was originally reported by Barbara Rodriguez of . .

In mid-December, Dr. Annie Andrews turned on her camera to record. The pediatrician — among a growing cohort of medical professionals who use social media to break down health care news and misinformation — had a public service announcement.

“As the entire country is aware, we have a measles outbreak in the upstate of South Carolina,” Andrews said. At the time, there had been of the highly contagious disease in the state, where she and her three school-aged children reside.

Andrews noted that the vaccine available to prevent measles — known as the measles-mumps-rubella (MMR) vaccine — . She offered practical advice for adults who might want to check if their measles immunity had waned. And she cautioned people to be extra mindful amid holiday travel.

“Please stay home if you have a fever, stay home if you have obvious cold symptoms like a cough and a runny nose,” she said. “Certainly stay home if you have a rash along with that fever. Protect your loved ones and do what you can to stop the spread of measles here in South Carolina and in the other parts of the country where it is currently spreading.”

Her video ended with an image promoting her campaign for the U.S. Senate.

“I never in a million years, when I was in medical school, thought that I would be running for the U.S. Senate and also talking about measles nearly every single day,” Andrews told The 19th.

A growing measles outbreak — since start of the year, in the United States, with South Carolina being the epicenter — has become a cornerstone of Andrews’ messaging for her , which she balances while working at a children’s hospital and parenting.

And Andrews suspects that mothers are paying close attention to her campaign. She calls mothers of school-aged children her most loyal base of supporters. They leave positive messages on social media, stop her after campaign events and while she’s shopping at the grocery store.

“As we see our children under constant threats — whether it’s from or now sort of the politicization of HHS and vaccine recommendations — moms have had enough and they’re fighting back,” she said. “I think I’m tapping into something here in South Carolina and across the country. Moms who just get that ‘mama bear’ instinct — and now they understand that politics is a really important way to fight back and protect their kids.”

The Democrat faces an uphill battle as she challenges Sen. Lindsey Graham, a four-term Republican incumbent who’s held the seat for more than 20 years. While Andrews outraised Graham in the third and fourth quarters of 2025 , the senator has more cash-on-hand to spend. Both candidates are heavily favored to win their primaries in June.

Andrews first ran unsuccessfully for Congress against Republican Rep. Nancy Mace in the 2022 midterm election. in a race that centered . After her last congressional bid, Andrews did not plan to run again.

Then Robert F. Kennedy Jr. was confirmed as health secretary.

“The fact that it is 2026 and here I am in South Carolina, where we are in the midst of a measles outbreak because of disinformation and conspiracy theories spread by people like RFK Jr. — is just really mind-blowing to me as a health care professional, as a physician, as a clinical researcher,” she said. “And so it really was the reason I decided to get in this race.”

Andrews connects Kennedy’s actions on vaccines — his department has made , , to senators like Graham in part by noting their critical confirmation votes. A spokesperson for Graham did not respond to a request for comment about the senator’s stance on the measles outbreak in his home state. A review of recent public news releases on Graham’s Senate website does not appear to address the topic.

But Andrews’ campaign also focuses on health concerns more broadly: Andrews believes the political headwinds are shifting. Republicans, who control Congress, last year enacted massive budget cuts to programs like , and they allowed under the Affordable Care Act to lapse, sending premiums skyrocketing.

“South Carolina has a lot of health care deserts, folks who live in rural areas, who have to drive many, many miles and cross county lines to reach a hospital system and an emergency department and maternity care,” she said. “All of that is going to be made so much worse because of what we’ve seen from this Trump administration — of course, enabled and supported by Lindsey Graham.”

Andrews is tapping into a topic with massive implications on public health, said Shaughnessy Naughton, president of 314 Action, a political action committee that tries to elect Democrats with a STEM background to office and has endorsed Andrews. Before the record-setting cases in 2025, the United States had averaged 180 cases of measles annually since 2000, when the disease was declared eliminated. this year and the United States is on the brink of losing its elimination status.

“As a pediatrician in kind of ground zero of the measles outbreak in South Carolina, she is a voice of real credibility and authority,” Naughton said.

Doctors and health care professionals have increasingly declared candidacies ahead of the midterms, according to 314 Action. Last November, the group endorsed and supported 148 candidates in races that included seats in New Jersey and Virginia — 108 won.

314 Action launched a new last year aimed at electing more doctors, nurses and public health experts to state and federal offices. It has received 200 applications from doctors interested in running, according to Naughton.

“Americans overwhelmingly support childhood vaccines that have been shown to be effective and safe. Americans wanted the ACA subsidies to be extended so they could continue to purchase health insurance to keep their family safe and healthy,” she said. “You couple it with a cut to public health and research that provides future hope for people and cures — it’s just an administration that is not listening to what Americans want.”

Kayla Hancock is director of Public Health Watch, a health-focused communications initiative from the health care advocacy group Protect Our Care. She said the Trump administration’s health policies — led in part by Kennedy — have forced the electorate to pay attention. shows 75 percent of voters say the cost of health care will impact how they vote in the midterms.

“Every day, the consequences of the Trump administration’s policies around health and public health are mounting,” she said. “Between disruptive vaccine development and now deadly outbreaks of diseases that we had previously had under control, and then, of course, .”&�Բ�����;

Andrews is running for office while commuting between Charleston, where her children attend public school and she co-parents with her ex-spouse, and Washington, D.C, where she works at a children’s hospital. She said going back and forth between these two worlds — the campaign trail and her job as a doctor — has grounded her candidacy.

“I’m taking care of kids who are struggling with food insecurity. Kids who have asthma and live in a home with mold on the walls and can’t afford to move to a different apartment. Kids whose parents can’t afford their prescription drugs. Kids who can’t access mental health resources in their community, and kids who have a past medical history of gunshot wounds, which is really only something you see in America,” she said. “It reminds me of all the reasons I’ve sacrificed so much to run for office. Because these problems are so urgent.”&�Բ�����;

Andrews’ campaign platform extends beyond health care. Through her lens as a parent, she talks about addressing gun violence, making groceries more affordable for families and restoring federal abortion rights.

Still, disease prevention has been a central issue for her. Even before the outbreak in South Carolina, Andrews featured an X-ray of a kid with measles pneumonia and noted the condition could be prevented by vaccines. It’s a point she often brings up now both online and on the campaign trail, partially because the outbreak in her state has worsened since her December PSA: As of early February, cases in the state , mostly involving children 17 and under.

More than 240 cases involve children under the age of 5, some of the most vulnerable to infection since children under the age of 1 are typically too young to get the MMR vaccine. Most of the infections reported were among people not vaccinated.

The consequences to children only crystallize Andrews’ decision to run. She pointed out that while doctors have served in the Senate, a pediatrician has never been elected into the centuries-old chamber. (Rep. Kim Schrier of Washington state, a Democrat elected in 2018, .)

This week, Andrews focused on measles and related resources for parents.

“There’s never been a more important time for people who have an understanding of our health care system and basic medical principles to be in the room where decisions about our health care system — decisions about the public health guidance that is coming out of the federal government — are being made,” Andrews said.

If such a change goes into effect, “pediatric hospitals will be overwhelmed with [childhood] infections that have virtually been non-existent for the last 40 years,” said Florida-based infectious disease specialist Frederick Southwick. Southwick attended a Dec. 12 public comment workshop on the issue hosted by the Florida Department of Health. 

“We’re in trouble right now,” he added, pointing to and the likelihood that some diseases could become endemic. “We’re getting there, and this [ending the mandate] would just do-in little kids.”

The session delved into the proposed language the department has drafted for a rule change that would do away with vaccine mandates for four key immunizations: varicella, more commonly known as chickenpox; hepatitis B, pneumococcal bacteria and Haemophilus influenzae type B, or HiB. Currently, children cannot attend school in Florida without proof of these four immunizations, among others, including the measles, mumps and rubella vaccine. 

Although Florida is not considering removing the mandate for the MMR vaccine, health experts see the move it is contemplating as eroding childhood immunization generally. It comes when in South Carolina because of a burgeoning measles outbreak.

Rana Alissa, president of the Florida Chapter of the American Academy of Pediatrics, was also in attendance to express her concerns. She told ����Ӱ�� this week that thanks to the success of vaccines, she’s never had to treat some of these “horrible diseases,” including HiB, which can lead to meningitis.

“Don’t make our kids — Florida’s kids — guinea pigs to teach me and my classmates and other pediatricians how to manage these diseases,” she implored.

Tallahassee parent Cathy Mayfield lost her 18-year-old daughter, Lawson, to meningitis in 2009, a few months before she was supposed to leave for college and just before she was due for a booster shot. (At the time, the booster was not recommended until college, according to Mayfield.)

“You just don’t realize until it happens to you,” she said.

She hopes others will learn the importance of vaccinating their own kids from her family’s story. 

“All the information I learned through our tragedy about vaccinations made me very supportive of the safeguards [they] offer,” she said.

“You’ve also got to realize,” Mayfield added, “that your decisions affect your community, and that’s something I think has gotten lost in … all this conversation and hesitancy about vaccinations.”

Equating vaccine mandates to slavery

The workshop, which was announced the day before Thanksgiving, was held in Panama City Beach, in the Florida Panhandle, far from the state’s main population centers. About 100 people showed up to the session, which was characterized by attendees as but civil. Northe Saunders, president of the pro-vaccine advocacy organization and who was there, estimated that about 30 people spoke in favor of keeping the current vaccine mandates, while approximately 20 spoke in opposition.

Some speakers opposed to vaccine mandates included conspiracy theories in their arguments, according to news reports and numerous people present at the workshop, echoing language heard from the federal government since Secretary Robert F. Kennedy Jr., a long-time vaccine skeptic, took over the Department of Health and Human Services.

One attendee argued that giving children multiple jabs in a 30-day period “accounts to attempted murder,” according to . A number of others questioned if this year’s reported measles outbreaks, which resulted in the in Texas, had actually occurred.

Florida leaders’ desire to become the first state to was announced in September by its surgeon general, Joseph A. Ladapo, standing beside Gov. Ron DeSantis in the gym of a private Christian high school. In sharing their plan, Ladapo claimed that “every last [mandate] is wrong and drips with disdain and slavery.”&�Բ�����;

Only four vaccines are mandated through a Department of Health rule and are therefore under Lapado’s purview. The remaining nine, which in addition to the MMR shot include polio, are part of state law and can only be changed through legislative action. 

Experts told ����Ӱ�� this is a much more difficult feat, one that state legislators — even conservative ones — don’t seem to have an appetite for. Richard Hughes, a George Washington University law professor and leading vaccine law expert, said such a legislative attempt would “warrant legal action.”

‘We really need to turn this around’ 

The debate in Florida and other states over mandatory childhood immunization comes as the country teeters on the edge of losing its measles elimination status. This year alone has seen nearly confirmed cases, the most since 2000, when measles was declared eliminated in the U.S. by the World Health Organization. Just over 10% of cases have led to hospitalization. The current South Carolina outbreak has infected at least , and among those forced to quarantine are students from nine schools. 

Significant educational implications from the outbreaks emerged in a by the Annenberg Institute at Brown University, which found that absences increased 41% in a school district at the center of the West Texas outbreak, with larger effects among younger students.

The spread of measles is also a warning of the ramifications of dropping vaccine rates, according to William Moss, executive director at Johns Hopkins’ International Vaccine Access Center.

