Key points from AP’s study on how lack of increased funding led to Texas measles outbreak and could exacerbate situation

The measles outbreak in West Texas didn’t happen just by chance.

The disease that was once eliminated in the U.S. in 2000, is now causing havoc in Texas due to a lack of funding for vaccine programs in health departments, according to officials.

Immunization programs across the country have become vulnerable as federal, state, and local governments have not provided sufficient funds for many years. While there was some extra funding allocated for dealing with COVID-19, it was not adequate to compensate for the previous neglect.

This lack of funding in Texas and other places has created ideal conditions for a measles outbreak and has facilitated its rapid spread. Moreover, recent cuts in federal funding may further jeopardize the efforts to control it.

Already, the more than 700 measles cases reported this year in the U.S. have surpassed last year’s total. The vast majority — more than 540 — are in Texas, but cases have popped up in 23 other states. Two Texas children have died.

Here are some takeaways from The Associated Press examination of funding for vaccination programs, how it exacerbates growing vaccine hesitancy and how that fuels outbreaks of infectious disease.

Decreasing vaccine rates provide kindling for disease outbreaks

Children in the U.S. are generally required to be vaccinated to go to school, which in the past ensured vaccination rates stayed high enough to prevent infectious diseases like measles from spreading. But a growing number of parents have been skipping the shots for their kids. The share of children exempted from vaccine requirements has reached an all-time high, and just 92.7% of kindergartners got their required shots in 2023. That’s well below the 95% coverage level that keeps diseases at bay.

Though the outbreak in Texas started in Mennonite communities that have been resistant to vaccines and distrustful of government intervention, it quickly jumped to other places with low vaccination rates. There are similar under-vaccinated pockets across the country that could provide the tinder that sparks another outbreak.

Keeping vaccination rates high requires vigilance, commitment and money.

Even as the population grew, funding for immunization programs in Texas health departments stayed the same

U.S. immunization programs are funded by a variable mix of federal, state and local money. Without enough money, health departments struggle.

Lubbock, about a 90-minute drive from the outbreak’s epicenter, receives a $254,000 immunization grant from the state annually that can be used for staff, outreach, advertising, education and other elements of a vaccine program. That hasn’t increased in at least 15 years.

It used to be enough for three nurses, an administrative assistant, advertising and even goodies to give out at health fairs, said Katherine Wells, the health director. “Now it covers a nurse, a quarter of a nurse, a little bit of an admin assistant, and basically nothing else.”

Other local health departments have seen the same trend. Some, such as Andrews County, have shored up programs with local money. But others haven’t.

Overall, Texas has among the lowest per capita state funding for public health in the nation, just $17 per person in 2023, according to the State Health Access Data Assistance Center.

Funding issues extend far beyond Texas

The health departments millions of Americans depend on for their shots largely rely on two federal programs: Vaccines for Children and Section 317 of the Public Health Services Act. Vaccines for Children mostly provides the actual vaccines. Section 317 provides grants for vaccines but also to run programs and get shots into arms.

Health departments generally use the programs in tandem, and since the pandemic they’ve often been allowed to supplement it with COVID-19 funds.

The 317 funds have been flat for years, even as costs of everything from salaries to vaccines went up. A 2023 CDC report to Congress estimated $1.6 billion was needed to fully fund a comprehensive 317 vaccine program. Last year, Congress approved less than half that: $682 million.

This, along with insufficient state and local funding, forces hard choices, officials and advocates said. Rural clinics may have to be closed, evening and weekend hours eliminated and efforts to fight vaccine mistrust curtailed.

Recent federal funding cuts are making things worse

In March, the Trump administration pulled billions of dollars in COVID-19 related funding for state and local health departments — $2 billion of it slated for immunization programs for various diseases. They said it was cut because the pandemic was over, but the federal government had allowed it to be used to shore up public health infrastructure generally, including immunization programs.

After 23 states sued, a judge put a hold on the cuts for now in those states but not in Texas or other states that didn’t join the lawsuit.

Meanwhile, local health departments are not taking chances and are moving to cut services. Details are starting to trickle out.

For example, Dallas County, 350 miles from where the outbreak began, had to cancel more than 50 immunization clinics, said Dr. Philip Huang, the county’s health director. New Mexico, where the outbreak has spread, lost grants that funded vaccine education. Other states have also been hit.

As the cuts further cripple already struggling health departments, alongside increasingly prominent and powerful anti-vaccine voices, doctors worry that vaccine hesitancy will keep spreading. And measles and other viruses will too.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.