The outbreak of measles in West Texas did not happen by chance.
The easily preventable disease excluded in the United States in 2000 has torn apart communities across more than 20 Texas County as the health department is hungry for the funds needed to run a vaccine program.
“They’re excited to be aware of the outbreak,” said Catherine Wells, health director at Lubbock, a 90-minute drive from the outbreak epicenter.
National vaccination programs have been left vulnerable due to years of stagnant funding by federal, state and local governments. In Texas and elsewhere, this has encouraged the setting of measles outbreak and its widespread adoption. Now, federal funding has been cut and efforts to prevent more lawsuits and outbreaks are threatened.
The Health Department has got cash inflows to deal with Covid-19, but making up for years of negligence was not enough. Plus, trust in vaccines is eroding. Health officials warn that the situation is being prepared to get worse.
Recent cuts by the Trump administration have drawn billions of dollars in Covid-19-related funding. The cut is supervised by Health Secretary Robert F. Kennedy Jr., who has become prominent as the leader in the anti-vaccine movement. Kennedy says he hopes his agency will prevent future outbreaks, but he has also been refused to provide a consistent, powerful message that will help him do so.
At the same time, Texas lawmakers and about two-thirds of states have introduced laws this year that make it easier for them to opt out of vaccines and make it easier for more people to win shots. Health officials said it would further undermine efforts to keep the infection at bay.
More than 700 measles cases reported in the US this year are already above the total last year. The majority (over 540) are in Texas, but cases have appeared in 23 other states. Two Texas children have passed away. The six-year-old girl from Gaines County, the heart of the outbreak, passed away in February, the first American measles death in 10 years. An 8-year-old girl from a Seminole from the same town passed away earlier this month.
Children in the US generally need to get vaccinated to go to school. This ensured that in the past they were in good condition to prevent the spread of infections like measles. But more and more parents are skipping shots for their children. The share of children exempt from the vaccine requirements reaches an all-time high, with only 92.7% of kindergarten children in need. This is well below the 95% coverage level that keeps the disease at bay.
Keeping vaccination rates high requires vigilance, commitment and money.
The Texas outbreak began in Mennonite communities that resisted vaccines and were distrustful of government interventions, but soon jumped elsewhere with low vaccination rates. There are similar unvaccinated pockets across the country, allowing them to provide craters that will cause another outbreak.
“We’ve seen a lot of trouble with our children,” said Dr. Peter Hotes, co-director of the Texas Children’s Hospital Center for the Texas Children’s Hospital Center in Houston. “As long as there is warm water, the hurricane will continue to accelerate. In this case, warm water is a child who has not been vaccinated.”
Texas flatline vaccine funding
Lubbock receives a $254,000 vaccination grant from the state each year that can be used for staff, outreach, advertising, education, and other components of its vaccine program. As the population grows, it has not increased for at least 15 years.
Wells said it was enough for three nurses, administrative assistants, an ad, and even enough nurses to give at the Health Fair. “Now it covers nurses, a quarter of nurses, a little administrative assistant, and basically nothing else.”
Texas has the lowest per capita state funding for national public health, at just $17 per person in 2023.
Vaccines are one of the most successful tools in the public health arsenal, preventing debilitating diseases and reducing the need for expensive medical care. According to the U.S. Centers for Disease Control and Prevention, the measles vaccine will save approximately 19 million lives by 2030, and the childhood vaccine prevents 4 million deaths worldwide each year.
The US vaccination program is funded by a fluctuating mix of federal, state and local money. The federal government will go to all states and decide how much to send to the local health department.
The stagnation of vaccination grants in Texas has made it difficult for local health departments to maintain the program. For example, Lubbock’s health department doesn’t have the money to pay for targeted Facebook ads to promote vaccinations and provide robust community outreach to build trust.
In Andrews County, which borders Gaines County, the biggest cost of a vaccination program is HR. But while everything has become more expensive, the grants remain the same, health director Gordon Mattimo said. It transfers the burden to the county government. Some kick more money, while others don’t. He did.
Problem: To keep people safe from outbreaks, high vaccination rates are required across a wide area, and bacteria do not stop at county borders.
Andrews County, with a population of 18,000, offers walk-in vaccine clinics Monday through Friday, but other West Texas communities aren’t. More than half of those who come to the clinic travel from other counties, Mattimaw said it includes much larger locations and Gaines County.
Some had to drive for more than an hour. They did so because they struggled to get shots in their hometown counties due to long waits, shortages of providers and other issues.
“They can’t get that where they live. … People are flooded here,” Mattimor said. “There’s an access issue.”
