The recent measles outbreak in West Texas did not occur by accident. Once declared eliminated in the U.S. in 2000, this easily preventable disease has now affected communities across more than 20 counties in Texas. Health officials attribute the outbreak, in part, to a lack of funding that has crippled essential vaccination programs. “We haven’t had a strong immunization program that can really do a lot of boots-on-the-ground work for years,” stated Katherine Wells, the health director in Lubbock, which is a 90-minute drive from the outbreak's epicenter.
Across the nation, immunization programs have suffered due to years of stagnant funding from federal, state, and local governments. This financial neglect has set the stage for the current measles outbreak and has facilitated its rapid spread. Alarmingly, recent cuts to federal funding are jeopardizing efforts to prevent additional cases. Although health departments received an influx of cash to combat COVID-19, it fell short of addressing years of underfunding.
Compounding the issue, public trust in vaccines has eroded significantly. Health officials warn that the situation may worsen. Recent cuts initiated by the Trump administration have slashed billions in COVID-19-related funding, including $2 billion designated for immunization programs targeting various diseases. Oversight of these cuts falls to Health Secretary Robert F. Kennedy Jr., a notable figure in the anti-vaccine movement. While Kennedy claims he aims to prevent future outbreaks, he has not consistently promoted vaccination, failing to assure the public of its safety.
In Texas and about two-thirds of other states, lawmakers have introduced legislation this year that makes it easier to opt out of vaccines. According to an analysis by The Associated Press, these legislative changes further undermine efforts to control infectious diseases. In 2023, the U.S. has already reported over 700 measles cases, exceeding last year's total, with more than 540 cases occurring in Texas alone. Tragically, two children in Texas have died from measles complications this year, marking the first recorded measles deaths in the U.S. in a decade.
Children in the U.S. are generally required to receive vaccinations before attending school, a policy that has historically maintained high vaccination rates and prevented the spread of infectious diseases like measles. However, an increasing number of parents are opting out of vaccinations for their children. In 2023, only 92.7% of kindergartners received their required vaccinations, significantly below the 95% coverage threshold necessary to prevent outbreaks.
The outbreak began in Mennonite communities known for their resistance to vaccines, but it has quickly spread to other areas with low vaccination rates. Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development in Houston, likened the situation to a hurricane over warm water, stating, “As long as there’s warm water, the hurricane will continue to accelerate. In this case, the warm water is the unvaccinated kids.”
The health department in Lubbock receives an annual immunization grant of $254,000 from the state, a figure that has remained unchanged for over 15 years despite population growth. This funding once supported the salaries of three nurses, an administrative assistant, advertising, and outreach initiatives. Today, it barely covers one nurse and a fraction of an administrative assistant's salary. Texas ranks among the lowest in the nation for state funding per capita for public health, currently at just $17 per person in 2023.
Vaccines are among the most effective tools in public health, preventing debilitating illnesses and reducing the need for costly medical care. According to the U.S. Centers for Disease Control and Prevention (CDC), childhood vaccines save approximately 4 million lives globally each year, and the measles vaccine alone is projected to save another 19 million lives by 2030.
Local health departments that millions of Americans rely on for vaccinations primarily depend on two federal programs: Vaccines for Children and Section 317 of the Public Health Services Act. While Vaccines for Children provides the vaccines themselves, Section 317 grants are crucial for running immunization programs and facilitating outreach to get shots into arms. Unfortunately, funding for these programs has stagnated for years, despite rising costs. A 2023 CDC report estimated that $1.6 billion is necessary to fully fund a comprehensive 317 vaccine program, yet Congress approved less than half that amount in the previous year.
Health departments face difficult choices each year regarding which diseases to prevent and how many people they can afford to protect. Dr. Kelly Moore, a preventive medicine specialist, highlighted the challenges that arise from underfunding, stating, “It becomes difficult for them to staff the clinics they have and difficult for the people in those communities to access them, especially if they’re the working poor.”
As health officials grapple with funding cuts, they also emphasize the need for more resources to combat misinformation and mistrust surrounding vaccines. A 2023 survey by the National Association of County and City Health Officials revealed that 80% of local health departments reported encountering vaccine hesitancy among patients or their parents, a significant increase from 56% in 2017. Dr. Moore stressed the importance of investing in education to control the spread of infectious diseases.
With ongoing funding cuts and rising vaccine hesitancy, the situation continues to deteriorate. In March, Kennedy's health department canceled billions of dollars in state and local funding for immunization programs. Although a judge temporarily halted the cuts in some states, Texas health departments have not received similar protections and are facing a loss of $125 million in immunization-related federal funding.
As a result, local health departments are already scaling back services. In Dallas County, over 50 immunization clinics have been canceled, and Lubbock’s health department faces potential layoffs due to funding losses. These cuts extend beyond Texas, affecting vaccination programs across the country. For instance, Washington state anticipates losing about $20 million in vaccination-related funding, while Connecticut officials predict a loss of $26 million.
As funding diminishes and anti-vaccine sentiments gain traction, health experts worry that vaccine hesitancy will continue to spread, leading to the resurgence of measles and other preventable diseases. Dr. Moore poignantly remarked, “If we don’t invest in them to get them in arms, then we don’t see their benefits.” Without adequate funding and public trust, the fight against vaccine-preventable diseases like measles remains at risk.
