Texas could be on the verge of spreading measles into a national epidemic and Dr. Peter Hotez, an expert on vaccines and public health, says the virus will “keep going until everyone gets infected or gets vaccinated.”
Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, said he predicted a measles outbreak would happen and has repeatedly recommended vaccination as the quick fix.
“It’s kind of hit Ground Zero in the United States,” he said. “If I had to pick two of the worst places for measles to show up, one would be West Texas; another might be the state of Idaho. If you look at statewide immunization rates, Idaho is the worst. It’s a libertarian ideology and a pretty strong anti-vaccine movement there like West Texas.”
The advice comes as health officials say the highly contagious disease — once declared eliminated from the U.S. — has re-emerged due to international travel, permeating West Texas and now being reported in the Panhandle, East Texas, New Mexico and Oklahoma. It’s the largest Texas measles outbreak in 30 years.
More than 300 cases have been confirmed since late January, primarily concentrated in Gaines County, which includes a Mennonite community in Texas’ South Plains region where vaccination rates are low.
“I don’t know that it’s only the Mennonite community,” Hotez said. “There are other counties in West Texas with low immunization rates. If you were to look at a map of Texas for COVID vaccination rates, there’s two distinct patterns. You have very high COVID vaccination rates in the big urban areas of the Texas Triangle and in South Texas, also very high.
“It’s quite low in the more rural areas of West Texas and the rural areas of East Texas. Those are the places where we also have counties with low childhood immunization rates. As long as there are low childhood immunization rates, measles will find a way to get to those areas because it’s so highly transmissible.”
The incubation period of measles is almost two weeks, Hotez added, so “every time there’s a new increase it means we’re in this epidemic for at least another two weeks.
“The way things are going right now, I envision this thing will go well into the spring,” he said.
Recently the parents of a 6-year-old who died of measles in West Texas said they stand by their decision to not vaccinate their child, saying that the virus helps build up a child’s immune system and it wasn’t as bad as the media made it out to be. The couple reportedly had other children who contracted measles after their sister’s death who survived and were treated with castor oil and steroids.
Almost everyone born before 1957 is immune to measles and many younger Texans received a single dose of the measles-mumps-rubella (MMR) vaccine as a requirement to enter schools, childcare centers and colleges, but parents can now opt out of such vaccinations for personal beliefs, Hotez said. Texans can also claim an exemption if they’re in the military or if a health provider determines it’s unsafe. Vaccine exemption requests through the Texas Department of State Health Services reportedly grew since 2018 to more than 93,000.
A metaphor Hotez uses is that as long as there is warm Caribbean water, a hurricane will continue to accelerate.
“As long as you’ve got these counties, these pockets with low vaccination rates in West Texas and East Texas, measles will continue,” he said. “There’s nothing that’s going to stop it except catch-up vaccination campaigns.”
Why the resistance to childhood vaccines? Hotez said parents don’t trust the government and are buying into a myth that vaccines cause autism.
“There’s a very aggressive anti-vaccine lobby and disinformation campaign in the state of Texas,” he said. “Parents, when they’re trying to download meaningful information on the Internet about vaccines, they’re primarily getting disinformation and they’re getting disinformation from others in the community. The way I look at it, these parents themselves are victims of this disinformation campaign, which unfortunately is often politically motivated.”
A public relations campaign is needed to remind Texans that MMR vaccines are important, safe and effective, the doctor explained.
“The anti-vaccine groups do the opposite, right, they tend to blow up any rare side effects of the vaccine while downplaying the severity of measles,” he said. “That’s what they did with COVID. That has to be counteracted.”
Vaccines also need to be well-stocked and accessible, he said.
“The state health response has been pretty robust,” Hotez said. “I think the problem is at the policy level that makes it so easy to file exemptions from getting vaccinations. That’s an enabler of low vaccinations and therefore epidemics. The problem is that the policies we have in place don’t do enough to really send home the message that vaccination rates are really important to protect the health and safety of children.”
A message on the homepage of the Harris County Public Health website advises that “vaccines save lives.” Pop-up clinics have been stationed around Houston and vaccines are available by appointment throughout Harris County.
“Measles is one of the most contagious and potentially dangerous diseases, but it is completely preventable through vaccination,” the website states.
But it appears some Texans are ignoring the advice of public health professionals, and because travel isn’t banned, it doesn’t look like the measles spread will slow down anytime soon. Contact tracing — quickly identifying, assessing, and managing individuals potentially exposed to someone with measles to prevent further transmission — is doable in counties where just a few cases have been reported, but is problematic in areas like West Texas, Hotez said.
“It may be more efficient to set up the vaccination clinics and encourage vaccination,” Hotez said. “It all comes down to getting vaccinated.”
