An Insider’s View of the Texas Measles Outbreak

Katherine Wells has been an epidemiologist working to protect the public from disease outbreaks for 25 years. Until January, she had never encountered measles.

“I mean, we considered measles eradicated in the United States,” she said.

Now, as public health director for Lubbock, Texas, Wells is at the center of a measles outbreak that has infected more than 700 people in Texas alone, sent more than 90 to the hospital and killed two otherwise healthy children.

The outbreak is the largest since 2000, according to the Centers for Disease Control and Prevention. Infections have surpassed the number of cases that occurred during a 2019 outbreak in New York, previously the largest one, the CDC said.

“It’s frustrating,” Wells said, “because we have the solution, which is a very effective vaccine.”

Wells strongly believes her best chance to stop the viral infections is to boost vaccination across West Texas, where immunization rates among kindergarteners have dropped in many counties, as they have nationally.

One of her toughest challenges: Anti-vaccine advocates have flooded the region with false claims about risks from vaccines. “They are moving ten times the speed we are,” Wells told Tradeoffs when we caught up with her to talk about her experiences. Those false messages not only undermine the public’s confidence in vaccines, she said, they sow distrust in public health more broadly.

Countering the misinformation takes money, Wells said, and the federal government — a reliable partner to local health officials in the past — has taken a step back. Wells’ city and state abruptly lost federal public health funding in March when the U.S. Department of Health and Human Services cancelled more than $11 billion in grants nationwide. A spokesman for the state of Texas told Tradeoffs there aren’t funds available to send to Lubbock, though the state has provided other types of support.

Wells isn’t giving up. “We can’t let that noise disrupt what we need to do,” she said. “We still need to focus on our community. We need to get vaccines in arms, even if that takes having one-on-one conversations with individuals.”

Below are highlights from our conversation with Wells, edited for length and clarity.

On the shock of facing a measles outbreak 

Public health always happens at 4:30 on a Friday afternoon. That afternoon my staff told me that we had two cases, two potential cases, of measles in the hospital. And that’s not unusual. You always have doctors that see a rash and they want to test for measles. So I didn’t think much of it. That next Monday, I’m actually on board for one of our community nonprofits, and I was sitting in that board meeting and the woman next to me said, ‘My husband is a trainer of paramedics out in the rural areas and yesterday he told me that there was a lot of measles in Gaines County.’ I literally got up out of my seat, walked out and started making some phone calls.

It was scary. I’m going, well, am I overreacting or is this really something? But my gut feeling inside said there’s something more going on. … If you underreact, then it’s so contagious, it’s just like exponential growth. So you want to get in as quickly as possible and figure out exactly how many cases there are. What’s going on, on the ground? Are there other sick individuals? How can we make sure it stays in that one community and doesn’t spread to other communities out in the region?

On the ways  federal upheaval has complicated the measles fight

We’re watching the CDC, HHS colleagues being laid off. All of this uncertainty. … I don’t know what’s going to be cut, what public health’s going to look like at the local level.

But we have this team of people coming into work, seven days a week, helping families that are impacted with measles, combating the misinformation about vaccines, working with our providers who are needing to get children tested or adults tested, talking to businesses that might have had a measles exposure.

That core public health work is continuing. And that’s just an amazing workforce that’s getting, you know, beat up in the national media, accused of their job not being important. But these people, because of their caring for the community, are continuing to show up every day, day in and day out, and making sure that the work that needs to happen during a measles outbreak happens.

On facing the ‘machine’ that’s churning out vaccine disinformation 

It is definitely a challenge. I almost call it a misinformation machine. … It’s just hard to keep up with the messaging. You feel like you combat one bullet point on some kind of false information and then they pivot and find another. … You’re watching the Children’s Health Defense swoop in and start talking to the parents of the children who have died — giving false hope to a community and peddling cod liver oil and vitamin A.

Being healthy — or taking these supplements — is not going to prevent your child from getting measles. And we don’t know which child is going to have severe complications from measles. We don’t know who’s going to end up in the hospital and we don’t know, unfortunately, which child may die.

On how to help people who are afraid of vaccines  

Trying to get somebody to take an injection when they’re not sick, to prevent illness, just causes a lot of fear of the unknown. I’ve talked to a lot of parents that have said, “Well, we never had measles or polio or mumps in our community. So why, even if the risk for vaccines is so minuscule, why even take that risk if that disease doesn’t exist?” We’re seeing more physicians in our community willing to speak up on the importance of vaccine, more physicians willing to take the time with their patients to have those conversations.

I think the one that really touched my heart was a mother with five young children, who had never vaccinated her children before. … She felt comfortable enough to come in and have that conversation with one of our nurses and got all five children vaccinated against measles with the MMR. … So we are getting through to individuals. It’s just a slow process. She’s just one of many parents that are now coming into the public health department — because we are that trusted messenger — to get the vaccine. … It’s uplifting. You’re so exhausted. I mean, we have worked three months straight without a day off, and it just gives you that boost of energy again— and some hope.

On cultivating community for the future of public health

It makes me want to double down on my work in public health. … Ten years from now, I hope that the narrative around vaccines is changed and we’re back into a place where people can trust science and trust public health, and listen to those messages, and believe in community.

I still have some hope for all of this. There are 2,000 other health department directors out here, in the United States, who do this work day in and day out. And public health really happens on that local level – with individuals who know their community and want to make their community a better place.

Dan Gorenstein is executive editor and Melanie Evans is a reporter for Tradeoffs, a nonprofit news organization that reports on health care’s toughest choices. You can sign up for Tradeoffs’ weekly newsletter to get the latest stories in your inbox each Thursday morning. To hear more from Katherine Wells, listen to the full Tradeoffs podcast episode below.