CDC Struggles During Measles Outbreak in Texas Amid Administration Changes

This year, measles outbreaks in Texas raised significant concerns, particularly as actions taken by the Trump administration created an environment of fear and uncertainty among CDC scientists. An investigation revealed that these issues hampered the agency’s emergency response capabilities at a crucial time.

The situation escalated to become the worst measles outbreak in over 30 years in the United States.

Shortly after Donald Trump took office, his administration intervened in CDC communications, delayed reports, censored data, and made abrupt staff layoffs. This turmoil caused CDC experts to feel restricted from communicating effectively with local public health officials, as revealed by interviews with several CDC personnel and local health department emails obtained through public records requests.

“CDC hasn’t reached out to us locally,” noted Katherine Wells, public health director in Lubbock, Texas, in an email two weeks following the hospitalization of measles cases in the area. “My staff feels like we are out here all alone,” she added, highlighting the isolation local health authorities felt during the outbreak.

Tragically, a child passed away before the CDC reached out to Wells.

“All of us at CDC train for this moment, a massive outbreak,” one researcher mentioned, expressing the frustration of being unable to act despite their extensive training.

Delayed responses can have severe repercussions in communities with low vaccination rates, particularly in parts of West Texas. Researchers estimate that if a measles-infected person is in a room with ten unvaccinated individuals, nine are likely to contract the disease. If those individuals then interact with the public, the numbers can increase dramatically.

This outbreak in West Texas emphasizes the vulnerabilities facing the nation under the Trump administration, with declining vaccination rates, rampant misinformation, and budget cuts to public health further jeopardizing safety.

At the same time, Health Secretary Robert F. Kennedy Jr. spread doubt about vaccines and overstated the effectiveness of vitamin supplements against illnesses. The impact was serious—the outbreak spread to New Mexico, Oklahoma, Kansas, Colorado, and even into Mexico’s Chihuahua state, collectively resulting in over 4,500 infections and at least 16 deaths.

“This is absolutely outrageous,” reacted Jennifer Nuzzo from Brown University’s Pandemic Center. “When you’re battling contagious diseases, time is everything.”

Upon learning about the measles cases involving unvaccinated children in late January, Wells was immediately concerned. Although hospitals are mandated to report measles cases to the CDC, she feared many children were not being tested.

“I think this may be very large,” she conveyed in a Feb. 3 email to state health officials, sharing community insights that suggested parents were aware of unreported cases.

Wells sought to connect with CDC experts who could assist with complex questions regarding testing and care for exposed infants. However, what followed was a frustrating series of communications.

One query involved whether clinics could effectively clean rooms used by measles patients, given space constraints. Scott Milton from the Texas health department communicated the situation to Wells, indicating that the CDC was already overwhelmed.

In light of the communication breakdown, local officials turned to external sources for guidance, including the Immunization Partnership, a Texas nonprofit.

“The CDC had gone dark,” noted Terri Burke, its executive director. “We anticipated a measles outbreak, but we didn’t expect the federal government to be in collapse.”

Officially, the Trump administration’s communication restrictions were lifted on Feb. 1, yet CDC scientists reported lingering confusion about what information they could share. “There was a lot of confusion and nonanswers,” one scientist noted.

Georges Benjamin, executive director of the American Public Health Association, pointed out that this issue extended beyond measles, affecting overall public health communication. With major information fed through the CDC’s communications office, scientists were effectively silenced.

Despite the complexity, federal health officials traditionally did not need explicit permission to communicate with local departments. Anne Schuchat, a past CDC deputy director, recalled that outreach and assistance were customary during outbreaks.

While the state claimed it never blocked CDC communications, emails sought by KFF Health News to clarify their correspondence were withheld as confidential. The Texas health department did confirm that resources were dispatched to West Texas early in February.

Dealing with an outbreak in areas with low vaccination coverage is decidedly challenging. Ideally, public health workers should immediately notify those exposed, urging vaccinations. If they decline, officials would advise them to limit public interactions to curb further spread.

However, Holbrooks, the health district’s executive director, indicated this was almost impossible in tightly-knit Mennonite communities that often preferred home remedies. Many community members were reluctant to be tested or engage with health authorities, stemming from a history of persecution and deepening mistrust due to the COVID-19 pandemic.

Some residents, having immigrated from other countries, might be undocumented, complicating their willingness to interact with officials. “I have no idea how many cases we might have missed,” Holbrooks acknowledged, as many lived in the shadows.

Public health experts characterized the scenario in Gaines County as both challenging yet familiar. Undervaccinated communities typically face similar hurdles, with public health workers needing to navigate various barriers to ensure vaccinations.

For example, a prior measles outbreak in Clark County, Washington, involved a massive response, with public health teams maintaining daily contact with unvaccinated individuals and working closely with CDC scientists.

In New York, a measles outbreak among Orthodox Jewish communities prompted extensive outreach, involving meetings with leaders and the distribution of informative materials to combat vaccine skepticism. The efforts incurring significant costs ultimately resulted in substantial savings compared to the financial burdens of hospitalization and missed work.

In contrast, public health departments in West Texas were already struggling with limited staff. Wells expressed feeling overwhelmed amidst the crisis.

On Feb. 26, the tragic news broke of a 6-year-old child dying from measles. The CDC reached out to Wells for the first time the next day, coinciding with its first public notice regarding the outbreak. The notice recommended vaccinations but raised concerns among specialists for promoting vitamin A as a treatment.

Texas health officials privately deliberated the potential repercussions of the CDC’s communication, worried that misinformation might lead parents to medicate their children with vitamin A instead of seeking timely medical attention. A local pharmacy noted high sales of vitamin A supplements following the outbreak.

Excessive vitamin A can result in serious health issues, which further troubled Milton, who feared misinformation had shifted parental focus away from necessary vaccinations.

CDC scientists were also concerned about how HHS insisted on including vitamin A in communications, advising that if pregnant women consumed too much during the outbreak, there could be severe consequences for their babies. Yet, federal communication remained stifled.

Meanwhile, Kennedy continued to promote the benefits of nutrition while also casting doubt on vaccines, attributing deaths to medical mismanagement without substantiation. His claims about the effectiveness of vitamin A were misaligned with the data on its utility in the U.S. context.

Despite national scrutiny after the first measles death in a decade, the situation in West Texas continued to worsen, leading to an overwhelmed health system as the outbreak spread. Local hospitals reported being at capacity, as authorities sought urgent resources without support from federal sources.

As the outbreak approached 500 cases, the situation escalated further, with additional children dying from measles. In a rare acknowledgment, a CDC scientist at a meeting in April addressed the overwhelming needs from Texas regarding resources.

It wasn’t until late May that federal assistance arrived, but by that point, the outbreak had largely burned through affected populations. Many cases likely went unrecorded as families presumed their children were infected without seeking confirmation.

Health officials declared the outbreak over by mid-August, but its repercussions will linger. The chains of infection have not necessarily halted, spreading further both domestically and into Mexico.

Looking forward, Nuzzo warned that more outbreaks are inevitable as a rising number of parents choose not to vaccinate their children due to persistent misinformation. Moreover, with public health programs facing major cuts, the landscape for managing such outbreaks appears increasingly dire.

In challenging months, Wells sent a hopeful email to her staff, acknowledging the uncertainties ahead yet recognizing their daily commitment as a sign of resilience.