As measles surged in TexasEarly this year, the actions taken by the Trump administration caused anxiety and uncertainty among CDC scientists, hindering their ability to carry out the agency’s most vital role — emergency response — at a crucial time, according to an investigation by KFF Health News.
The epidemic quickly turned into theworst the United States has experienced in over three decades.
In the month following Donald Trump’s inauguration, his administrationinterfered withCenters for Disease Control and Prevention messaging,stalled the agency’s reports, censored its data, and abruptly laid offstaff. During the turmoil, CDC specialists found themselves limited in their ability to communicate freely with local public health professionals, as reported in interviews with seven CDC officials who were directly involved, along with internal emails from local health departments obtained by KFF Health News via public records requests.
CDC hasn’t contacted us locally,” Katherine Wells, the public health director in Lubbock, Texas, stated in an email conversation with a colleague on February 5, two weeks after children with measles were admitted to the hospital in Lubbock. “My team feels like they’re out here by themselves,she added.
A child would pass away before the CDC researchers reached Wells.
All of us at the CDC have prepared for this situation, a large-scale outbreak,” said a CDC researcher to KFF Health News, which has chosen not to identify CDC officials who are concerned about facing consequences for talking to the media. “All of this preparation, and yet we weren’t permitted to take any action.
Delays can lead to severe outcomes when measles outbreaks occur in communities with low vaccination rates, such as those found in West Texas. If someone infected with measles is in a room with 10 unvaccinated individuals, nine of them are likely to become infected.researchers estimate. If those nine move through public areas, the numbers increase rapidly.
The epidemic that emerged in West Texas highlights the risks the nation is encountering due to vaccination.rates drop, misinformationflourishes, public health funding is reduced, and scientific organizations face political interference.
Although the Trump administration restricted CDC communications, health secretary Robert F. Kennedy Jr.fueled doubt in vaccines and exaggerated the ability of vitaminsto prevent illness. Pain ensued: TheTexas outbreak spread to New Mexico, Oklahoma, Kansas, Colorado, and Mexico’s Chihuahua state—at minimum. Together theselinked outbreakshas made over 4,500 individuals ill, resulted in at least 16 deaths, and imposed extremely high expenses on hospitals, health agencies, and individuals covering medical costs.
This is truly shocking,” remarked Jennifer Nuzzo, head of the Pandemic Center at Brown University. “In the fight against infectious diseases, time is critical.
The CDC is currently ‘stressed’
Wells was worried the instant she found out that two unvaccinated children were hospitalized inlate Januarycontracted measles. Medical facilities are legally obligated to report instances of measles to local health authorities and the CDC, yet Wells was concerned that numerous children were not being tested.
“I believe this could be quite big,” she wrote in aFeb. 3 emailto the Texas Department of State Health Services. Wells communicated inanother emailwhat she had discovered through discussions with community members: “One of the women I talked to mentioned that 55 children were missing from a school on 1/24. The women noted that there were children who were ill with measles-like symptoms as early as November.”
In that email and othersWells requested that state health officials connect her with CDC experts who could address complex questions about testing and caring for infants exposed to measles, among other issues. What followed was a slow and tedious game of telephone.
One emailWas it asked whether clinics could clean rooms where individuals with measles had recently been, if the clinics were too small to adhere to the CDC’s guideline of keeping those rooms vacant for two hours?
“Is it feasible to schedule a meeting with the CDC?” Wells wrote on February 5.
“It’s never harmful to consult the CDC,” stated Scott Milton, a medical officer with the Texas health department. Approximately 25 minutes later, he informed Wells that an information specialist from the CDC had repeated the guidelines recommending a two-hour duration.
I requested that he forward this inquiry to a more suitable individual,Milton wroteOf course, we are aware that the CDC is currently ‘stressed’.
Local authorities turned to guidance from medical professionals and academics outside of the government, including those at theImmunization Partnership, a Texas nonprofit.
