may die from respiratory and neurological conditions resulting from the virus.
Gaines County is home to a significant Mennonite population, a community that often opts against vaccinations. Albert Pilkington, CEO of the Seminole Hospital District situated in the county’s heart, remarked in an interview with Texas Standard, “We respect everyone’s right to vaccinate or not get vaccinated. That’s just what it means to be an American, right?” Local health officials are striving to convince the parents of unvaccinated children to bring them to pop-up clinics for measles vaccinations. “Some people who were unsure, who thought measles wasn’t something their kids would encounter, are recalibrating and coming forward for vaccination,” Wells stated.
To combat the outbreak, local health departments have deployed mobile testing units outside schools to detect infections preemptively. They are also staffing clinics that can provide prophylactic treatment for infants exposed to the virus, who are too young to be vaccinated. Health officials are guiding daycare centers on how to protect young children and educating school nurses on recognizing measles symptoms. “I am allocating 75% of my staff to this outbreak,” Wells emphasized. Although Lubbock isn’t at the outbreak’s epicenter, individuals diagnosed with measles have sought treatment there. “If someone infected was in the [emergency room], we need to identify everyone who was in that ER within two hours of that visit, notify them, and determine their vaccination status,” she added.
Rural health departments face chronic underfunding, and Wells noted that the increased workload has forced them to pause other vital programs, such as substance abuse education initiatives. Zach Holbrooks, executive director of the South Plains Public Health District, which encompasses Gaines County, stated that health officials adhered to the Centers for Disease Control and Prevention guidelines by suggesting schools keep unvaccinated children at home for 21 days if they had shared space with an infected individual. Consequently, many parents may find themselves needing to stay home from work to care for their children. “Many private schools have shut down because of a high number of sick children,” Holbrooks remarked.
As measles outbreaks expand, they impose a growing burden. A 2018 outbreak in Washington state, which involved 72 cases, cost approximately $2.3 million to contain, along with $76,000 in medical expenses and an estimated $1 million in economic losses resulting from illnesses, quarantines, and caregiving.
Public health researchers anticipate such outbreaks will become larger and more frequent due to numerous laws across the U.S.—both pending and recently enacted—that ultimately diminish vaccination rates by allowing parents to exempt their children from vaccine requirements in public schools and certain private schools. These policies coincide with a rise in misinformation regarding childhood vaccination that is now endorsed at the highest levels of government. For instance, Robert F. Kennedy Jr., the new director of the Department of Health and Human Services, has wrongfully associated vaccines with autism, referencing discredited theories that have been disproven by numerous scientific studies.
During Kennedy’s first week in office, HHS delayed a significant meeting of the CDC’s Advisory Committee on Immunization Practices without providing a timeline for its rescheduling. Moreover, the CDC’s template letter advising school principals to keep unvaccinated children home for 21 days if exposed to measles is no longer available on the agency’s website; an outdated version remains in the archives.
Community protection against measles requires that at least 95% of individuals be vaccinated. This threshold is critical for safeguarding infants too young for the vaccine, individuals who cannot receive vaccines for medical reasons, and those who do not develop strong immune responses to vaccinations. According to the CDC, last school year saw the highest recorded number of kindergarteners exempted from vaccine requirements. In Gaines County, these exemptions reached nearly 20% for the 2023-24 academic year, positioning it as one of Texas’ lowest vaccination rate areas. A local public school district in Loop reported that only 46% of kindergarten students have received measles vaccinations.
Amidst this measles outbreak highlighting the health impact in undervaccinated areas of America, Texas lawmakers have introduced around 25 bills in the current legislative session that could further restrict vaccination. Lakshmanan emphasized the necessity for the public—of whom a majority recognize the importance of measles vaccination—to contact their representatives regarding the risks posed by such policies. Her organization and others provide resources for public engagement. “We’ve got children winding up in the hospital, and yet lawmakers are ignoring the facts,” she lamented, referring to proposed policies likely to weaken vaccination rates. “It’s just mind-blowing.”
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