“Measles often serves as what we [call] the canary in the coal mine,” he said. “It really identifies weaknesses in the immunization system and programs, because of its high contagiousness.”

“Unfortunately, I see a perfect storm brewing for the resurgence of vaccine preventable diseases,” he added, “… We really need to turn this around.”

Earlier this week, the Centers for Disease Control and Prevention , and in the preceding months changed policies surrounding the measles, mumps, rubella and varicella (chickenpox) combination vaccine and this year’s COVID 19 booster — all based on recommendations from an advisory committee hand-picked by Kennedy. The universal birth dose of the hepatitis B vaccine, in place for decades, was credited with nearly eliminating the highly contagious and dangerous virus in infants.

Lynn Nelson, the president of the National Association of School Nurses, fears that other, more conservative states will now look to Florida as an example.

“We already have seen outbreaks all over, and they’re only going to escalate if you have an area of the country whose herd immunity levels slip down further than they already are, which I think will happen if those [anti-mandate rules] come into effect,” she said. “That, in combination with some of the other misinformation that’s coming out, people will feel validated in decisions not to immunize their children.”

Florida’s Department of Health appears to be moving ahead to end requirements for the four vaccines it controls, despite indicating nearly two-thirds of Floridians oppose the action. Proposed draft language presented at the Dec. 12 workshop would also allow parents to opt their kids out of the state’s immunization registry, Florida SHOTS, and expand exemptions. 

Currently, all 50 states have vaccine requirements for children entering child care and schools. Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons and most states — including Florida — also have religious exemptions. Part of the proposed changes presented at the Dec. 12 meeting would add Florida to the 20 states that additionally have some form of , further widening parents’ ability to opt their kids out of routine vaccines. 

The public comment period remains open through Dec. 22, after which the department will decide whether or not to move forward with the rule change. In the interim, advocates are pushing state health officials to conduct epidemiological research around the impact of removing the vaccine mandates and studies on the potential economic costs. Florida is and out-of-state visitors. 

Without that information, pro-vaccine advocate Saunders said these critical public health care decisions will be made “at the whim of an appointed official.”&�Բ�����;

“The nation,” he added, “is looking at Florida.”

Before the pandemic helped fuel the growth of vaccine politicization across the country, less than 1% of Austin school district’s kindergarteners in the fall of 2019 failed to comply with the state’s vaccine reporting requirements.

Five years later, Austin ISD had some of the state’s highest number of kindergarteners who neglected those state requirements — about 1 in 5 kindergarteners had not proven they were fully vaccinated against measles and did not file an exemption.

A Texas Tribune analysis has found that this explosion of vaccine non-compliance has played out across many school districts in the state in recent years, helping to push Texas’ measles vaccine coverage to the lowest it’s been since at least 2011.

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“We definitely were on a better trajectory [before the pandemic],” said Alana Bejarano, executive director of health services and nursing for the Austin school district, which reported a 23% delinquency rate for the measles vaccines among their kindergarteners.

“I don’t know that I can pinpoint the concrete answer, except [preschool and kindergarteners] were born at a time where everything kind of went off track and getting them back into that, you know, that’s been difficult.”

The Tribune examined kindergarten measles vaccination compliance because it’s the earliest the state documents school vaccination rates and measles can be especially deadly for young children. The state’s two measles deaths this year were girls ages 6 and 8. Under Texas vaccine requirements, most kindergarteners must show they are fully vaccinated against measles or file an exemption to enroll in school; most who are not fully vaccinated have an exemption.

During the pandemic, the statewide measles vaccine delinquency rate — a term the Texas Department of State Health Services uses to track students not compliant with those requirements — more than doubled.

The Tribune estimated the number of vaccine-delinquent kindergarteners in each district by comparing delinquency rates and enrollment totals.

In school districts with the most delinquent kindergarteners in the 2024-25 school year, the latest data available from the state, as much as 44% of their kindergarteners were delinquent in the measles vaccines, and their delinquencies also outnumbered exemptions, which was not the case at the state level. Those school districts had vaccine delinquency rates as small as a fraction of a percent just five years prior.

The five other vaccinations required for kindergarten followed similar increases in delinquency rates during the same time period.

The pandemic is the driving force behind the increase in vaccine delinquency, school district officials say. Many children are entering school after falling behind on their immunizations during the pandemic, making it an untenable task for resource-strapped school districts to chase after parents to vaccinate their children or submit an exemption.

Meanwhile, access to vaccines, especially free and low-cost doses, have also dwindled over the last several years amid funding cuts and the politicization of vaccines.

State laws and rules don’t dictate who has to enforce vaccine compliance, although the Texas Department of State Health Services administers the law and school districts have traditionally been among the first line of enforcement.

While school districts acknowledge they are enrolling students not compliant with state vaccine requirements, district officials say they are caught in a no-win situation. Pushing vaccines too hard could lead to retaliation from groups and politicians opposed to vaccine mandates, and district officials don’t want to disenroll students — public schools have a responsibility to educate all children and so much of their funding is tied to attendance, too.

“We encourage our school nurses to advocate strongly to promote and protect public health at their campus,” Becca Harkleroad, executive director of the Texas School Nurse Organization. “But ultimately it’s up to the superintendent and the principal to decide how strictly they are going to enforce it or if they are going to enforce it.”

Statewide, the percentage of kindergarteners who were delinquent in getting the measles vaccine more than doubled to 2.68% between 2019-20 and 2024-25, the latest data available. The delinquency rate jumped to 3.1% in 2021-22, surpassing the number of students who had an exemption. Those rates have not returned to pre-pandemic levels, although the exemption rate has returned to exceeding the delinquency rate.

The federal Centers for Disease Control and Prevention estimates that a year ago 25,000 Texas kindergarteners were not fully vaccinated against measles. Of those, more than 16,000 had an exemption, and about 9,000 did not have an exemption and under the state’s definition, were vaccine delinquent.

The overall vaccine delinquency rates may be small, but anything that causes vaccination levels to fall means more children are vulnerable. Ideally, schools try to keep their vaccination levels at 95% to help protect those children with compromised immune systems or medical conditions that keep them from being vaccinated.

In addition to vaccine delinquency, the state also tracks the percentage of students who are vaccinated, formally exempt from vaccinations, and provisionally enrolled because of vaccination status.

Most unvaccinated students in Texas are permitted to enroll because they have an exemption form or a note from a doctor. They can also provisionally enroll without proving vaccination status if they are homeless, military dependents or in foster care and their records cannot be obtained by the start of the school year.

The Texas measles kindergarten vaccination rate of 93% is the lowest it’s been since at least 2011, ranking the state 18th nationally.

“The decrease in vaccination rates overall is certainly a concern because it leaves our population vulnerable to different infections,” said Dr. Erin Nicholson, a pediatric infection physician at Texas Children’s Hospital and an assistant professor at Baylor College of Medicine. “And we saw that front and center with the measles outbreak that recently happened.”

Schools: A first line of defense against infectious disease

By the time most children enter kindergarten, they have received two MMR vaccination doses, against measles, as well as mumps and rubella for most people. The MMR vaccination for kindergarteners is considered one of the .

State health officials audit school vaccination records each year for accuracy, by sampling school district records, explains Chris Van Deusen, spokesperson for the Texas Department of State Health Services. But there is nothing in state rules that requires DSHS to enforce the vaccination requirement.

As a result, the de facto enforcement has traditionally fallen to school districts.

Some of the state’s highest kindergarten measles delinquency rates were in larger school districts and charter networks: KIPP Texas Public Schools (44%), Spring ISD (30%), Austin ISD (23%), Dallas ISD (20%), and Houston ISD (7%).

The five public school systems with the highest counts made up more than half of all delinquent kindergartners in the state, despite enrolling less than 10% of the state’s public school kindergarteners.

Some district officials, including Dallas, say they try to follow state requirements by sending home students who do not have completed vaccination requirements or an exemption. But, they enroll those students, contributing to the district’s vaccine delinquency rate.

The Austin school district will also enroll the students who don’t meet vaccine requirements, but they wait to send those students home until their parents have been notified of their vaccine delinquency three times, Bejarano said. They can return once they have proof of vaccination or the exemption form.

State data doesn’t track how many vaccine-delinquent students school districts send home. It also doesn’t reflect changes to vaccine delinquency later in the year because the data is based on surveys school districts submit in the first half of the school year.

While some school districts say they try to send home students who don’t meet vaccine requirements, Houston ISD officials said they are keeping those students in the classroom. They, too, dedicate time and resources to track all students’ vaccination status and try to communicate information with parents about the need for staying up to date on the schedule.

But, they are “not excluding students from learning based on vaccine status,” according to a statement to the Tribune.

Chanthini Thomas, a school nurse who retired from her job at Houston ISD’s Bellaire High School last summer, said the conflicting messages from the district, resource reductions and the yearlong chase to get vaccine paperwork in was frustrating.

“You have little support,” she said. “Why would you say…that’s a requirement to any school for the state of Texas but then you put out a mandate from the district to say, don’t let immunizations prevent enrollment? And the reason is because they need the numbers, because the numbers were dwindling.”

Like many other urban school districts, HISD is battling — and the funding that comes with it — as more families move toward better job opportunities and lower housing costs in the suburbs or choose charter and private schools.

As school nurses have told the Tribune over the summer, school districts choose to enroll unvaccinated children so they can keep “butts in the seats” and the base amount of money they receive from state and local sources to educate each student — .

“I see the school as being in a tough spot,” said Melissa Gilkey, a University of North Carolina professor who studies vaccine efforts at schools. “We work so hard to minimize absenteeism…that I do have some sympathy for that idea that it’s hard to exclude them for one health service.”

KIPP Texas Public Schools, a charter network with campuses across the state, declined an interview but insisted it was following the state immunization requirements. Its kindergarten measles vaccine delinquency rate was less than 1% in 2019 compared to 44% last year.

Spring ISD, north of Houston, reported last year that more than 30% of its kindergarteners were measles vaccine delinquent. The district informed the Tribune it also follows state rules closely but said its high MMR delinquency rate was evidence of “enrollment and access issues” and that Spring ISD was “actively working to strengthen this process.”

The Spring district cited family’s frequent moves in the area, limited access to health care and language barriers as reasons there’s a delay in getting student shot records updated in time for school.

“We are committed to improving compliance rates and ensuring our students are protected against preventable diseases,” said Shane Strubhart, the Spring ISD spokesperson.

Access to vaccines has dwindled

The pandemic disrupted preventive health care, becoming most apparent in some of the most recent kindergarten classes, filled with students born around the first COVID-19 outbreak. The COVID-19 pandemic not only interrupted home and school life, experts say, it upended regular health checkups younger children typically receive before they start school and that impact continues to be felt today.

Families “going to see the doctors got off track for everyone during the pandemic,” Austin ISD’s Bejarano said.

For low-income and immigrant families who already found health care access a challenge, more are struggling to find what Bejarano calls their “medical” home, a regular primary care doctor who can either vaccinate their children or answer concerns and perhaps direct them to the state’s exemption process if they feel strong enough to opt out.

“COVID didn’t do vaccination or education and many other things as a whole, any favors,” said Jennifer Finley, executive director of health services for Dallas ISD. The district’s kindergarten measles delinquency rate jumped to 20% last school year compared to 1% during the 2019-20 school year.

Diminished vaccine access is also a factor. Up until the early aughts, public health departments, churches and even lawmakers would hold free or low-cost immunization clinics over the summer for families.