The CDC had gone silent,” said Terri Burke, executive director of the partnership. “We had expected a measles outbreak, but we weren’t prepared for the federal government to be in disarray when it occurred.
Technically, the Trump administration’s freeze on federal communicationsEnded on Feb. 1. However, CDC scientists informed KFF Health News that they were unable to speak openly for several weeks afterward.
“A significant amount of confusion and vague responses existed regarding what forms of communication were permitted,” said one CDC scientist.
Georges Benjamin, the head of the American Public Health Association, stated that the issue was not specific to measles. “Similar to other public health groups, we couldn’t reach our program staff in February,” he mentioned. Details emerged gradually via the CDC’s public relations department, but CDC scientists did not hold media briefings and remained unresponsive to their key collaborators nationwide. “The CDC was silenced,” he remarked.
In private discussions, Benjamin mentioned that he found out CDC experts were being redirected to remove content from websites in line with executive orders. They were hesitant to restart communication without approval from their supervisors or the Department of Health and Human Services as they observed the Trump administration’s actions.lay off CDC staffers in droves.
It’s not as if the CDC was negligent,” Benjamin stated. “It’s that they were restricted from taking action.
To operate on the ground, the CDC requires an invitation from the state. However, Anne Schuchat, a former CDC deputy director, mentioned that during her 33 years at the agency, federal health officials did not need specific authorization to communicate openly with local health departments during outbreaks. “We would always initiate a discussion and ask if there was anything we could assist with,” she stated.
Lara Anton, a press officer with the Texas health department, stated that the state did not stop the CDC from contacting local officials. To find out more about the state’s communications with the CDC, KFF Health News submitted a public records request to the Texas health department. The department declined to provide the documents. Anton described the records as “protected by the Texas Health and Safety Code.”
Anton mentioned that the state provided vaccines, testing materials, and personnel to support West Texas during the initial weeks of February. That’scorroborated in emailsfrom the South Plains Public Health District, which is responsible for Gaines County, the region most severely affected by measles.
“Texas will address what it needs to prior to reaching out to the CDC,” Zach Holbrooks, the health district’s executive director, said to KFF Health News.
Addressing an outbreak in a community with low vaccination rates demands significant effort. To prevent the numbers from rising sharply, public health professionals should ideally inform everyone who came into contact with an infected individual and urge them to get vaccinated right away if they hadn’t already. If they refused, authorities would attempt to convince them to stay away from public areas for three weeks to avoid transmitting measles to others.
Holbrooks stated that this was almost impossible. Instances were focused inclose-knit Mennonite communitiesPeople often used home treatments before turning to professional medical help. He mentioned that many individuals were unwilling to get tested, didn’t want to identify their contacts, and avoided communication with the health department. “It’s pointless having resources if people don’t use them,” Holbrooks stated.
Historically, Mennonites have experienced persecution in various countries, leading them to be cautious about engaging with officials, according to Holbrooks. A reaction against COVID-19 restrictions further increased this suspicion.
Another factor that may lead Mennonites to steer clear of officials is that somelive in the United States without proper documentation, having moved to Texas from Canada, Mexico, and Bolivia in different waves over the last 50 years.Locals guessthe number of residents in Seminole, the primary city within Gaines County, isfar larger than the U.S. Census count.
I’m not sure how many cases we might have overlooked, as I don’t know the total number of people in the community,” Holbrooks stated. “There are many individuals living in the shadows around here.
Public health specialists describe the conditions in Gaines County as challenging yet recognizable. Measles often spreads in areas with low vaccination rates, requiring public health professionals to address suspicion, false information, language difficulties, and other obstacles.
Approximately 450 individuals — comprising local health officials, CDC researchers, nurses, and helpers — worked to manage a measles outbreak that originated within an Eastern European immigrant neighborhood inClark County, Washington, in 2018.
