West Texas Measles Outbreak
One in five kindergarteners in Gaines County schools has a non-medical vaccine exemption. Low vaccination rates prime the area for the easy, natural spread of measles.
On the New Mexico-Texas border, a measles outbreak is underway, fueled by extremely low vaccination rates and high vaccine exemptions.
As of February 7, Gaines County, Texas, reports 14 confirmed and six probable measles cases, all among unvaccinated school-aged children.
Measles is one of the most contagious viruses known to humans. It lingers in the air for up to two hours after an infected person coughs or sneezes. If one person has measles, 90% of unvaccinated individuals around them are likely to become infected. An infected person can spread the virus for four days before and four days after symptoms appear,1 making early containment nearly impossible in under-vaccinated communities.
Consequently, Gaines County infections are expected to rise.
Easy Vaccine Exemptions in Texas
Since 1971, Texas has allowed both medical and religious exemptions. In 2003, the Texas Legislature passed a provision allowing for a conscientious exemption to vaccination. All parents must do to exempt a child from vaccination and still attend public school is submit a simple affidavit to the Department of Health.
Texas has a kindergarten vaccination rate of just 94.3%, below the 95% threshold required for herd immunity to protect against measles outbreaks. Houston fares even worse at 93.6%. As a whole, 3.9% of all kindergarteners in Texas have an exemption.
The Texas Department of State Health (DSHS) tracks conscientious exemptions to vaccination in an annual report, providing vaccination data among kindergarteners, 7th graders, and inclusive K-12.
In a state that makes vaccine exemptions easy to obtain, Gaines County has one of the lowest vaccination rates in Texas.
17.6% of kindergartners in Gaines County have a vaccine exemption on file, and nearly 14% of 7th graders also have exemptions. Gaines County is far below the vaccination rate needed to prevent outbreaks.
Three Gaines school districts contributed to DSHS exemption data.
Seminole Independent School District, the largest district in the county, serves just over 3,000 students and has almost 14% of students with a vaccine exemption.
Loop Independent School District (spanning Gaines and Terry Counties) has a single school, serving kids from kindergarten to 12th grade. The school had 157 students in the 2022-2023 school year. According to the health department survey, nearly 50% of Loop students have a vaccine exemption on file.
Seagraves Independent School District exemptions remains low, below 2%.
The Wakefield Legacy Continues to Harm Public Health
It has been 25 years since Andrew Wakefield published his now-retracted study falsely linking the MMR (measles-mumps-rubella) vaccine to autism, yet its damage persists. His fraudulent research—denounced by scientists, disproven in every legitimate study since, and ultimately leading to his loss of his UK medical license—gave birth to a global anti-vaccine movement that continues to fuel preventable disease outbreaks today.
It’s this antivaccination movement that drove states like Texas to add objections of conscience to their law in the early 2000s.
While vaccine hesitancy is as old as vaccination itself, the popularization of Wakefield’s bogus work launched a new era of anti-vaccine sentiment. Combined with charismatic anti-vaccine advocates, an American social structure indexed on individualized interests over communal ones, high pressure and blame on mothers as family health organizers, a medical community loath to discuss its mistreatment of patients and their concerns, and decreasing trust in expertise and scientific research, the anti-vaccine movement has a stronger foothold than ever before.
America’s Falling Vaccination Rates and Rising Exemptions
Last October, public health researchers released an update on vaccination among US kindergarteners during the 2023-2024 school year. The numbers tell the story of a setup for an entirely predictable and preventable public health disaster:
Nationwide, 3.3% of kindergartners now have a vaccine exemption
Non-medical exemptions make up the vast majority of vaccine exemptions (3.1%)
Exemptions increased in 40 states and the District of Columbia
Thirty states exceed the 3.3% national exemption rate
In 14 states, exemptions exceed 5%
Vaccination coverage among kindergartners decreased for all reported vaccines from the year before
More than 30 states have worse coverage for MMR, DTaP, poliovirus vaccine (polio), and varicella vaccine (VAR) compared to the prior year.
About 280,000 kindergarteners attended school without documented MMR vaccine series completion during the 2023-2024 school year
These numbers are not just statistics; they are a roadmap to future outbreaks.
