Texas measles outbreak puts a weakened health system on the ropes

Twenty-five percent of Texas counties do not have a hospital: 64 out of 254. And in West Texas, an endless, dry, sparsely populated plain that stretches into neighboring New Mexico, that requires patience and creativity amid the largest measles outbreak — a disease declared eradicated in the United States in 2000 — in 30 years. Without real isolation rooms, separate spaces have been set up for testing, in some cases in other empty municipal buildings, local media report. And once the test is done, you have to drive dozens of miles with it to be sent to the lab. Then you have to wait up to two more days for the result, during which time the potentially infected person could be spreading the virus. Meanwhile, confirmed cases are rising in a climate in which the only proven effective response, the triple viral vaccine (MMR), raises deep suspicions.

The latest official update, from last Friday, put the number of confirmed cases nationwide at 222, 198 of them in Texas, in addition to two deaths: one of a Texas child and the other of an adult in New Mexico. The vast majority of infections have occurred in the western part of Texas, a largely rural area dominated by agriculture and oil wells, where Mennonite communities, generally wary of modern medicine, are being hit hardest. In fact, local doctors believe that since many are not coming forward to report an infection, the number of cases is probably higher. Cases are also expected to continue to rise, as vaccination rates are below what is needed to achieve herd immunity amid the rise of the anti-vaccination movement. Faced with this situation, the public health system of one of the poorest regions of the state, with the highest percentage of people without health insurance, itself poorly funded and with insufficient material resources, faces the challenge of fighting an extremely contagious virus and the misinformation that is helping it.

It’s not just that many counties don’t have hospitals — 25 don’t even have a primary health post. And in rural areas where they do exist, they are mostly in dilapidated buildings, lack modern equipment and facilities, and are understaffed, according to several official and external reports in recent years. At the same time, Texas is spending billions of dollars on an anti-immigration program of dubious effectiveness and legality. For example, the state has a shortage of pediatricians, which is a particularly serious problem in the midst of a historic measles outbreak, which disproportionately affects children.

The situation is bringing back recent memories of the Covid pandemic. After years of underinvestment, Texas’ public health system was overwhelmed, especially in rural areas that are now in the eye of the storm. According to an analysis by the Austin American-Statesman, the Covid death rate in counties without a hospital was 20% higher than in those with one.

But the legacy of Covid is also present in another way: in the growing distrust of vaccines. In Gaines County, the epicenter of the outbreak, the conscientious exemption from vaccination for preschoolers — parents who choose not to inoculate their children — has risen from about 7% a decade ago to 18% last year. Dr. Wendell Parkey, the medical director of the family clinic in Seminole, Gaines’ main city, put it bluntly to the Wall Street Journal. “Before Covid, I could convince some people. Now it’s like, ‘Forget it.’”

The fight is made more complicated by the anti-vaccine credentials of Washington’s Health Secretary, Robert F. Kennedy Jr., and the loudspeaker he has at his disposal. In an interview on Fox News, he argued that vaccination is a parental choice and strongly recommended cod liver oil and vitamin A to fight measles. By contrast, health systems in this part of Texas do not have the resources to mount an effective campaign to inform and educate the public.

Only after the death of a child, the first in the outbreak, did state and federal support intensify. Twenty-seven contractors were sent to the area last week to assist local health agencies, state Health Services Commissioner Jennifer Shuford told a legislative hearing. A public awareness campaign was also launched with billboards and social media posts. And the federal Centers for Disease Control and Prevention sent “disease detectives” to West Texas to figure out the source of the infections, which remains a mystery.

Still, the logistical challenges inherent in an area where long distances are the norm pose an added obstacle to combating misinformation. Most counties rely on one of Texas’ 11 regional public health departments, with limited budgets and little knowledge of local communities. The targeted campaigns they can conduct are often short, due to travel times, and relatively sparsely attended, reflecting the low population density and poor communication channels with residents.

In any case, any measures now are reactive, which is not ideal when the battle is against measles: since it is one of the most contagious viruses known and the outbreak is already well advanced, containing it effectively is very difficult. So the current strategy of local officials, though not of the health secretary, is to reinforce the importance of vaccines, which are effective even in people already infected, and to counter misinformation about home remedies.

Five years after the Covid pandemic hit the world, the measles outbreak in Texas is once again highlighting how a deficient health system leaves rural communities in Texas very vulnerable. Gordon Mattimone, director of the Andrews County health department, told the Texas Tribune: “We are in a public health shortage zone. We have to be creative.”

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