Alan Melnick, the director of public health for Clark County, mentioned that his team communicated with hundreds of unvaccinated individuals who had been exposed. “We were contacting them daily to check on their well-being and urge them to avoid going out in public,” he stated.
Melnick communicated with CDC scientists from the beginning, and the level of response was supported by emergency declarations from both the county and the state. After a few months, the outbreak was mostly under control. No fatalities occurred, and only two individuals required hospitalization.
In New YorkOver the course of 2018 and 2019, hundreds of individuals within the city’s health department addressed a significant measles outbreak that primarily affected Orthodox Jewish communities. Their efforts involved engaging with numerous rabbis and providing booklets to almost 30,000 households in an attempt to counter vaccine-related misinformation.
The expense exceeded $7 million, yet Jane Zucker, who was the assistant health commissioner in New York City at that time, mentioned that it resulted in significant savings. The typical medical bill for measles hospitalizations is approximately $18,500, as reported bydata from prior outbreaks. Then there’s the expense of redirecting hospital resources, children being absent from school, parents taking time off work to look after ill children, andthe lasting tollsome cases of measles infections, includingdeafness or worse.
“I don’t believe there’s a cost that can be placed on the loss of a child’s life that could have been saved,” Zucker stated.
Local health departments in West Texas have always had a shortage of staff. The South Plains health department, which serves four large rural counties, has around 18 employees. Meanwhile, the Lubbock department has about 50 staff members, and patients were being hospitalized while health workers tried to determine who had been exposed. In mid-February, Wellsemailed a colleague: “I’m so overwhelmed.”
A demise triggers a reaction
On February 26, Texas declared thatA 6-year-old child passed awayof measles. Wells learned from CDC scientists the very next day. Also on that day, the CDC released abrief noticeat the onset. The notice advised on vaccines, but it concerned public health experts as it also endorsed vitamin A as a therapy when administered by a healthcare professional.
In emails, Texas health officials privately talked about how the CDC’s notice could make things worsea problem: Doctors were treating childrensuffering from measles due to toxic amounts of vitamin A, indicating that parents were postponing professional medical treatment and giving the supplements at home. A local Lubbock news sourcecovered a major pharmacywhere vitamin A supplements and cod liver oil, which is rich in vitamin A, were “selling quickly.”
Excessive intake of vitamin A may lead to liver harm, vision loss, anddire abnormalities during fetal development.
Milton was concerned that parents were being influenced by false information from anti-vaccine organizations — includingone foundedby Kennedy—this reduced the necessity for immunization byinaccurately claimingthat vitamin A prevented the most severe effects of the illness.
“How many individuals will opt for Vitamin A instead of a vaccine, as they perceive there are two choices?” Milton questioned.in an email.
CDC scientists also expressed concerns privately. “HHS urged us to include vitamin A in all our messages to doctors and health officials,” a CDC scientist said to KFF Health News, referencing the agency’s announcements and alerts. “If pregnant women consumed excessive vitamin A during the outbreak, their babies could suffer severe disabilities. We haven’t witnessed those cases yet.”
A different CDC representative mentioned that they have had to “navigate a delicate balance” between safeguarding the public using scientific data and adhering to HHS guidelines.
Although CDC scientists remained silent, Kennedy overstated the impact of nutrition and vitamin A, while also increasing skepticism towards vaccines. “We are delivering vitamin A,” Kennedy mentioned in an interview onFox NewsThere have been numerous studies, with some indicating an 87% level of effectiveness,” he stated, “in preventing severe illness and mortality.
The studies Kennedy referencedwere carried out in low-income nations where children suffer from poor nutrition. Research indicates that taking vitamin A supplements isseldom usefulagainst measles in the United States, as deficiencies are extremely uncommon.