This makes it more likely that people won’t take shots.
In Gaines County, only 82% of kindergarteners have been vaccinated against measles, mumps and rubella. Even Andrews County has cut 2 percent points since 2020, at 97%, as vaccination rates exceed the 95% threshold to prevent outbreaks.
Texas isn’t the only vaccine funding crisis
The health department relies heavily on the shots of millions of Americans, and is heavily on two federal programs in section 317 of the Children’s Vaccines and Public Health Services Act. Vaccines for children primarily provide real vaccines. Section 317 provides vaccine grants, but you can also run the program and shoot on your arm.
Approximately half of children are eligible for vaccines for children, a safety net program created in response to the measles epidemic of 1989-1991. This corresponds to the measles epidemic, which has sickened 55,000 people and killed 123 people.
The health department usually uses the program in tandem, and since the pandemic they have often been allowed to supplement it with Covid-19 funding.
Even with all costs from payroll to vaccines rising, 317 funds remained flat for years. A 2023 CDC report to Congress was estimated to require $1.6 billion to fully fund the comprehensive 317 vaccine program. Last year, Congress approved less than half of that, under $682 million.
This forces tough choices along with inadequate state and local funding. Preventive medicine expert Dr. Kelly Moore said he faced this dilemma when he directed Tennessee’s vaccination program from 2004 to 2018.
“What kind of diseases can we afford to prevent and how many people can we protect? These decisions must be made annually in every state,” said Moore, who currently runs the advocacy group Immunize.org.
Rural clinics may need to be closed or eliminated evenings and weekend times, she said. “It will be difficult to staff the clinics they have, and it will be difficult for people in those communities to access them.
At the same time, health officials say they need more funds to combat misinformation and mistrust about the vaccine. In a 2023 survey by the National Association of County and City Health Authorities, 80% of local health departments reported vaccine hesitancy among patients or their parents, up from 56% in 2017.
“If we don’t invest in education, it’s even more difficult to control these illnesses,” Moore said.
Given the continued reduction and hesitation, an uncertain future
Facing these headwinds, things got worse in March when Kennedy’s health department canceled billions of dollars with state and local funding. After 23 states sued, judges have now curbed cuts in these states, but not in Texas and other states that did not take part in the lawsuit.
However, the local health department has not taken the opportunity and is cutting services.
The HHS said the money allocated through the Covid-19 initiative was cut as the pandemic was over. However, the CDC allowed money to be used to strengthen public health infrastructure in general, including vaccination programs.
Before he was confirmed as Health Secretary, Kennedy vowed not to take the vaccine. But in Texas, his division cuts have resulted in state and local health departments losing $125 million in federal vaccination-related funds to deal with the measles outbreak. A federal health department spokesperson did not respond to an AP request for comment.
Dallas County, 350 miles from where the outbreak began, had to cancel more than 50 vaccination clinics, including schools with low measles vaccination rates, according to county health director Dr. Philip Fan.
Near the heart of the outbreak, Lubbock’s health department said seven jobs were on the line as they were paid through those grants. Vaccinations are included in the jobs affected.
Crossing the border of New Mexico, where the outbreak is spreading, the state lost grants that funded vaccine education.
Kennedy’s cuts also hit vaccination programs in other states
It is still unclear how the recently announced $2 billion cut will affect vaccination programs nationwide, but details are beginning to flow from some states.
Washington, for example, would lose about $20 million in vaccination-related funds. Authorities have been forced to suspend efforts on the “Care-a-Van” mobile vaccine, which has been administered more than 6,800 Covid-19 vaccines, 3,900 influenza vaccines and 5,700 pediatric vaccines since July. The state also had to cancel more than 100 vaccine clinics scheduled through June.
Connecticut health officials estimate that if cuts are on the rise, they will lose $26 million to vaccinate. Among other cuts, this means cancelling 43 contracts with local health departments, increasing vaccination rates, increasing confidence in vaccines, losing vaccination clinics and mobile outreach in underserved communities, and halting the distribution of vaccine-related educational materials.
Several of 23 states suing the federal government, including Minnesota, Rhode Island and Massachusetts, cite losses from the vaccine program.
As the medical sector, where cutting is even more struggling, already struggles, along with an increasingly prominent and powerful anti-vaccine voice, doctors are worried that vaccine hesitations will continue to spread. And so are measles and other viruses.
“My lifelong purpose is to prevent people from suffering, and vaccines are an incredible way to do that,” Moore said. “But if we don’t invest in them to bring them into arms, we won’t see their profits.”
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