In 2004, the Dallas school district turned away hundreds of students, who walked and drove to nearby clinics for free or low-cost vaccines, according to a Dallas Morning News article.

After the pandemic, those resources are even fewer.

“It really stopped during the pandemic,” Finley said. “Some of the folks lost their funding.”

Schools rely heavily on local public health departments to help them with vaccination clinics. Once the threat of COVID lessened, public health departments used those funds to add more staff and hold more vaccination clinics.

But two things began by local health departments. First, those leftover funds were clawed back early by the Trump administration this year, prompting some staff to look for other jobs, thereby causing staff shortages in public health vaccination departments. And second, public health officials suspect more immigrant families are shying away from vaccination because of stepped-up immigration efforts and deportations.

In Texas, there are an , all of whom do not qualify for state Medicaid health insurance coverage, attending school.

“We typically have big lines and the waiting room is packed. Our whole lobby is packed,” Dr. Phil Huang, the director of the Dallas County Health and Human Services Department, told the Tribune in August. “This year it has not been that way.”

Vaccine hesitancy changing school messaging

After the pandemic, many parents watched as debates raged over the safety of the quickly-developed COVID-19 vaccine. As a result, they are asking more questions about all childhood vaccinations.

In many cases, parents are spreading MMR doses out and that, too, could be the reason for more kindergartners showing up with an incomplete vaccination status, Bejarano said.

“The main concern [among parents] is basically, ‘Am I doing the right thing for my child, that is in their best interest and help me understand what the risks are of these infectious diseases that vaccines are trying to prevent,’” Nicholson, the Texas Children’s physician, said.

Before COVID, many doctors adopted an imperial tone — “you should do this because I’m the expert,” she said. That changed after the pandemic. “We are looking at how we talk to these parents, because the last thing that we want to do is come across as condescending.”

School nurses have also worked tirelessly to try to find a winning formula to reach families of vaccine-delinquent kids. At a national school nurse conference in Austin this summer, an entire session was devoted to teaching nurses how to have tension-free conversations with parents who are skeptical of vaccine requirements.

Ultimately, school nurses just want to inform parents of their two options to stay compliant with state rules: either provide proof of vaccination or an exemption, Bejarano said.

“We’ve made these large campaigns and we are really kind when they register, letting them know what is the law, what the exemptions [are],” Bejarano said. “I just think the district in general is understanding we need to do better when it comes to public health and getting these rates up.”

The good news, she says, is that the greater efforts made by school nurses in the fall to try to help parents become vaccine compliant tends to push down the high delinquency rates by the end of the school year. Data provided to the Tribune by Austin ISD proved that out. That 23% delinquency rate for kindergartners recorded in the fall of 2024 fell drastically to 6% by May 2025 possibly due to the fear produced by the measles outbreak in the months prior.

“I do think that everybody came together in the Austin community and really did try to push for that” compliance, Bejarano said. “And I think that’s why it helped the rate last year.”

Finley points to other lesser-known reasons complicating the back-to-school vaccination picture. Among them, an influx of students came to Texas from other states, many already armed with vaccination exemptions or with incomplete vaccination histories who are having to be re-educated about Texas requirements.

Starting Sept. 1, Texas parents can more easily obtain a vaccine exemption form by downloading it off the state’s website, but how that will impact the delinquency gap won’t be seen until data is released next year.

Nicholson, Finley, Bejarano and others say they would like to see more data that clearly explains the rising delinquency rate and how many students who were once marked delinquent end up becoming fully vaccinated or obtaining an exemption by the end of the year.

“Does it mean, you know, people are just struggling with paperwork?” Nicholson said. “Or does it mean that really those vaccinations are falling?”

This first appeared on .

The 12 members, who were recently handpicked by controversial Health and Human Services Secretary Robert F. Kennedy Jr., also debated overturning decades of established practice around hepatitis B shots for newborns, though they ultimately tabled that vote.

The other two shots in play were the measles, mumps, rubella and varicella (chickenpox) combination vaccine, also known as MMRV, and this year’s COVID 19 booster. 

By the end of the week, the Advisory Committee on Immunization Practices, also known as ACIP, voted to no longer recommend the MMRV combination vaccine for kids under 4 years old, rendering it largely inaccessible for that age group. 

The committee also voted to shift the COVID 19 booster recommendation to “shared clinical decision making” for all people over 6 months old — regardless of age or risk level — meaning that before getting the shot, individuals will need to talk through the pros and cons with a health care provider, which includes pharmacists. 

Through this departure, the committee largely preserved access and insurance coverage, while also raising doubts about the effectiveness and safety of the vaccine, at times citing debunked theories.

“There is just widespread confusion about, ‘What should I do as a parent? Who should I listen to?’” said Northe Saunders, executive director of the pro-vaccine advocacy organization , formerly called SAFE Communities Coalition. 

“American parents and American providers don’t actually know what the best recommendations are anymore,” he added, “and so that is going to lead to more hesitancy, because there’s uncertainty about what the right thing to do is, and that’s going to lead to declining immunization rates.”

Before the ACIP meeting, MMRV and hepatitis B vaccine recommendations were based on decades of established practices supported by science, which experts described as “settled,” so it was unclear why they were being relitigated, according to numerous medical professionals, including those who spoke during the meetings as well as those interviewed by ����Ӱ��.

The point of these conversations is, “to raise doubt, to confuse people,” said Paul Offit, the director of the and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. Offit was instrumental in the creation of the rotavirus vaccine and previously served as an ACIP member. 

“The degree to which the public is confused about vaccines is the degree to which they will be less likely to get them,” he said, “and that is RFK Jr’s goal: to make vaccines less available, less affordable and more feared.”

The meetings themselves appeared to be marked by moments of pronounced confusion for the new committee members, some of whom asked for clarification around what they were voting on multiple times.

At least some of this was likely due to their unusual level of inexperience, which committee Chair Martin Kulldorff even noted as he opened day two on Friday.

“We are rookies,” Kulldorff “With one exception, this was either our first ACIP meeting or our second.”

Typically, committee members are highly qualified medical professionals who are vetted for months to years before serving. In an unprecedented upheaval earlier in June, Kennedy Jr. fired all 17 existing advisory members via a Wall Street Journal — after promising he would leave the committee’s recommendations intact. 

Almost immediately he brought on eight new members, a number of whom have espoused anti-vaccine rhetoric and other scientific misinformation. One of them eventually stepped down and Kennedy then added an additional five members leading up to last week’s sessions.

Measles, mumps, rubella and varicella

The MMR vaccine was in the United States in 1971, followed by the MMRV vaccine in 2005. Two doses of the combined shot were preferred until 2008, when monitoring studies showed an increased risk of febrile seizures — convulsions in a young child caused by a fever — following the first dose. 

While these seizures are short-lived, resolve themselves and are not associated with any long-term negative outcomes, “they’re hard to watch,” said Offit.

So by 2009, the CDC released updated recommendations, in place up until Thursday’s vote, which advocate for separating MMR and varicella for the first dose at age 12-47 months and administrating the combined shot for the second dose at age 4-6 years old. These vaccines are among those required for school entry in all 50 states, though numerous states have recently introduced legislation to loosen mandates, and exemptions are on the rise.

The vast majority of parents (85%) opted to follow that recommendation for separating the shots, with 15% still choosing the combination vaccine for the first dose, often to avoid multiple jabs of an infant.

The committee’s recent update to the recommendations will mean that choice no longer exists.

While this change itself is “not a huge deal,” Offit said, the arguments brought up by committee members were “intellectually disingenuous” and will only continue to “raise doubt.”

Stacy Buchanan is a pediatric nurse practitioner and a clinical professor who is the National Association of Pediatric Nurse Practitioners’ liaison to ACIP

“I really feel like this was brought up to just further confuse caregivers that are already questioning whether or not they want to have their child vaccinated,” said Buchanan. “And in a time where we’re seeing unprecedented numbers of measles in communities, I think that we need to be really clear that the MMR vaccine — whether you’re getting the combined or two separate injections — is really key and needs to be administered routinely based on the schedule.”

In past years, the liaisons like Buchanan, who have on-the-ground clinical experience, would weigh in during the committee’s working group meetings to help evaluate the evidence. That precedent was unexpectedly overturned in late July when the liaisons received an email accusing them of being and no longer permitted to serve. Now they can only be heard during the public comment portion of the meetings.

In a statement released Thursday, the American Academy of Pediatrics wrote, “Today’s meeting of the federal Advisory Committee on Immunization Practices (ACIP) promoted false claims and misguided information about vaccines as part of an unprecedented effort to limit access to routine childhood immunizations and sow fear and mistrust in vaccines. Following today’s meeting, instead of emerging with clear guidance about vaccines that we know protect against serious illnesses, families are left with confusion, chaos and false information.”

The AAP also emphasized that they had released their own , which includes unchanged MMRV vaccination recommendations.

Committee members elected for the combination shot for those under 4 to remain covered by Vaccines for Children, which provides vaccines to millions of kids who otherwise wouldn’t be able to afford them, despite their recommendation against its use. Some members apparently misunderstood what they had voted on Thursday and reversed their stance the next morning. 

COVID 19 booster

On Friday, the committee voted on four measures surrounding the COVID 19 booster shot. Three passed, and the fourth, which was the most controversial and would have recommended required prescriptions for anyone seeking to get the shot, ended in a tie vote that ultimately failed.

During his presentation, Retsef Levi, put in charge of the working group on COVID, raised a number of concerns around mRNA vaccines that have been widely disputed, including the assertion that they could change the way the body reacts to its own genetic material. Levi is a professor of operations management at MIT’s Sloan School of Management and has no formal medical training.

The three provisions that did pass will mean that while the vaccine is not actively recommended for anyone — including those at high risk of infection — those over the age of 6 months can access it as long as they make the decision in conjunction with a health care provider.

Richard Hughes, a George Washington University law professor and leading vaccine law expert, said the committee appears to be using the practice known as “shared clinical decision making,” because it “gets at that medical freedom rhetoric — and provides an option other than ‘no recommendation’ — but is not a good option.”

While this sort of policy sounds like it’s creating greater choice, ultimately evidence shows it leads to struggles for health care providers who haven’t been given clear risk factors, Hughes said. This can be cumbersome, time consuming and lead to patient distrust.

“When you know that it’s an automatic ‘you should get it’ that’s different than ‘I don’t know, it’s kind of murky,’” he added.

The new policy is particularly confusing, said Offit, since last month the Food and Drug Administration only licensed the boosters for those . 

“The good news is, anybody can use it,” Offit said, “even though, according to the FDA, they’d be using it off label. But we don’t recommend it for anybody. Basically, that’s what they’re saying.”

He described this as a “bad choice” which will lead to fewer people being vaccinated and fragmented state-by-state policies.

Earlier this month, the governors of Washington, California and Oregon announced they’d be forming to establish their own vaccine recommendations, which Hawaii quickly joined. A few weeks later, seven northeastern states, including New York and Pennsylvania, formed with a similar goal.

Hepatitis B

The hepatitis B vaccine was first recommended by ACIP in Before that point, an estimated 200,000 to 300,000 people, including about 20,000 children, were infected with the highly contagious virus each year. 

This was particularly dangerous for infants who have a 90% chance of developing liver cancer or chronic liver disease, if they contract the virus. For 4- and 5-year-olds, that chance remains high at 30-40%.

