Texas leaders quiet amid the biggest measles outbreak in decades

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Texas is facing its worst measles outbreak in decades, as cases have jumped from two to 146 in just one month. A child is dead, 20 more are hospitalized and the worst is likely still ahead, public health experts say, as Texas’ decreasing vaccination rates leave swaths of the state exposed to the most contagious virus humans currently face.

State and local health officials are setting up vaccine clinics and encouraging people to get the shot, which is more than 97% effective at warding off measles.

But neither Gov. Greg Abbott nor lawmakers from the hardest hit areas have addressed the outbreak publicly in press conferences, social media posts or public calls for people to consider getting vaccinated. State and local authorities in West Texas have not yet enacted more significant measures that other places have adopted during outbreaks, like excluding unvaccinated students from school before they are exposed, or enforcing quarantine after exposure.

The response to Texas’ first major public health crisis since COVID is being shaped by the long-term consequences of the pandemic, experts say — stronger vaccine hesitancy, decreased trust in science and authorities, and an unwillingness from politicians to aggressively push public health measures like vaccination and quarantine.

“Everybody is so sensitive to the vaccine topic due to COVID,” said Ector County Judge Dustin Fawcett. “We need to be very careful about how we address this topic … Our job is to provide the resources, not to tell people what they need to do.”

If there was ever an appetite for more aggressive government response to a disease outbreak, it’s long gone in Texas, said Catherine Troisi, an infectious disease epidemiologist at UTHealth Houston.

“I think there’s less political will now” than before COVID, she said. “Texas is such an independent state. People don’t want to be told what to do, forgetting that what they do can affect others. And measles is an example of that.”

Public health steps

When Clark County, Washington identified its third measles case in January 2019, the county quickly declared a public health emergency. The state soon followed suit.

“You gotta jump on this,” said public health director Dr. Alan Melnick. “Measles is one where you have to jump on it right away, and all hands on deck.”

The county ordered all unvaccinated students in the county to stay home from school for 21 days, whether or not they’d been exposed. Melnick said this was a difficult decision, but he saw it as the only way to stop the highly contagious disease from spreading like wildfire through the schools.

“It doesn't matter whether it's rural or urban. If you have congregate settings and if you have susceptible, exposed people, you have to do it,” he said. “Or you're not going to get control over this.”

Clark County’s outbreak ended four months later, with 71 total cases and no deaths. The public health response cost $2.3 million. Melnick said Texas’ fast rising case counts worried him, and he was shocked that unvaccinated students in the area were still being allowed to go to school.

“I’m just blown away,” he said. “This is not politics. I’m just talking science and medicine here.”

School districts in Texas are required to exclude unvaccinated students for at least 21 days after they are exposed to measles. Because measles is so contagious and can remain in the air for up to two hours after an infected person has left the area, large numbers of students could be excluded from school at once, Texas Department of State Health Services spokesperson Lara Anton said.

But to proactively exclude unvaccinated students before they are known to be exposed requires the Texas health commissioner to declare a public health emergency, which can be activated when there is a health threat that potentially poses a risk of death or severe illness or harm to the public. Anton said there are no plans to declare an emergency at this time, noting that more than 90% of Texans are vaccinated for measles.

State and local authorities are also recommending that unvaccinated people who have been exposed to measles quarantine at home for 21 days. But that quarantine period is not enforced or tracked, Anton said.

In Ector County, where there have been two confirmed cases, Fawcett said he doesn’t anticipate state or local authorities pursuing widespread shutdowns like during COVID.

“We haven't really been given guidance of what perhaps even we should do” in case of a county outbreak, he said. “My best guess is to provide resources and information. There's not going to be a call to quarantine, or any of that, unless an outbreak happens at a particular educational facility.”

In a statement, Andrew Mahaleris, Abbott’s press secretary, said Texas was prepared to “deploy all necessary resources to ensure the safety and health of Texans,” noting that DSHS was helping local authorities with epidemiology, immunization and specimen collection, and had activated the State Medical Operations Center to coordinate the response.

House Speaker Dustin Burrows, a Republican from Lubbock, said in a statement that he was closely monitoring the situation, and was praying for the family who tragically lost their child.

“At this time, there are no local unmet needs, but we are remaining vigilant and will respond as needed,” he said.

State Rep. Ken King and state Sen. Kevin Sparks, Republicans who represent Gaines County, did not respond to requests for comment about the measles outbreak. Neither they nor Abbott or Burrows have posted publicly about the outbreak.

Vaccination hesitancy

The last few weeks have felt like deja vu for Lubbock public health authority Dr. Ron Cook. A deadly disease is on the warpath. There’s a vaccine that can save lives. But too many in his community simply won’t take it.

“There’s all kinds of social media stuff, anecdotal treatments, or people saying, ‘let’s have a measles party,’ or this is just big government overreach,” he said.

Cook and his team are having to battle long-standing misinformation about the measles vaccine, as well as new concerns from people who developed anti-vaccine views during the pandemic, he said. The number of people requesting vaccine exemptions for their children has almost doubled since 2018, to almost 100,000 families in 2024.

Anytime a community drops below 95% vaccination status, they are vulnerable to a measles outbreak, Troisi said. Gaines County, the epicenter of the outbreak, has among the lowest vaccination rates in the state at 82% in 2024 but half of counties in Texas are below the recommended vaccination rate.

That’s a lot of people who might get the measles, Troisi said.

“This is entirely due to low vaccination rates. Measles spreads because kids aren’t vaccinated,” she said. “And kids aren’t vaccinated because there is so much misinformation out there. There’s so much distrust of government.”

The only answer, other than letting measles rip through whole communities of unvaccinated children, is to increase vaccination rates, Troisi said. Katherine Wells, public health director for the City of Lubbock, said they’ve vaccinated more than 100 people over the weekend, many of whom said they felt like measles wasn’t a big enough threat to justify getting the shot before now.

In previous outbreaks, some areas have taken more extreme measures to enforce vaccination, either by revoking religious exemptions or, in the case of an outbreak in New York in 2019, mandating people in the most impacted areas get the shot, with a $1,000 fine for non-compliance. The Orthodox Jewish community at the heart of the outbreak challenged the order in court, but it was upheld by a judge.

"A fireman need not obtain the informed consent of the owner before extinguishing a house fire," Judge Lawrence Knipel wrote in his ruling. "Vaccination is known to extinguish the fire of contagion.”

But Troisi and other public health experts don’t anticipate similar action in Texas. Since the pandemic, Texas’ elected leaders have shown more support for the opposite, opposing vaccine mandates and loosening Texas’ vaccine exemption rules. There are bills proposed this session that would make it easier for parents to opt out of vaccines and prohibit schools from excluding unvaccinated students during an outbreak like the one Texas is currently facing.

It remains to be seen whether the current measles outbreak will impact the direction of these bills, but Dr. Peter Hotez, a leading vaccine expert and dean for the National School of Tropical Medicine at Baylor College of Medicine, said he’s not optimistic that this will be a turning point.

“There was no auto-correction after 40,000 Texans needlessly died because they refused the COVID vaccine,” he said. “It just spilled over more to childhood immunizations. So I don’t know what brings us back, exactly.”

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