Outbreaks Follow A Predictable Pattern
We have seen this before. Measles was declared eliminated in the U.S. in 2000, but the antivaccine movement has caused significant threats to maintaining elimination status.2
The 2014-2015 Disneyland measles outbreak exposed the risk of easily granting non-medical vaccine exemptions. The disease spread rapidly among unvaccinated people, including a significant number of intentionally unvaccinated children and adults. It spread to vulnerable people, including 12 infants too young to be vaccinated.
In response, California passed SB 277, eliminating all non-medical exemptions and tightening loopholes for fraudulent medical exemptions. The result? California now has one of the lowest exemption rates in the country. Consequently, medical exemptions increased, leading state medical boards to discipline physicians found to be issuing exemptions with insufficient cause.
In 2019, 1,274 U.S. measles cases were reported, the highest annual number since 1992. 89% of measles patients were unvaccinated or had an unknown vaccination status, and 10% were hospitalized. 86% of cases were associated with outbreaks in under-immunized, close-knit communities, including two outbreaks in New York Orthodox Jewish communities.
New York state responded by eliminating religious exemptions to vaccination.
Tightening non-medical vaccine exemptions is one way to curb decreased vaccination rates. However, anti-vaccination, once primarily among liberal leaning hippy parents, has become a hot button partisan issue. Recent polling by KFF found that Republican parents are more likely to delay or skip their children’s vaccines (it won’t be a surprise that Gaines is a deeply red county). Passing legislation like California, New York, and other states will be highly unlikely in more conservative states.
Public Health in an Era of Disinformation
The Gaines County outbreak also comes at a time of federal backpedaling on public health transparency. CDC data is being altered or removed from public access, including critical infectious disease guidance. The NIH funding freeze is ongoing.
While not yet confirmed, the expected top public health official in the country - Robert F. Kennedy, Jr. - is a career vaccine skeptic who has spent decades peddling vaccine misinformation. He has openly praised disgraced Andrew Wakefield on numerous occasions and parroted the long disproven claim about vaccines and autism. If anything, with RFK Jr expected to be confirmed as head of the Department of Health and Human Services, I expect that states will be emboldened to expand non-medical exemptions.
My friend
wrote beautifully in Ms Magazine about her young daughter’s leukemia diagnosis coinciding with the COVID vaccine rollout and how RFK Jr’s rhetoric harms kids like hers:“My family didn’t have the luxury of such skepticism. The vaccine wasn’t about politics or liberty for us. It was about life and death.”
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Public schools in most states still require vaccination for attendance unless a child has a valid exemption. However, as the anti-vaccine movement gains political influence, laws requiring school immunization will face ongoing threats. Kennedy’s anti-vaccine non-profit Children’s Health Defense filed numerous lawsuits targeting public health laws.
Not In Isolation
The Gaines County outbreak is not an isolated event but a symptom of a larger failure to protect evidence-based public health policies and to partner with families to ensure they have access to supportive environments for vaccine discussions.
Policy shifts weakening public health do not occur in a vacuum. They are part of a broader effort to dismantle trust in public health institutions, a strategy that will lead to more disease outbreaks and, consequently, more preventable illness and deaths - especially among children.
Sources
Seither R, et al. Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2023-24 School Year. MMWR Morb Mortal Wkly Rep. 2024 Oct 17;73(41):925-932. doi: 10.15585/mmwr.mm7341a3. PMID: 39418212; PMCID: PMC11486350.
Godlee F, Smith J, Marcovitch H. Wakefield's article linking MMR vaccine and autism was fraudulent. BMJ. 2011 Jan 5;342:c7452. doi: 10.1136/bmj.c7452. PMID: 21209060.
Zipprich J, et al. Centers for Disease Control and Prevention (CDC). Measles outbreak--California, December 2014-February 2015. MMWR Morb Mortal Wkly Rep. 2015 Feb 20;64(6):153-4. Erratum in: MMWR Morb Mortal Wkly Rep. 2015 Feb 27;64(7):196. PMID: 25695321; PMCID: PMC4584705.
For context, a person with influenza is usually contagious for about 1 day before symptoms appear and up to a week after.
Measles elimination is defined as the absence of endemic measles virus transmission in a region or other defined geographic area for ≥12 months in the presence of a high-quality surveillance system that meets the targets of key performance indicators. Independent regional commissions verify a country’s elimination status.