At one point, the vaccine was only recommended for infants whose mothers tested positive for the virus, since it can be transmitted during birth, but for a number of reasons — including inaccurate test results — this was found to be ineffective. So by 1991, ACIP’s recommendation was expanded to include universal birth doses. Since then, infant infections have dropped by 95%.

According to Offit, the birth dose “has always been a target of anti-vaccine activists,” since the hepatitis B virus can be transmitted sexually. But it can also be transmitted in many other ways, including through surfaces. 

On Thursday, ACIP members were meant to vote on an updated recommendation which would have delayed the initial dose until an infant is one month, a move that would likely lead to a serious reduction in uptake, according to doctors.

Ultimately, after hours of arguments, which included research Offit called “bogus,” the committee ran out of time to vote on the measure Thursday. Friday morning they chose to table it indefinitely. 

Buchanan, the nurse practitioner, expressed concern that the safety of the well-established vaccine was even being reargued in the first place: “The ‘why’ was never there, and that’s so important, because we should not be bringing things to a formal ACIP committee vote without having a science-based rationale for bringing the question forward.”

While Hughes was relieved the vote was punted, Offit was more pessimistic, expressing fears that the committee will eventually try to push the first dose even later than one month.

“And that would be a tragic decision,” he said. “That would mean that there will be children in this country who will get hepatitis B in the first year of life, or in childhood … which will limit their life for no reason.”

School nurse Jennifer Comer vividly remembers the number of students she had to exclude from Clark Middle School in Bonner Springs on a single day in 2013: 289.

Why? They weren’t up to date on their state-required immunizations. 

In the past, the Bonner Springs-Edwardsville School District in Wyandotte County technically required vaccines. But if families flouted the rules, their kids could still go to school. 

School nurses had been pushing district leaders to take the requirements more seriously. Twelve years ago, they finally got their wish. 

So when the school’s deadline for vaccinations hit, staff members started calling families to come pick up their kids. 

It wasn’t fun, and it didn’t get better right away. 

“It was painful the first couple years,” said Kimberly Bolewski, the district’s nurse coordinator, stationed at McDanield Preschool. She noted that families weren’t used to the requirements being enforced. “Here we are saying, ‘No, really, you can’t start school.’” 

But that pain has paid off.

 — the most recent available — show kindergarteners at Bonner Springs schools had the best , mumps and rubella (MMR)  in Johnson or Wyandotte counties, a rate of nearly 98%. 

Earlier this month — 25 years after the United States declared measles eliminated — nationwide measles cases  annual number . But the district is “in a pretty good spot” to weather a local outbreak without widespread illness and quarantines, Bolewski said. 

“If our vaccination rates weren’t really high, it would be a nightmare,” she said. “The higher the vaccination rate, the less likely of a lot of our students becoming ill.”

Not all districts in the state or county are equally secure. While Kansas’ Department of Health and Environment determines  for school and the state , districts control enforcement. 

That’s partially why neighboring Kansas City, Kansas, Public Schools had a kindergarten MMR vaccination rate of about 67% percent in 2023-24, though less than 2% of students had medical or religious exemptions. KCKPS says its overall vaccination rate is now 80% and rising.

KCKPS stopped excluding unvaccinated students when they were learning remotely during the COVID-19 pandemic, Director of Health Services Lajasmia Bates said. The district plans to resume enforcing the policy for the 2025-26 school year. 

“We do realize that when those compliance rates are low, that we’re at a higher risk,” Bates said. “We wanted to do something about that to make sure that we can get as close (as possible) to having a herd immunity to be able to stop the spread of those communicable diseases, including measles.”&�Բ�����;

State vaccine requirements

Kansas law  to decide which specific vaccines or tests families must obtain before children can attend school. 

The state currently , some of which immunize against multiple illnesses. 

For example, the MMR vaccine protects against measles, mumps and rubella. Kansas says children should have two doses: one at age 12-15 months and another before entering kindergarten. 

There’s a  if children fall behind, and exemptions if a physician certifies that vaccines “seriously endanger” the child or a parent says that the child’s religious denomination opposes vaccines. 

Federal laws also ensure children can enroll without all of their required paperwork, including proof of vaccination, if they’re in the  or . 

Schools must notify parents of vaccine requirements before May 15 each year. And  the school board “may exclude from school attendance” any students who haven’t complied. 

School officials told The Beacon that gives districts leeway to determine exactly when — or even whether — they exclude students who fall behind on required vaccines.

Measles vaccination in Kansas

That’s led to a situation where vaccination rates can range wildly. 

In 2023-24, Riley County schools recorded the state’s lowest kindergarten MMR vaccination rate: 36.67%. The neighboring Manhattan-Ogden district had a rate of 97.27%. Meanwhile, about three dozen districts claim a 100% rate. 

About one-third of the 238 districts with public vaccine data have an MMR kindergarten immunization rate at or above the 95% threshold needed for herd immunity for measles. Herd immunity means that enough people are vaccinated that the disease is unlikely to spread. 

MMR vaccine rates  have followed a similar pattern, falling from about 95% in 2019-20 to about 91% in 2023-24. Missouri does not report individual districts’ data. 

In Johnson and Wyandotte counties, the Bonner Springs, Piper-Kansas City, Blue Valley and Shawnee Mission school districts had kindergarten measles vaccination rates high enough for herd immunity during the 2023-24 school year. 

Olathe is barely below the herd immunity threshold. De Soto, Turner-Kansas City, Spring Hill and Gardner Edgerton range from approximately 1 to 4 percentage points below, and Kansas City, Kansas, is well below. 

Comparing two districts’ policies

KCKPS policy already says that unvaccinated students may be excluded. But it hasn’t actually taken that step in recent years. 

As it moves to enforce its policy again, the plan is to enroll students whether or not they’re vaccinated, Bates said, and give them 30 days to comply. 

In Bonner Springs, vaccine records are required for enrollment. But the rules aren’t one-size-fits-all there, either. 

Nurses are flexible when it’s clear a family is doing their best to get vaccination figured out, said Kristi Flack, the school nurse at Delaware Ridge Elementary. 

Students can start school if they show proof of an upcoming vaccine appointment, she said, or if it’s obvious they had a mix-up about which vaccines they were supposed to get. 

In those cases, she said, “The parents clearly took the time to do it. I’m not going to say, ‘OK, sorry, you didn’t get it. You can’t come back.’ I work with them.”

Nurses also work with families who have special circumstances such as getting medical records from overseas. If proof doesn’t arrive, they can help plan a catch-up schedule. 

Vaccine skepticism

Bolewski said she’s starting to see more vaccine hesitancy at the preschool age. 

“I think that’s from misinformation,” she said. Nurses have to ask: “‘How can I help you understand? Who can I connect you with?’ It doesn’t work to just simply say, ‘Well, you just have to do it.’”

Comer has run into issues as well. 

“I’ve had threats. I’ve had very, very angry parents,” she said. Some will abruptly claim religious exemptions. “But most parents want what’s best for their kids, and they just get busy and time gets away from them.”

Comer said she’s followed news of outbreaks around the U.S. and tracked state and national-level conversations that could complicate efforts to vaccinate kids. She’s worried Kansas could broaden vaccine exemptions and said misinformation, including from the federal level, is “very scary.”&�Բ�����;

Doctors and major medical organizations overwhelmingly recommend childhood vaccinations, which have been used for decades to prevent diseases like measles, diphtheria and whooping cough. 

But now that Robert F. Kennedy Jr., a known vaccine skeptic, leads the U.S. Department of Health and Human Services, public health officials worry that vaccine skepticism is growing.

In June, Kennedy dismissed members of an advisory committee that is charged with recommending vaccines and, ultimately, influences which will be covered by insurance. Kennedy’s appointments to fill those vacancies have included vaccine skeptics, fueling fear that long-standing vaccine protocols could be uprooted. 

Kennedy has also  whether vaccines are linked to autism, a debunked claim. And in May he released a  that included calls for increased scrutiny of childhood vaccines. The report was  inaccurate citations and reportedly .

Dr. Christelle Ilboudo, a pediatric infectious disease doctor at Children’s Mercy Hospital, said she often gets referrals to consult with parents who are questioning whether to move forward with recommended childhood vaccinations.

“Oftentimes we spend up to an hour in our clinic … going over the different vaccines,” she said. “Ultimately, the decision is up to the parents. But our duty is to make sure that they are truly making an informed decision based on the facts that we’ve discussed and presented to them.”

Overcoming other barriers

In addition to skepticism or health concerns that make some parents hesitant about having their children vaccinated, some families also run into logistical barriers related to language, transportation, cost and scheduling, the school nurses said.

Flack said her district tries to help parents by sending reminders, scheduling appointments and finding interpreters if needed. 

Comer suggests families with insurance try pharmacies like Walgreens, CVS and Walmart that may have longer hours if appointments during the workday are tough. For walk-in appointments, she recommends the , which she said accepts residents of other counties as well. 

In addition to its normal walk-in schedule, the department is offering . Public information officer Ashley Follett said in an email that those clinics are meant to offer a “more convenient and efficient option” for school vaccines specifically.   

The Wyandotte County Health Department also offers low-cost vaccinations to  and plans to offer vaccines at back-to-school events. 

In KCKPS, Bates said the district has been communicating with families and warning them about the upcoming enforcement, which helped increase the K-12 vaccination rate to about 80%.

KCKPS has worked to translate information into languages families understand, direct them to where vaccines are available and give context for requirements, she said. 

“The nurses aren’t just sending out a letter telling them what immunization their student needs,” Bates said. “We’re telling them, OK, if the student doesn’t get the immunization, what could happen? What are the benefits of getting the immunization?”

Preparing for a measles outbreak 

Both districts said they’d heavily rely on the Wyandotte County Health Department for guidance in the case of a measles outbreak. 

Flack got a preview when a student came down with whooping cough, another disease that can be largely prevented with a vaccine. She said the department told her exactly what to do, spoke to the family and gave her information for other families in the class. 

“They handled it really well, and made me feel confident that I could do what I needed to do,” she said.

If a suspected or confirmed measles case were to appear, Flack said the district would have to contact the county and state health departments within hours. 

“​​We would mask them, wear gloves and then keep them separate from the general population until they’re able to be picked up from school,” Bates said. 

The Bonner Springs nurses said a measles outbreak in a district with a low vaccination rate would be very serious. Not only is the disease highly contagious and capable of causing major health complications, but quarantine times are long for unvaccinated students who get exposed. 

An outbreak would mean contact tracing and kids missing lots of school. 

Even if an unvaccinated student were lucky enough not to catch the disease from an exposure, they would have to be out of school for three weeks, Flack said.

If that child still doesn’t get vaccinated and is exposed again, she said, “then they have to start their exclusion all over again.”

In a district with fewer unvaccinated students such as Bonner Springs, the disruption could be much less severe. Most students could stay in school even if exposed. 

And parents shouldn’t forget, Ilboudo of Children’s Mercy said, that vaccines prevent dangerous and sometimes life-threatening diseases.

“Our biggest challenge is that vaccines have worked too well,” Ilboudo said. “When you talk to people who have seen their classmates or their neighbors go through polio, they remember. They remember their neighbor who died from measles. They remember their neighbor who was paralyzed because of polio. 

“Nowadays parents truly don’t know the risks that these infections will present because we haven’t seen them. We haven’t seen them for years and years and years.”

