One year after the historic measles outbreak in West Texas that sickened hundreds of people and led to the deaths of two children, local health officials worry the U.S. could lose its measles elimination status.
The outbreak, which lasted for months, was the largest in the country in more than 35 years, with more than 750 cases across 37 counties confirmed. Now, a year later, Texas public health officials said they’re concerned about decreasing vaccination rates.
Katherine Wells, director of Lubbock Public Health, played a critical role in managing the outbreak. She said before, she never had to respond to a case of measles in over a decade at the local health department.
“For decades, high uptake of the [measles, mumps and rubella, or MRR] vaccine kept measles from gaining a foothold in our communities,” Wells said during a webinar hosted by the Big Cities Health Coalition Wednesday.
Measles requires a vaccination rate above 95% to prevent outbreaks. However, in some school districts in West Texas, Wells said vaccination rates have fallen as low as 70%.
“When vaccination rates decline and large groups of people remain unvaccinated, the introduction of even a single infectious person can ignite a large and sustained outbreak,” she said. “That's exactly what happened here.”
Measles is one of the most contagious human viruses. After the vaccine was introduced in 1963, national and international health agencies set several elimination goals. The first national goal in the U.S. was announced in 1966. It wasn’t until 2000 that the U.S. officially achieved elimination status.
Dr. Philip Huang, the director of Dallas County Health and Human Services, said the U.S is “on the brink” of losing that status.
“What’s very frustrating…is the sort of environment that we're working in,” Huang said. “The sort of undermining us at local public health to be able to provide these vaccines that we know work and are safe.”
Huang said there are a number of factors leading to lower vaccination rates, including confusion caused by federal messaging, fears around law enforcement and immigration crackdowns and cuts that effect access.
Chrissie Juliano, executive director of the Big Cities Health Coalition, said two weeks ago, the U.S. Department of Health and Human Services issued changes to the recommended childhood vaccine schedule, which “significantly” reduces the number of recommended vaccines for kids.
“While the two-dose MMR recommendation remains unchanged, leaders of the federal health agencies continue to downplay MMR vaccine,” she said. “Even at the height of various outbreaks, while promoting cures that have little to no efficacy.”
Juliano said HHS has created a lot of instability for public health officials, doctors and parents.
“Health departments and health care providers across the country are encountering more confusion and skepticism,” she said.
At the same time, local health departments have encountered challenges related to funding and policy changes.
Huang said Dallas County lost more than $4 million in COVID-19 funding that was clawed back by HHS – which he said the department used to support vaccination efforts for more than just COVID. Dallas County had to cancel more than 50 community outreach vaccine clinics and lost 25 staff members.
“We were losing those funds to do some targeted vaccination efforts at some of the schools that we'd identified with low vaccination rates,” Huang said. “At the same time that Texas had this measles outbreak, the Texas legislature this last session passed legislation that made it easier for parents to opt out of the required childhood vaccination from school.”
Meanwhile, Texas Attorney General Ken Paxton announced on Wednesday a “wide-sweeping” investigation into medical providers, insurance companies and vaccine manufacturers over vaccines. Paxton claims medical providers have been “illegally incentivized” to recommend childhood vaccines, and alleges children are denied care based on their vaccination status.
Huang said factors like these have undermined vaccine efforts – leading to almost half the number of vaccinations in 2025 compared to the previous year. The Dallas County coverage rate dropped from 94% to 89% last year.
“I’ve seen some official statements coming from CDC that [outbreaks] would be the cost of doing business…and that measles elimination status isn't really a concern, which is just crazy,” Huang said.
Wells said preventing the next outbreak requires sustained commitment to science and public health systems.
“We need to recognize that outbreaks like this are not inevitable, but unfortunately now I think they're predictable,” Wells said. “When vaccination rates fall, measles will find those gaps.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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