Kennedy diverted attention from individuals who label him as anti-vaccine,saying thatAny parent in Texas who desires a measles vaccine is able to obtain one. He then proceeded with severalinaccurate statements”There are negative side effects associated with the vaccine. It can lead to deaths each year,” he stated. “It results in all the diseases that measles itself brings, such as encephalitis and blindness, among others.” There isno evidencethat measles vaccines “lead to deaths each year.” Numerous studies demonstrate that the vaccinedoesn’t causeencephalitis, which has the most potential side effects that typically resolve on their own, with severe adverse reactions being much less common than those caused by measles.
In another interview,Kennedy stated, “The MMR vaccine includes a significant amount of aborted fetal tissue.” The measles, mumps, and rubella, or MMR, vaccinedoes not containa trace of fetal cells
A spokesperson for HHS, Andrew Nixon, and representatives from the CDC did not respond to inquiries from KFF Health News.
“Staff are exhausted”
Although the nation took notice following the country’s first measles death in ten years, West Texas found itself overwhelmed. In late February and March, hospital administrators and health officials communicated via email about ways to advocate for additional resources.
Local medical facilities are full,wrote Jeffrey Hill, a senior vice president at the University Medical Center Health System in Lubbock. “The state indicates that emergency funds which usually support a response such as the measles outbreak are not accessible from the federal government at this time,”he added.
“I am writing to convey our pressing requirement for more personnel and financial support,” Ronald Cook, medical director for Lubbock, stated inan email, prepared in collaboration with other Lubbock health officials, to the deputy city manager. “Our Resources Are Overburdened: The health department has been functioning seven days a week since February 2nd. Employees are worn out.”
The city of Lubbock provided financial support to assist the local health department in hiring temporary personnel. The state did not offer funding, but it requested the CDC to send epidemiologists. A few arrived in Texas at the beginning of March. Afterward, Texas sought federal financial assistance.
No one arrived, even as the outbreak reached 500 cases. Itspread to MexicoWhen an unvaccinated Mennonite child visited family in Seminole and came back home with an illness. This would trigger the biggest outbreak Mexico has experienced.in decades, with a minimum of 3,700 cases and13 deathsin the state of Chihuahua.
Then another child in western Texasdied of measles.
In a rare display of honesty, CDC scientist David Sugarman referred to the outbreak during a vaccine discussion.advisory meetinglate April. “There are many resource requests arriving, especially from Texas,” Sugarman stated. “We are struggling to locate the resources and staff required to assist Texas and other areas.”
Federal funds reached Texas on May 21, according to Anton, a spokesperson for the state health department. At that point, the crisis was beginning to subside. The outbreak appeared to have spread until every unvaccinated individual in Seminole had been infected, said Richard Eby, a physician at Permian Regional Medical Center who treated some measles patients. Hundreds, if not thousands, of cases likely went unnoticed, he added. “Many people assumed their children had measles,” he noted, “and didn’t feel the need to verify it.”
On August 18, medical authorities announced the situation in West Texasoutbreak over, but the effects of the disaster will endure.
The incidents it caused throughout the U.S. and Mexico continue to be on the rise.
More are unavoidable, Nuzzo stated. An increasing number of parents are choosingnot to vaccinatetheir children, worried by false claims about the vaccines. Misinformation is spreading rapidly, particularly after Kennedy dismissed vaccine advisors at the CDC and hired doctors and researchers who do not have experience in vaccines and infectious diseases, including some who have shown anti-vaccine opinions. One of his latest appointments, Robert Malone,accused of causing the deaths of childrenwith measles in “medical mismanagement,”without evidence.
At the same time, states are reducing initiatives for emergency response, disease monitoring, and vaccination following the Trump administration’s rollback of more than$11 billionearlier this year in public health funding
During Lubbock’s most challenging months, Wells sentan emailto the department’s tired employees. “The future is uncertain, and I understand this is a stressful period for many of us,” she wrote. “Every day we come in and perform our duties is a demonstration of strength.”
KFF Health Newsis a national newsroom that creates detailed reporting on health topics and is one of the main operational initiatives atKFF— an independent resource for health policy research, surveys, and media coverage.