Suzanne King contributed to this story. 

This first appeared on and is republished here under a .

was originally reported by Barbara Rodriguez of .

, and so is the risk of exposure and infection at child care facilities, which often serve kids too young to be vaccinated against the highly contagious disease.

Children’s health is the most immediate challenge amid an exposure, but not the only one. Parents may face three weeks of quarantine that requires them to keep their child at home, leaving them scrambling to figure out how to work without reliable child care.

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A mother in Iowa is highlighting just how complicated things can get. Martha Martin has been posting on social media about the ripple effects after a person who visited her 9-month-old son’s day care in Cedar Rapids later tested positive for the illness. The individual was vaccinated and is . Not all of the infections appear to be connected.

It took public health officials several days to notify the day care of the exposure, but Martin’s son — who had not yet received his first dose of the because of his age — was able to receive a post-exposure antibody known as . The alert came too late for her son to get an emergency MMR shot, which can be available within 72 hours of exposure.

Martin said she and her husband took their son to an emergency room for the antibody treatment, and she has received some mixed messaging about whether the couple will be on the hook to pay out of pocket. Other children from the day care were given immunoglobulin shots through a clinic organized by UnityPoint Health – St. Luke’s Hospital and the local county public health department. A spokesperson for the hospital system confirmed those details but did not respond to questions about the cost of the shots.

“Day cares can be a terrible place to have a measles outbreak,” said Dr. Tina Tan, a pediatric infectious diseases physician and president of the Infectious Diseases Society of America. “There’s going to be babies there that are too young to receive a measles vaccine. And they are at very high risk, if they get measles, to get a severe case.”

The state of Iowa for non-immune people, a typical period in part because of how long a person may be able to spread the disease. But Martin said the day care instructed the couple to keep their son at home for 28 days .

“I’m not sure what we’re going to do about that, not sure what we’re going to do about me going to work, my husband, everything like that,” Martin said that has now been viewed 2.5 million times.

Martin initially responded to an interview request from The 19th but later stopped communication.

A senior staff member who answered a call at the Iowa day care directed inquiries to local and state public health officials. A spokesperson for the public health department in Linn County, Iowa, said it continues to monitor the day care and other places of exposure as needed after “hours and hours” of contact tracing. A spokesperson for the Iowa Department of Health and Human Services confirmed that the day care is open and highlighted its protocol .

Martin said her son appears to be fine for now, but she knows symptoms can take some time to emerge. She said while her employer has been understanding, she will use vacation days and her husband will take unpaid time off to care for their son. Throughout her posts, Martin hammered one point a few times.

“Get your kids vaccinated,” she said, adding: “Your kids, you yourself not getting vaccinated — you are harming everybody else.”

In late March, a measles outbreak in West Texas reached a day care in Lubbock, where a child with measles infected several children, according to news reports. Some parents were told to keep their kids at home for 21 days of quarantine.

A representative for the Texas day care did not immediately respond to a request for comment, but its co-owner that the facility took a mix of precautions in order to keep its doors open. That meant sending some children home and isolating vulnerable children into a classroom while they still attended day care.

“Sending an infant home for 21 days is a huge burden on working families so there was the need to balance risk of exposure vs the need for income,” said Katherine Wells, director of the Lubbock Health Department, in an email.

America’s child care system runs under different levels of regulations, with varying rules by state when it comes to handling infectious disease outbreaks.

Ruth Friedman is a senior fellow at , a progressive think tank, and former director of the (OCC). She said day cares work under tight financial margins, and infectious diseases like measles could be a major financial blow, a dynamic that has parallels to the COVID-19 pandemic when some centers had to reduce services or close.

“If you destabilize the attendance and enrollment of children in child care, it can very quickly lead to programs closing their doors and child care broadly becoming unavailable to a community,” she said.

Wells said some parents expressed anger about their child being quarantined, while others said they were simply fearful about their children being exposed to the disease, which can make people very sick: complications include pneumonia, brain swelling and death. Children under 5 and pregnant people are . And according to the Centers for Disease Control and Prevention, about 1 in 5 unvaccinated people with measles are hospitalized.

The first MMR shot is typically administered to a child between 12 and 15 months of age, with a second dose between the ages of 4 and 6. Children between 6 months old and a year are eligible for an earlier shot if they live in or travel to an outbreak area or are traveling internationally.

Iowa health officials , which can include receiving the second MMR shot as early as 28 days after the first dose. Two doses are 97 percent effective against measles, which is at .

The risk of measles at day cares is not new. Between December 2023 and January 2024, that spread in part because . The child, as well as the parent, later tested positive for measles.

Dr. Ericka Hayes, an attending physician and senior medical director of infection prevention at Children’s Hospital of Philadelphia, said the chances of more outbreaks in child care settings will depend on factors like vaccination rates within the facility and how it adheres to its policies around illness. She noted that children are contagious with measles — often a primary symptom — but other early signs of infection can look a lot like a common viral infection: fever, cough, runny nose, and red and watery eyes.

“So equally important is if a child is sick they should be excluded from day care,” she said via email.

Friedman said the case out of Philadelphia previews a potential conflict that could emerge as parents reckon with health considerations amid work responsibilities that ensure they can pay their daily and monthly expenses. Federal law does not require employers to offer paid sick leave to its workers, leaving such options up to states. In some cases, .

“There’s this tension — what are you supposed to do with your child if you need to work?” she said. “From a family perspective and from a child care sector perspective, I think the implications could potentially be really, really troubling.”

Childhood vaccination rates have markedly declined across the U.S. since the start of COVID, according to new Johns Hopkins University showing 78% of more than 2,000 counties reported drops and the average immunization rate had fallen to 91% — further below the 95% threshold needed for herd immunity.

While existing Centers for Disease Control and Prevention data has historically shown broadly declining measles-mumps-rubella vaccination rates at the state and national levels, the county-level analysis published this week in JAMA is far more granular.

It provides a “better understanding of these pockets where you have more exceptionally high risk,” said senior author Lauren Gardner, the director of Johns Hopkins University’s Center for Systems Science and Engineering.

“Knowing where there are problem areas,” she added, “gives policymakers and public health professionals locations to target their limited resources to try and improve vaccination coverage and therefore minimize the potential risk of measles outbreaks.”

The country is currently experiencing a deadly measles outbreak that has infected over people across 30 states and killed two unvaccinated children. Case numbers this year have already surpassed 2024’s total and mark the second-highest number of confirmed cases in a year since the disease was declared eradicated in the U.S. in 2000. Some 96% of reported infections have involved a person who was unvaccinated or whose status was unknown and 13% have resulted in hospitalization.

Gardner, who also led the data collection efforts behind , and her team collected county-level, two-dose MMR vaccine rates for kindergarteners from each state’s department of health website from 2017 to 2024, where available. Ultimately, they were able to analyze trends in 2,066 counties across 33 states and made all their data available to download.

While state level average rates may decline by a few percentage points, the researchers found 130 counties where they dropped by at least 10 percentage points, and in 15 of those counties, they plummeted more than 20.

Only four of the states studied — California, Connecticut, Maine and New York — reported an increase in the median county-level vaccination rate. They are currently the only four states that exclusively allow medical — and not philosophical or religious — exemptions to mandatory vaccines for school-aged children.

Gardner said she pursued the county-level data after observing growing vaccine hesitancy and misinformation. Based on her years of work in the field, she said she was “100% expecting to see [these current outbreaks].”&�Բ�����;

If vaccination rates continue to drop “measles is likely to return to endemic levels in the US,” according to the Johns Hopkins’ report — a concern other experts see as heightened by Robert F. Kennedy Jr. now heading the U.S. Department of Health & Human Services. A well-known vaccine skeptic, Kennedy initially the measles spread in late February and has been in his support of the MMR vaccine.

Under Kennedy’s leadership, the Trump administration released the controversial “Make America Healthy Again” on May 22, which misinterpreted studies, and is suspected of being generated in part . The report, which involved , questions the safety and importance of some childhood vaccines.

“Despite the growth of the childhood vaccine schedule,” the report reads, “there has been limited scientific inquiry into the links between vaccines and chronic disease, the impacts of vaccine injury, and conflicts of interest in the development of the vaccine schedule.”&�Բ�����;

Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a professor of pediatrics at the University of Pennsylvania Perelman School of Medicine, pushed back on these assertions.

The issue has been well studied, and there is no evidence of links between childhood vaccines and chronic diseases — including diabetes and autism — said Offit, who is also member of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee.

He referenced 24 studies across seven countries and three continents involving thousands of children that show they’re at no greater risk of developing autism if they receive the MMR vaccine.

Current skepticism is not isolated to the measles vaccine: The Food and Drug Administration, which falls under HHS, recently released which no longer recommends the COVID vaccine for healthy children or pregnant women. In response, a top COVID vaccine adviser at the CDC resigned this week, according to reporting from  

And across the country, numerous states have introduced legislation to loosen vaccine requirements for school-aged children, opening the door for more parents to opt their kids out.

“I think this is only going to get worse,” Offit said. “I think vaccines are under attack. You have a secretary of Health and Human Services who will do everything he can during the years that he is in that position to make vaccines less available, less affordable and more feared. … So I think this is a dangerous time to be a child in the United States of America.”

Correction: In a previous version of this story, we incorrectly characterized Dr. Paul Offit’s status on the CDC’s Advisory Committee on Immunization Practices. He is a former voting member of the CDC’s advisory committee and a current member of the FDA’s vaccine advisory committee.

Two groups filed a lawsuit against West Virginia’s state Department of Health, its Bureau for Public Health and agency leaders on Friday, challenging Gov. Patrick Morrisey’s January executive order, which opened the door for religious and philosophical exemptions to mandatory school vaccination policies. The American Civil Liberties Union’s West Virginia chapter and Mountain State Justice filed the suit in Kanawha County Circuit Court on behalf of two parents with immunocompromised children, according to reporting by

Just over 330 requests for religious and philosophical exemptions to West Virginia’s school vaccine policy have been submitted — and approved — for this school year and 35 have been granted for the coming year, according to records obtained by ����Ӱ��.

The newly approved religious and philosophical exemptions already outpace the 203 permanent medical exemptions granted in the state over the past decade, at one time the only exemptions allowed in West Virginia.

Before January, when Gov. Patrick Morrisey signed an opening the door for broader exemptions, the state had some of the nation’s strictest childhood vaccination policies. 

The loosening of those policies is occurring amid a deadly measles outbreak that has infected over  across 30 states and despite state legislators rejecting a bill in March which would have codified religious exemptions into state law. The conflict between the governor’s order and the legislature’s action has over how West Virginia officials should proceed and could ultimately lead to legal action between the two branches of government. 

In the meantime, the West Virginia Department of Health is granting religious and philosophical exemptions based on the governor’s order and shared those numbers in response to a Freedom of Information Act request by ����Ӱ��.

No requests for the newer category of exemptions has been denied, the department said. In contrast, 125 requests for medical exemptions to mandatory school vaccines have been rejected since 2015. Temporary medical exemptions have been granted to 288 West Virginia children in the past decade.

Richard Hughes, a George Washington University law professor and leading vaccine law expert, said the 331 religious and philosophical exemptions sought in just five months represent a “drastic, dramatic increase in the request for exemptions, and that’s going to potentially have public health consequences.”

He added the state appears to be approving them liberally and without real scrutiny.

