In the first few months of the year, measles spread like wildfire among a largely unvaccinated population, the number of cases quickly outpacing the total for the entire previous year. Then the U.S. Centers for Disease Control and Prevention sent a strike team, spending long days assisting local efforts to vaccinate, help patients isolate, and trace their contacts. The community in question wasn’t opposed to vaccines; they simply hadn’t had steady access to health care, and they gladly rolled up their sleeves. The outbreak was controlled, and the worst was avoided.
That was last year, in Chicago. Now a similar situation is unfolding in West Texas. The population is different—this time, it’s spreading largely among rural Mennonite communities; then, it was clustered around an urban immigrant shelter—but the same underlying issues of access persist.
And this year, the CDC isn’t sending a team.
On Thursday afternoon, amid rapid-fire news of the Trump administration’s firings and funding cuts to federal agencies, the CDC finally posted a short online statement about the Texas outbreak. The CDC is in “close communication” with state health officials and is offering technical assistance, laboratory support, vaccines, and medications, the statement says, and Robert F. Kennedy Jr., the new health secretary and longtime anti-vaccine activist, has expressed a “willingness to support local efforts.” A CDC official sent me a link to this statement in response to a list of questions I’d sent the agency.
The statement suggested a terrifyingly laid-back approach to combating deadly disease outbreaks. While RFK Jr. changed his tone on Friday, calling the measles outbreak a “top priority,” little changed in the administration’s approach. And with measles vaccination rates nationwide now hovering perilously close to or even below the recommended 95 percent threshold, what’s happening in Texas could conceivably happen anywhere.
Last week, an unvaccinated school-age child became the first person in the United States to die of measles in a decade. It’s possible that more deaths may follow. As of Friday, there were 146 cases identified in Texas in the current outbreak, with 20 hospitalizations, and nine cases reported in New Mexico.
The vast majority of cases have been among unvaccinated children and teens, many of whom are Mennonite. But there isn’t an ideological push among Mennonites against vaccines. “The church isn’t the reason that they’re not vaccinated,” Lara Anton, a spokesperson for the Texas Department of State Health Services, told AP in mid-February. In fact, amid news of the outbreak, people who previously hadn’t vaccinated their kids are rushing to do so now.
Rather, the community hasn’t had regular access to health care—and in this area of West Texas, it’s a common story. Medical care can be an hour’s drive or more away. There are immense structural and logistical barriers to reaching people at risk: Only 90 percent of Texans are vaccinated—below the 95 percent threshold recommended for community immunity (also called herd immunity).
Even one dose of the combined measles, mumps, and rubella, or MMR, vaccine—which is usually given at one year of age but can be administered as early as six months—is 93 percent effective at preventing measles cases. Two doses are 97 percent effective. That is a stunning achievement against a dangerous and unusually contagious disease, which can be debilitating even when it doesn’t kill: One in five unvaccinated people who contract measles wind up hospitalized. It also causes “immune amnesia,” where your body loses its immune responses to all previous pathogens, and can lead to fatal brain swelling years later. But to really stop this disease in its tracks—to protect some people who can’t be vaccinated for health reasons and to make up for that 3 percent of the time that it manages to evade a vaccinated person’s immune system—overall vaccination rates need to be high.
“We have the means to prevent this. We have a very, very effective vaccine,” Neil Maniar, professor of public health practice at Northeastern University, told me. “This is a critical moment to really improve vaccination rates in areas where we are below that 95 percent threshold.… You want to make sure that you have enough of the population vaccinated that there’s really nowhere for the disease to go.”
The goal for how many people need to be vaccinated to stop circulation depends on the disease—how contagious it is, how it’s transmitted, how long people are sick, and how many people they’re likely to encounter. Measles is, by all accounts, a formidable foe. It can linger in the air and on surfaces for up to two hours—which means you might step into an elevator long after a patient leaves it and still get sick. Every person with measles can infect 12 to 18 unvaccinated people, Maniar said. “That is a pretty remarkable number.” That means the vaccination rate needs to be similarly high—which means almost everyone in the country needs to be reached, a daunting logistical feat that until now has been carried out quietly but effectively.
In politics, “if you got two-thirds of people agreeing with something, that’s a landslide,” said Richard Pan, a pediatrician and former state senator in California who helped usher in a new law limiting exemptions to vaccines. “We need to get to 95 percent to do community immunity. We’ve got to get more than a landslide.” Even though vaccines continue to enjoy overwhelming popularity, there has been growing ideological opposition, led by Kennedy. But narrowing religious or personal exemption loopholes to vaccine requirements can help, Pan said.
Falling below 95 percent puts everyone at risk. But aiming even higher than 95 percent at the state level could help boost protection in local areas with lower rates, Pan said. “Getting above 95 percent is not impossible. We’re doing it in California for the most part.”
But this can’t happen without access to vaccines. And existing gaps in access may only worsen as the Trump administration questions vaccines in general, fires federal officials, and limits communications. “We can’t ignore what’s going on at the federal level in terms of public health,” Maniar said.
Kennedy has already halted a seasonal flu vaccine campaign, saying he wants to focus on “informed consent” instead. That’s an anti-vax talking point that would require health workers to list every adverse event in clinical trials—even unrelated ones, like accidents—before administering a vaccine. As soon as he took office, Kennedy said he’d investigate the childhood vaccine schedule, including the MMR vaccine: “Nothing is going to be off limits.” Meetings for independent advisers on vaccines for the CDC and the Food and Drug Administration have also been halted, and Kennedy has signaled he could do away with the system for processing legal claims over vaccine side effects, which would effectively take vaccines off the market.
Vaccination can be disrupted merely “by cutting funding for state and local programs,” Maniar said. “You can disrupt it by laying off the workforce that is responsible for overseeing these types of programs. You can disrupt it by limiting communication. And you can disrupt it just by questioning the validity of the science behind this.”
Pan has tangled with RFK Jr. in the past. When Pan was leading legislation on vaccine exemptions, Kennedy attempted to stop it. “He has not shown a strong record of honesty,” Pan said. “You can’t trust him.” After calling vaccines a “holocaust,” for instance, Kennedy apologized and vowed not to do it again. He has continued to use the term, though, Pan said. Kennedy has long called health agencies like the CDC and FDA corrupt and beholden to Big Pharma, “but when challenged to actually provide any proof that the vaccine … causes harm, he was unable to do so,” Pan said.
All of this is on top of the Trump administration’s effort to dismantle the government workforce and slash science funding. “We have significant cutbacks in the public health infrastructure at the federal level. We have pauses taking place. We have massive layoffs that have taken place,” Maniar said. All of this disruption inevitably spills into states and communities, making it even more difficult to deliver vaccines and control outbreaks. Already, emergency-response capabilities are being hampered. “And I think we’re going to see that continue, unless something is done very quickly to restore public health infrastructure,” Maniar said. “We’re cutting back at a time where we should really be building out.”
On Wednesday, RFK Jr. spoke about the Texas measles outbreak. “It’s not unusual—we have measles outbreaks every year,” he said. It’s a callous statement, horrifying given the death of a child. But he’s right. After coming incredibly close to eliminating measles from the U.S., and making progress to eradicate it around the globe, we’ve seen a resurgence in recent years, in part because of Kennedy and other prominent anti-vaxxers.
“We’ve been cutting it close,” Pan said. In 2019, as outbreaks mounted, measles almost returned to endemic status, which means a disease regularly circulates in an area rather than being introduced from the outside. In 2024, public health efforts again managed to halt the emergency. What experts really fear, though, is that measles could come back, a good a quarter-century after it was vanquished, Pan said. “Measles may become endemic in the United States.”
