Why the Texas measles outbreak was ‘inevitable’
An outbreak of measles is wreaking havoc in the South Plains region of Texas where nearly 60 children have been confirmed to be infected so far. Physicians in the state say the current situation was “inevitable” due to the low rates of vaccination among the largely Mennonite community.
As of Feb. 18, the Texas Department of State Health Services has confirmed 58 cases of measles with 13 patients hospitalized.
The outbreak comes as Robert F. Kennedy Jr., a leading vaccine skeptic, takes over the Department of Health and Human Services, which has spurred fears he will further fuel vaccine skepticism, an issue already politicized by the COVID-19 pandemic.
The South Plains region is home to an insular community of Mennonites, a conservative Christian sect dating back to 15th century, among whom vaccinations are not as popular as in the general population.
The ideal coverage for measles, mumps and rubella (MMR) vaccinations is 95 percent. The vaccination rate in Gaines County, the epicenter of the Texas outbreak, is closer to 80 percent. And about 91 percent of Texas children born in 2020 have received at least one dose of the MMR vaccination, according to data from the Texas Department of State Health Services (TDSHS).
Linda Yancey, an infectious disease specialist at the Memorial Hermann Health System in Texas, said the current situation was "inevitable” since anything shy of that ideal vaccination rate leaves communities vulnerable.
“Once a community falls below that 95 percent protection rate it is like dry kindling just waiting for that first spark,” Yancey told The Hill.
“And once you get that one case of measles in a vulnerable community, it spreads like wildfire. Any community with a less than 95 percent immunity rate is an outbreak waiting to happen with measles,” Yancey added. "These counties that have low immunity rates are going to have measles outbreaks. It is not a matter of if but when.”
Undervaccinated community
A TDSHS spokesperson confirmed to The Hill that most of the measles cases have occurred in the Mennonite community of the South Plains region but emphasized lifestyle choices and not religion led to low immunizations in this community.
“Most of the cases are in a close-knit, under vaccinated Mennonite community in Gaines County. The important nuance here is that it is their lifestyle and not the church that is the reason for many people being unvaccinated,” the spokesperson told The Hill in a statement.
“The Mennonite church allows for free choice on vaccination and it is not widely against vaccination,” they added. “Mennonite families don’t seek traditional health care regularly so they are not prompted to vaccinate their children on a schedule and many attend small private schools in their community so they are not required to get vaccinated for school.”
According to Texas health officials, part of the current response involves communicating the importance of immunizations to the affected communities.
“The Mennonite community speaks Low German, Spanish and English so we’ve been working on developing informational messaging in all three languages,” the spokesperson noted.
The TDSHS is in contact with the Centers for Disease Control and Prevention (CDC), and the agency’s field officer assigned to Texas has been deployed to the region to assist with epidemiology.
TDSHS data for the 2023-2024 school year indicated that in one of the three school districts in Gaines County, where 45 of the 58 cases have been confirmed, nearly half of all students had exemptions for vaccines. The Loop Independent School District reported 47.95 percent of K-12 students had a conscientious exemption for immunizations.
More frequent measles outbreaks
The U.S. has held the distinction of being a country where measles is considered eliminated since 2000. But in recent years, measles outbreaks across the country have become increasingly common, threatening that status.
“Where we would hear, you know, an outbreak every year, every two years. Now it's every other month,” said Luis Ostrosky, chief of infectious disease at UTHealth Houston. “The pattern is very similar. It's very tight-knit communities with low vaccination rates where you introduce a case of measles, and it goes like wildfires throughout community and spills into adjacent communities.”
In 2024, the CDC reported 16 measles outbreaks. So far, two outbreaks have been reported this year.
Given the seeming uptick in localized measles outbreaks, Ostrosky said the U.S. losing its elimination status is “a real possibility.”
“It would be so sad and so shameful that a country that has been a leader in public health for so many decades would be losing that edge,” he added.
Yancey, who herself has yet to encounter a measles patient in nearly 20 years of practicing medicine, said Texas is well-equipped to handle an outbreak despite how relatively uncommon measles still is.
“If the pandemic taught us nothing else, it is that we can handle almost anything. Would I like it if we had more public health resources? Of course. But we have the capacity to handle this and sadly, after the pandemic, the practice,” she said.
While there are no therapeutics or antivirals for measles, most people who contract measles make a full recovery. But 1 in 5 children who get the virus will be hospitalized, 1 in 20 will develop pneumonia, and 1 in 1,000 develop encephalitis that could lead to permanent disabilities.
Yancey advised concerned parents to isolate if they are in communities with widespread measles transmission and to ensure that members of their household are vaccinated against the virus.
Kennedy’s past with measles vaccine
Kennedy carries a controversial history regarding measles outbreaks.
In 2019, Kennedy traveled to Samoa while the country was dealing with widespread concerns over measles vaccinations after two babies died due to improperly prepared vaccines. The island’s government suspended measles vaccinations in response, but when the suspension was lifted, parents were still reluctant to get their children immunized.
Critics of Kennedy accused him of fostering anti-vaccine sentiment in Samoa, months before an outbreak ultimately resulted in 83 measles-related deaths and more than 5,600 infections.
Kennedy has consistently denied any responsibility for the measles outbreak in Samoa, though correspondence to former Samoan Prime Minister Tuilaʻepa Saʻilele Malielegaoi showed that Kennedy cast doubt on the efficacy and safety of what he referred to as “a defective Merck vaccine” after a state of emergency had already been declared on the island.
Democrats hammered Kennedy about his involvement in Samoa during his confirmation hearings, with Sen. Elizabeth Warren (D-Mass.) saying, “There's a measles outbreak, and children start dying, but you double down. You didn't give up.”
“You launched the idea that a measles vaccine caused these deaths,” Warren added. When she asked Kennedy if he accepted any responsibility for the drop in MMR vaccinations in Samoa and if he would do anything differently, he responded, “Absolutely not.”
The HHS did not respond to repeated inquiries by The Hill regarding the measles outbreak in Texas and what the department may do to assist in the response.
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