“Clearly, when you open the door to these types of exemptions, people use them,” he said. “There has been evidence before that when only religious exemption is available, people request them without any really sincerely held belief. This just opens the floodgates.”

While the 331 students who have received exemptions represent a very small percentage of the approximately enrolled in public schools across the state, experts fear the number will continue to rapidly climb, especially at the start of the coming school year.

“You see how fast we approved those? Hundred percent approved … So if we keep allowing an executive order that goes against West Virginia code, it’s going to change the vaccination rate …” said Sissy Price, a registered nurse who serves as co-director of West Virginia Families for Immunization. “And it’s not a matter of if it’s going to happen, it’s a matter of when.”

Experts also emphasized the importance of knowing which regions or schools in West Virginia the exempted students come from to better understand the impact on herd immunity and to allow parents — especially those of immunocompromised students — to make informed decisions about where to send their kids to school.

Despite the governor’s insistence that the state collect that information, an official at the Health Department wrote in an email to ����Ӱ��, “Nobody in the Department of Health or the Bureau for Public [Health] tracks that.”

“There’s a failure of government there,” said Northe Saunders, executive director of the pro-vaccine . “There’s a failure of making sure that parents can make the best informed decision that they can if we don’t know what immunization rates are like at the school level.”

The governor’s office and the Department of Health did not respond to requests for comment.

So far, West Virginia has no reported measles cases. Two children, both of whom were unvaccinated, have died during the current outbreak, whose case numbers have already surpassed 2024’s total and mark the second-highest number of confirmed cases in a year since the disease was declared eradicated in the U.S. in 2000. Some 96% of reported infections have involved a person who was unvaccinated or whose status was unknown and 13% have resulted in hospitalization. 

In issuing his Jan. 14 executive order, Morrisey relied on an interpretation of the state’s 2023 Equal Protection for Religion Act.

He argued that the law as it stood “forces” some West Virginians “to choose between their religious belief and their children’s fundamental right to public education,” and directed the commissioner of the Bureau for Public Health and the state health officer to establish a process for parents to object. The executive order noted that a “written, signed objection” was sufficient.

Based on the legislature voting down the measure to codify the broader exemption category, state schools Superintendent Michele Blatt issued a memo earlier this month to county superintendents recommending that students not be allowed to attend school next year without required immunizations, regardless of requests for religious exemptions. 

“We are faced with the fact that state law has not been changed by the Legislature and there is no religious exemption provided for in West Virginia law,” Blatt wrote, according to reporting by

But, by the end of the day she rescinded the memo, she had done so “at the Governor’s request.”&�Բ�����;

Morrisey then issued May 9 saying that despite the legislative hurdle, the executive order “still stands, and I have no intention of rescinding it.” He further clarified the process to receive an exemption: Each year, parents or guardians must send a signed letter with basic information including their child’s name, date of birth and mailing address. Notably, the letter does not need to include the reason for the requested exemption.

In the wake of this confusion, some school districts have begun seeking about how to respond. 

West Virginia is not an outlier in its quest to allow parents to opt their children out of the measles, mumps and rubella vaccine that is a requirement in all 50 states for children entering child care and schools. 

“It goes towards the general erosion of vaccine policy,” said Saunders. “We’ve seen these kinds of small, incremental changes that are eroding vaccine policy in states across the country. There are still school entry requirements in West Virginia — just like there are in every single state — but this is one other chink in the armor of strong vaccine policy driving strong immunization rates.”

Childhood vaccination since COVID, and there’s fear that decline will accelerate now that Robert F. Kennedy Jr., a well-known vaccine skeptic, is heading the U.S. Department of Health & Human Services. He initially in late February, and on May 14, at his in Congress since his confirmation, he waffled on the importance of vaccines.

When asked if he would vaccinate a child of his own against measles today “Probably for measles. What I would say is my opinions about vaccines are irrelevant.”

He continued, “I don’t want to make it seem like I’m being evasive, but I don’t think people should be taking medical advice from me.”

Last week, the Food and Drug Administration, which falls under HHS, released guidance for COVID vaccines, saying they may require additional studies before approving the shots for healthy Americans younger than 65.

Candice Lefeber, executive director of West Virginia’s chapter of the American Academy of Pediatrics, said this move played into one of her fears: “I think the administration is going to make it harder for vaccines to be available.”

“Not only are we not going to require it, but then access to vaccines would be compromised,” she continued. “It’s just really disheartening for science and for our country — and we’re in big trouble.”

was originally reported by Barbara Rodriguez of .

In mid-March, the parents of a 6-year-old girl in Texas who died of measles complications — the — decided to speak out about what happened to their daughter.

But it was not an interview with a news outlet. The parents had agreed to an exclusive on-camera interview with staff from the Children’s Health Defense (CHD), a nonprofit that promotes anti-vaccine sentiment and policies. Their daughter, Kayley, had been unvaccinated, a point the parents defended in the interview.

Kayley’s father, who spoke at times in a German dialect through a translator, said that measles is “not as bad as the media is making it out to be.”

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A few weeks later, the father of an 8-year-old who became the second measles-related death, according to public health officials, also spoke with CHD through video. Asked if he regrets not vaccinating his child, Daisy, or his other children, the father said: “Absolutely not. And from here on out, if I have any other kids in the future, they’re not going to be vaccinated at all.”

Health and Human Services Secretary Robert F. Kennedy Jr. met with these parents in April, he said , “to console the families and to be with the community in their moment of grief.” He advocated for the highly effective measles-mumps-rubella (MMR) vaccine in that same post. Hours later, in a separate post, .

As Kennedy tries to respond to the spread of measles cases in the United States — more than 700 cases have been reported in at least 25 states as of April 10, according to the Centers for Disease Control and Prevention (CDC) — medical experts say that messaging has been mixed. But any focus on vaccination is also being undermined by CHD, the anti-vaccine nonprofit Kennedy chaired from 2015 to 2023, the year he launched a presidential campaign.

As of , Kennedy has said he is no longer officially affiliated with the group, which has repeatedly questioned the safety of vaccines, . But CHD still prominently displays its former ties to Kennedy. The secretary has a standalone tab on the group’s “About” section, which credits him as its founder. Its video site features public appearances that Kennedy has made in his current role as secretary, including a recent trip to Indiana and his first major news conference in the role.

This year, CDH published a website that mimicked the design of a CDC site — with nearly identical layout, logos and typefaces — that laid out what it called research that vaccines cause autism () alongside some data debunking the theory. first reported on the existence of the mock site.

When asked about the site by The New York Times, the secretary would send a request to ask the group to take down the site.

An HHS spokesperson for Kennedy did not immediately respond to a request for comment. Representatives for CHD, contacted through a form on their website, did not immediately respond to a request for comment.

CHD boasts a media apparatus that includes a video-focused site and podcast that shares claims about vaccine safety, including about the MMR vaccine. On these platforms, commentators and an array of guests openly criticize news coverage on the growing measles cases and related deaths, which public health officials say includes an unvaccinated adult in New Mexico as well as the two children. (Many of the videos also note that the hosts’ and guests’ views are not necessarily the views of Children’s Health Defense.)

“This constant fear mongering by the media … to see them rampage like this on inaccuracies and peddling falsehoods and just distortions, it’s terrible,” said one guest identified as a doctor to discuss one of the girls’ medical histories.

Measles, a highly contagious airborne disease, can appear through fever and a rash. It : 1 in 20 people get pneumonia; 1 to 3 in 1,000 people get brain swelling known as encephalitis; and 1 in 1,000 people die.

The scope of the CHD messaging — including interviews with parents expressing vaccine skepticism — shows how so-called anti-vaxxers may be weaponizing tragedy to promote an agenda, said Kelsey Suter, a partner at Upswing, an opinion research and strategy firm that supports Democratic candidates and progressive causes. Suter has monitored online disinformation about vaccines since around the start of the pandemic for several clients.

“This group in particular has long cherry-picked individual stories and sort of held them up to represent a broader trend that doesn’t exist,” she said, noting that CHD has shared parent-centered videos in the past about purported vaccine injuries.

Kennedy who tried to distance himself from that record during his contentious to lead the country’s expansive health department. Before Kennedy’s longshot bid for the Democratic presidential nomination — which culminated in an independent candidacy and subsequent endorsement of Republican President Donald Trump — he was closely tied to the Children’s Health Defense.

The nonprofit, previously known as the World Mercury Project, says it aims to end “childhood health epidemics by eliminating toxic exposure.” Kennedy, also its former chief litigation counsel, took a leave from CHD in 2023 to run for office. During a Wednesday news conference, could play a role in autism — a framing that autism groups . (CHD has publicly linked vaccines to autism, .)

CHD’s messaging — which includes a standalone site for “news and views” and an accompanying newsletter — highlights an evolution of how misinformation and disinformation over vaccines is being directed at parents at a time when vaccination rates for kindergarteners . Parents are already targeted by social media influencer accounts about their children’s health and wellness. Some of that information is packaged in video that can be more widely shared than in previous eras of vaccine skepticism, a phenomenon that has existed since the development of the first vaccine more than 200 years ago.

Some of the misinformation circulating online is that measles was not a dangerous disease when it spread rampantly in the 60s. (In the decade before a vaccine was available in 1963, . Between 400 and 500 died and thousands were hospitalized each year at the time.)

“It’a this kind of broader lifestyle perspective that incorporates vaccine hesitancy and is being sort of packaged up and targeted for moms in particular, but parents generally,” Suter said.

The two-dose MMR vaccine is safe and . Side effects, which pediatricians share with parents when their children are vaccinated, can include a sore arm and mild rash. Medical professionals say the benefits of the vaccine far outweigh the risks of being unvaccinated.

“We’re not hiding the side effects, we’re just telling you what they are and we’re putting it in context,” said Dr. Kathryn Edwards, a longtime expert in infectious diseases who recently retired. “What is a more grave danger — to get infected with measles or to get the vaccine? And that is a really easy question. , it is much, much better to be immunized than to get the disease.”

The videos on “CHD.TV” run the gamut in terms of programming. In the video of the parents of the 6-year-old girl, they say their child had a fever, leading to a visit to a nearby hospital where her condition worsened. She died in February. Her siblings were also infected with measles, according to her parents, but they recovered. They credit treatments that medical experts say do not have a therapeutic role in treating or preventing measles infection. Still, Kennedy has defended the treatments for secondary symptoms.

In a separate video, staff speculated about whether the 8-year-old died from a different ailment related to her hospital stay — a sentiment also expressed by her father and . CHD staff also criticized the scope of hospital care that the girls received.

Abram Wagner is an assistant professor of epidemiology at the University of Michigan who studies vaccine hesitancy. He said building trust within a community that is hesitant about vaccines relies on messengers who are well-known members of that community. He said it can be potent for an anti-vaccine group to travel to these communities and highlight the personal stories of parents — including the narrative technique of imagery and voice through video — to emphasize an agenda because those parents are themselves potentially trusted messengers.

Wagner said it’s important for the public to take into account the framing of these interviews involving the parents of unvaccinated children. He noted they had experienced trauma — the loss of a child — and that makes them vulnerable in such settings. He also wondered about the social impact of losing a child in a close-knit community. Both families are members of a at the epicenter of the outbreak in West Texas.

It sets up hard work for the public health officials, including state officials, who go into these communities to counter anti-vaccine messaging, Wagner added. This week, a CDC official told a vaccine committee that federal officials were “scraping to find the resources and personnel needed to provide support to Texas and other jurisdictions” as it relates to the outbreaks.

“The issue is, how do you create trusted messengers and how do you develop that over time?” said Wagner.

Suter said she is not surprised that the MMR vaccine has been targeted in disinformation messaging, since falsely tied that vaccine to autism.

“The MMR vaccine was really the first modern vaccine to be targeted with this kind of disinformation questioning its safety,” she said.

Suter said that before the pandemic — which propelled distrust of COVID-19 vaccines — being against vaccines still included some left-wing partisan perspective that included “crunchy” mothers. But vaccine hesitancy is now rooted in a broader topic of distrust of government officials and of the health care system.

“Now, being anti-vaccine is not exclusively right-wing coded, but is much more integrated into right-wing politics than it used to be,” she said.

Edwards said Kennedy has opened a messaging vacuum on measles and the MMR vaccine that groups like CHD have filled. Edwards noted that when Kennedy was asked in late February about the growing measles outbreak that began in Texas, he said such outbreaks are “not unusual,” a description that . Kennedy later said that the decision to vaccinate “is a personal one” for parents — a framing that Edwards disagrees with.

“At that point, there should have been a strong message that vaccination should be done and will prevent disease,” she said. “The fact that there has been so much indecision and lack of clarity, in terms of what Secretary Kennedy has said and what he lets other people say, has really confused things. That has made families think that it’s appropriate not to vaccinate.”

Health and Human Services Secretary Robert F. Kennedy Jr. is more directly promoting measles vaccinations following the death of a second unvaccinated child. But he continues to highlight remedies that medical experts say do not prevent or treat the virus. As the number of measles cases grows around the country, experts worry that parents and other caregivers are getting mixed messaging about the safety of vaccines.

Over the weekend, Kennedy traveled to Texas for the funeral of an 8-year-old who public health officials say died this month of complications from measles. Kennedy met with the child’s family, as well as the family of a 6-year-old in the state who died in February of measles complications. . (An unvaccinated adult in New Mexico who died recently also had measles, .)

“The most effective way to prevent the spread of measles is the [measles-mumps-rubella] vaccine,” , the day of the funeral. In the lengthy post, he said he had redeployed Centers for Disease Control and Prevention teams to Texas at the request of the state’s governor. He said staff previously helped supply pharmacies and clinics with MMR vaccines, medicines and medical supplies, and supported contact investigations and community outreach.

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The MMR vaccine, which is , .

But in , which included photos with the impacted families, Kennedy also noted that he had visited with “two extraordinary healers” — Dr. Richard Bartlett and Dr. Ben Edwards. Kennedy claimed the two men have “treated and healed” about 300 children from at the epicenter of the outbreak using aerosolized budesonide and clarithromycin.

Aerosolized budesonide can open airways to . Clarithromycin is an antibiotic that can . But Patsy Stinchfield, an infectious disease nurse practitioner and a past president of the (NFID), told The 19th that neither is a measles antiviral medication.

Stinchfield said to suggest either treatment healed hundreds of children from measles “is distracting.” , though doctors can try to treat secondary symptoms that might emerge from an infection.

“The way that it’s being framed is confusing and misleading and kind of off the main message, which should be to vaccinate, vaccinate, vaccinate,” she said.

Both “healers” have a history of challenging . Bartlett faced disciplinary action from the Texas Medical Board in 2003 for “unusual use of risk-filled medications,” . At the height of the COVID-19 pandemic, he claimed vaccines were not needed and a combination of drugs, including budesonide, for treating the virus.

Edwards, who said mass infection is “God’s version of measles immunization,” , runs a facility in Texas where he reportedly treats some people for measles-related ailments with budesonide. A nearby store distributes cod liver oil, . Cod liver oil, which , is not a preventive measure for measles, Stinchfield said, and should not be used in place of the MMR vaccine.

HHS spokesperson Andrew Nixon said in an email that Kennedy has offered “clear guidance that vaccines are the most effective way to prevent measles” and defended the use of budesonide and clarithromycin to treat secondary symptoms.

Dr. Adam Ratner, who serves on an infectious diseases committee for the , said in an email to The 19th that there is no evidence to support the use of either treatment to care for children who have been infected with measles.

“Promoting unproven medications for measles treatment puts children at unnecessary risk, and the only way to prevent measles is by vaccination with the measles-mumps-rubella vaccine,” Ratner wrote.

Dr. John Swartzberg, a clinical professor emeritus at the UC Berkeley School of Public Health, made the same point in a separate email to The 19th.

“Budesonide and clarithromycin have NO therapeutic role in treating or preventing measles infection,” he wrote. “There is no credible science to support their use for this purpose.”

An HHS spokesperson did not immediately respond to a request for comment. Kennedy is traveling to parts of the Southwest this week.

Kennedy’s first expansive remarks on the measles outbreak came in an published on Fox News in early March, when the secretary encouraged parents to consult their health care providers about getting the MMR vaccine. He said at the time that the decision to vaccinate “is a personal one.”

Stinchfield said that messaging can dilute from efforts to end the current outbreaks, .

“When we’re talking about the most contagious virus that we have and how easily it spreads to other children, when someone chooses not to vaccinate … it is not a personal choice anymore,” she said. “You have now endangered other individuals, and especially little children, pregnant women. So an unvaccinated person is potentially a walking infectious risk to others.”

In his , Kennedy recommended that some people administer vitamin A under the supervision of a physician to reduce related measles deaths. Cod liver oil also contains vitamin A.

While people who are malnourished or have a weakened immune system may be treated with vitamin A — along with AAP and NFID — any other use of vitamin A is not recommended, and importantly, .

At Covenant Children’s Hospital in Lubbock, Texas — which has treated children infected with measles — a representative confirmed to The 19th that its staff had encountered cases of vitamin A toxicity among unvaccinated children who were initially hospitalized due to measles complications. Some patients used vitamin A for both treatment and measles prevention. As of late March, the staff had reported fewer than 10 vitamin A toxicity cases.

“This topic has garnered extensive attention on social media and other platforms,” according to a statement from Dr. Lara Johnson, pediatric hospitalist and chief medical office of Covenant

Health-Lubbock Service Area, which includes Covenant Children’s Hospital. “While there are potential benefits, it is crucial to consult with your primary care physician before initiating any new treatment regimen.”

Stinchfield said the takeaways from Kennedy’s posts are offering mixed messaging to parents at a time when the federal government should already have more urgent calls for immunization.

“We should be in all hands on deck mode and pouring resources into stopping the measles outbreak and I am not seeing that,” she later wrote in an email.

Kennedy has a long history of anti-vaccine views that he has tried to dispel as he begins to oversee HHS. During his Senate confirmation hearings, Kennedy told lawmakers that .

But since then he has alarmed some people within his own agency. In March, a top vaccine official within the U.S. Food and Drug Administration, which is run under HHS, announced he would .

“It has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies,” Dr. Peter Marks wrote in his resignation letter as director of the Center for Biologics Evaluation and Research. According to , Marks said he was asked to find data on brain swelling cases and deaths tied to the MMR vaccine — data that Marks said did not exist. Marks has encouraged parents to get the MMR vaccine for their children.

Swartzberg said he appreciates that Kennedy is “finally” stating that the best way to control measles infections and deaths is vaccination, but noted that it’s been months since the first cases were reported. He believes Kennedy’s promotion of vitamin A and other drugs has also steered people, including parents, away from vaccinating their kids.

“This came very late in the game,” he said. “And, he has never stated that the vaccine is safe.”

Stinchfield helped address a measles outbreak in Minnesota within the Somali community and measles outbreaks in the early 1990s. She’s seen firsthand how children suffer from a measles infection. It can include brain swelling, long-term complications and death. have been declining since around the start of the pandemic, a dynamic that some medical experts believe is partially attributed to a growing distrust of the government.

Stinchfield encouraged parents to seek reliable sources of information — including from , and trusted pediatric providers — amid an onslaught of misinformation online.

“You really need to make sure that you’re getting reliable information from people who know what they’re talking about,” she said.

was originally reported by Barbara Rodriguez of . Read more of their reporting on gender, politics and policy.

SEMINOLE — An 8-year-old girl with measles died Thursday morning, the second known measles-related death in an ongoing outbreak that has infected nearly 500 Texans since January. Her funeral was Sunday at a church in Seminole followed by a private burial.

Health and Human Services Secretary Robert F. Kennedy Jr., visited the West Texas town that has been the epicenter of the outbreak Sunday and was expected to meet with the family.

“My intention was to come down here quietly to console the families and to be with the community in their moment of grief,” Kennedy . He went on to describe the resources he deployed to Texas in March after , claiming that the “growth rates for new cases and hospitalizations have flattened” since Kennedy sent a team from the Centers for Disease Control and Prevention. The state reported 59 new cases in three days last week.

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The child who died Thursday, Daisy Hildebrand, was not vaccinated and had no known underlying health conditions, said a spokesperson for University Medical Center in Lubbock, where she had been hospitalized. She died from “measles pulmonary failure,” the Texas Department of State Health Services .

“This unfortunate event underscores the importance of vaccination,” Vice President of University Medical Center Aaron Davis said in a statement. “We encourage all individuals to stay current with their vaccinations to help protect themselves and the broader community.”

The death comes about five weeks after unvaccinated 6-year-old Kayley Fehr , the first such death in the country in a decade. Fehr’s that their stance on vaccination did not change after their daughter’s death.

The West Texas outbreak , most of whom are unvaccinated children, according to the state health department.

The outbreak began in Gaines County, located about 90 minutes southwest of Lubbock on the New Mexico border. Since then, cases have been reported in 18 other Texas counties, as far east as Erath County in central Texas.

The CDC has linked the Texas outbreak with measles cases in Oklahoma and New Mexico, where an unvaccinated individual who tested positive for measles died in March. And the World Health Organization reported that cases in Mexico were linked to Texas.

Measles is a highly contagious virus that spreads through respiratory droplets passed through the air by breathing, coughing and sneezing. Vaccination is the safest way to build immunity to the virus. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective, according to the CDC.

Measles was officially eliminated from the U.S. in 2000 following a highly successful vaccination program. But vaccine skeptics, fueled by misinformation and a disdain for COVID-era mandates, have sown distrust of public health and contributed to declining rates of vaccination. In Gaines County, 82% of kindergarteners are up to date on their MMR vaccine. Experts say communities need a 95% threshold to prevent the spread of measles.

A CDC spokesperson said in an email that Kennedy’s visit to Texas on Sunday resulted in discussions with Texas state health officials to deploy a second CDC response team to West Texas to further assist with the state’s efforts to protect its residents against measles and its complications.

Dr. Manisha Patel, incident manager for the CDC, said their team arrived in Gaines County in March and left on April 1. A spokesperson for the CDC said in light of today’s news and Kennedy’s order to re-deploy, another team will be in the county.

“We’re learning a lot in Gaines County on how we can help other jurisdictions also prepare for measles in their states,” Patel said.

Patel said it’s important to go in with a sensitive approach when it comes to small, close-knit communities that are unvaccinated.

However, she said there are three pieces to their measles control measures: the vaccine, not traveling if you’re exposed, and staying at home.

“MMR is the best way to protect yourself, your families, your communities against measles,” Patel said. “And, if you’re starting to get very sick from measles, not to delay care.”

Patel said for some communities, it’s important to find trusted messengers. In some cases, she said, the federal government might not be the best choice for that and it has to be someone in the community. To work around this, Patel said they’ve worked directly with state and local health departments to find who the trusted messengers are.

“Our role is making sure those trusted messengers have the materials and information they need,” Patel said. “So we translate, for example, materials into a German or Spanish or whatever the community needs.”

State health officials have said that the outbreak could persist for months. It has spread most quickly in pockets of Texas with below-average vaccination rates. In Gaines County, where a large unvaccinated Mennonite community resides, 315 people have been infected.

People infected with measles usually experience symptoms within a week or two of exposure. Early symptoms include high fever, runny nose and watery eyes. A few days later, a rash breaks out on the face and then spreads down the neck to the rest of the body. Infected individuals are contagious about four days before the rash appears and up to four days after, according to state health officials.

Doctors typically recommend all children get two doses of the MMR vaccine, starting with the first dose at 12 through 15 months and the second dose at 4 through 6 years of age.

Parents of infants aged 6 to 11 months living in outbreak areas should consult their pediatrician about getting the measles-mumps-rubella vaccine, Sara Safarzadeh Amiri, chief medical officer for Odessa Regional Medical Center and Scenic Mountain Medical Center, said on Sunday.

Amiri said she was unaware of the second reported death but that it is not unexpected given the continued spread of the outbreak.

So far, 56 measles patients in Texas have been hospitalized, according to state health officials.

This article originally appeared in at . The Texas Tribune is a member-supported, nonpartisan newsroom informing and engaging Texans on state politics and policy. Learn more at texastribune.org.

The West Virginia House Monday rejected its version of a Senate bill that would have loosened school vaccine requirements and expanded exemptions, voting it down

The bill’s defeat came after the House twice amended the Senate’s version of the legislation, first to remove both the philosophical and religious exemptions approved by the Senate and then to and to allow private and parochial schools to set their own mandatory vaccine requirements.

“The pro-vaccine messaging won out,” Northe Saunders, executive director of the pro-vaccine , told ����Ӱ�� Monday.

West Virginia now has among the country’s strictest regulations governing the immunizations required for children entering child care and schools, allowing for medical exemptions only. It’s unclear what might come next.

While the House’s vote effectively killed the current legislation, over a dozen other vaccine-related bills have been introduced in the West Virginia legislature and the governor signed an executive order in January establishing the religious and philosophical exemptions that House members rejected.

Saunders said time may be running out for the other vaccine-related bills to move forward during this legislative session.

An amendment that would give West Virginia parents much greater leeway to exempt their children from mandated school vaccinations was deleted from a House bill at the last minute this week, but the prospect of far fewer students in the state getting immunized remains strong.

As written, the would still expand and loosen requirements for medical exemptions for students, making them “the broadest … in the country,” one advocate said. The religious and philosophical exemptions that were struck from the House version of the legislation could also be reintroduced and, while it doesn’t carry the same force of law, Gov. Patrick Morrisey’s January order establishing similarly far-reaching exemptions is also hanging in the balance.

Historically, West Virginia has had some of the nation’s strictest childhood vaccination policies and the current move to soften them is occurring against a deadly measles outbreak that has infected in 15 states and taken the life of one school-age child in Texas. 

“It’s hard to wrap your head around why we would do this right now — or anytime,” said Candice Lefeber, executive director of West Virginia’s chapter of the . “But at such heightened alertness with measles spreading in our country, it should be a wake-up call. And unfortunately, I don’t think that’s happening,”

West Virginia is not an outlier in its quest to allow parents to opt their children out of the measles, mumps and rubella vaccine that is a requirement in all 50 states for children entering child care and schools. 

On Wednesday, Idaho lawmakers passed a that would significantly broaden an existing law banning COVID vaccine mandates to include mandates on any “medical treatment.” If the governor signs it, the bill would apply to public and private schools as well, making Idaho the first state in the country to remove all mandatory school vaccination requirements.

Childhood vaccination since COVID, and there’s fear that decline will accelerate now that Robert F. Kennedy Jr., a well-known vaccine skeptic, is heading the U.S. Department of Health & Human Services. He initially in late February, and in a March 4 seemed to link the ongoing outbreak and child fatality to malnutrition and poor health while pointing to unproven treatments, such as cod oil.

“The best thing Americans can do is to keep themselves healthy,” Kennedy said in the interview. “It is very, very difficult for measles to kill a healthy, well-nourished person.”

Three months in, the number of measles cases has already surpassed 2024’s total and in the 15 states where it’s spread, 95% of infections have involved a person who was unvaccinated or whose status was unknown. Three of those states border West Virginia, although, so far, the Mountain State has no reported cases. 

‘We just want the policy left alone’

The latest House bill still has a more wide-ranging medical exemption that also protects health care providers who grant them “in good faith” from civil liability, except in cases of “gross negligence or willful misconduct.”&�Բ�����;

It also includes no enforcement mechanism from a government oversight body nor is there guidance as to what qualifies someone for a medical exemption. 

Northe Saunders, executive director of the pro-vaccine , fears this might lead to bad actors writing “bogus” exemptions. Saunders’ group, which is based in Portland, Maine, opened a West Virginia chapter in February after local advocates asked for their help amid the exemptions push.

“We’re glad that the religious and philosophical exemptions were not part of the bill that came out of committee,” said Saunders, who believes the measles outbreak was a factor in their being cut, “but we expect [attempts to modify the bill] going forward.”&�Բ�����;

Saunders said his organization is tracking an additional 20 vaccine-related bills in the West Virginia legislature. And, across 20 states, 47 bills have been introduced which would add or broaden vaccine exemptions.

Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons. Most states also have religious exemptions, and 20 have some form of leaving a varied landscape. 

West Virginia is currently one of only five states that don’t allow any exemptions, beyond medical ones. Last school year, they had the for four of the major mandated vaccines, significantly outperforming national averages. Almost all kindergarteners there — 98.3% — had received both doses of the measles, mumps and rubella vaccine. 

The state also had the lowest rate of exemption, with less than 0.1% of kindergarteners being exempt from one or more vaccines. And it was the only state that supported Donald Trump for president in November that did not see an average rise in official exemptions. 

That could change, depending on the fate of the pending legislation and the governor’s executive order.

“The current policy as is, is something that is highly favored among myself and my colleagues,” said Andrea Lauffer, an internal medicine doctor and pediatrician at WVU Medicine – Thomas Memorial Hospital in South Charleston. “We just want the policy left alone.”

Michael Ramey, president of the , noted the role the pandemic has played in the current vaccine skepticism. He said that while his organization does not hold a position on the safety or efficacy of vaccines, it stands in support of bills like the one in West Virginia.

“We welcome a move to give parents greater authority to make the decision that’s best for their individual child,” he said. 

The vast majority of Americans — 88% — believe the benefits of the childhood vaccine for measles, mumps and rubella outweighs the risks, compared with just 10% who say the risks outweigh the benefits, according to a 2023 Seventy percent of Americans say healthy children should have to be vaccinated to attend school, down from 82% in 2019. And the share of parents who think they should be able to decide against vaccination is up 12 percentage points from four years ago, to 28%.

This shift is being driven by Republicans, 57% of whom now support vaccination requirements — down from 79% in 2019.

‘The heat is on’

The debate over vaccine mandates in West Virginia is not new, but “this year, definitely, the heat is on, for sure, at a higher temperature,” said Sissy Price, a registered nurse who serves as co-director of .

Last year, former Gov. Jim Justice vetoed a bill which would have allowed private and parochial schools to set their own vaccination policies. Meanwhile, Morrisey signed his executive order creating religious and philosophical exemptions on his first full day in office.

The governor wrote that current mandatory vaccine laws force West Virginians who have objections “to choose between their religious belief and their children’s fundamental right to public education.” The order, he said, was based on his interpretation of the Equal Protection for Religion Act, signed by Justice in 2023. 

The pending legislation was meant to clarify and codify his order. Even if the bill’s final version does not include religious and philosophical exemptions, the governor’s executive order would still stand, said Richard Hughes, a George Washington University law professor and leading vaccine law expert. 

While the ability to set new laws lies only with the legislature, the governor does have the ability to interpret those laws, which is what his executive order does, Hughes said.

If the executive order is not in line with what the legislature passes, however, it would remain vulnerable to court challenges.

“The governor could be checked by the courts on this interpretation,” he said.

Introduced Feb. 13, would have allowed parents to simply provide a written statement to exempt their child from vaccines for religious or philosophical reasons and applied to public, private and parochial schools.

In addition to loosening the medical exemption process and protecting medical professionals from disciplinary actions, it would also eliminate the position of state immunization officer and no longer require schools to report a violation if an unvaccinated child without an exemption attempted to enroll.  

At a Feb. 21 committee meeting, both Democratic and Republican senators spoke out in opposition to the bill. Many cited the measles outbreak that began in West Texas in late January as core to their concerns.

GOP Sen. Mike Oliverio read aloud from a letter written by one of his constituents, a retired physician.

“Loosening these requirements will eventually lead to outbreaks of these diseases, including in our children, as the number of vaccinated individuals fall,” he read. “I urge you to vote against this bill for the sake of West Virginia’s children.”

A number of Republican lawmakers also spoke in favor of the bill, which ultimately passed by a 20-12 vote, with two senators absent, before going to the House. 

The House bill that came out of committee this week is now expected to move to the floor, where it will be debated and potentially amended again. If the final House bill that passes still differs from the initial Senate bill, senators will need to either accept the House’s version or head to a conference committee to reconcile the two before sending it on for Morrisey’s signature. 

of those infected so far are vaccinated. The remaining patients are either unvaccinated or their vaccine status is unknown. 

Robert F. Kennedy Jr., the newly confirmed head of the U.S. Department of Health and Human Services, has a long history of around vaccines, including the one for measles. He recently put vaccine advisory meetings — where a panel of experts establish a vaccine schedule used to inform state policies — on indefinite and wields power over how organizations within HHS, such as the Centers for Disease Control and Prevention, respond to such crises. 

Earlier this month, his anti-vaccine organization, Children’s Health Defense, put out a blaming the Texas outbreak on the vaccines themselves, arguing, “The real issue is not a failure to vaccinate but a failing vaccine.”

“As measles outbreaks continue to surface, the mainstream media is now using them as a political weapon, attempting to blame … Secretary Robert F. Kennedy Jr. for so-called ‘anti-vaccine rhetoric,’” the statement read. “His warnings about vaccine-induced injuries and failures are validated by the very outbreaks being reported today.”

Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, a Texas-based education advocacy organization that promotes childhood and adult immunization, said she is “just absolutely flabbergasted that there is intentionality to put blame on the vaccine when that is not where anybody should be spending their time or their effort. Our effort should be supporting families, making sure they’ve got the right information and supporting helping our public sector partners so we can try to get to the end of this crisis sooner rather than later.”

“CDC is aware of the death of one child in Texas from measles, and our thoughts are with the family,” Andrew Nixon, director of communications at HHS, wrote in a statement to ����Ӱ��. “CDC continues to provide technical assistance, laboratory support, and vaccines as needed to the Texas Department of State Health Services and New Mexico Department of Health, which are leading the response to this outbreak.”

There are now also at least nine reported cases in neighboring  

Kennedy that he’s following updates on the outbreak, which he noted was mainly in the Mennonite community. Despite the confirmed death of a child, Kennedy appeared to downplay the spread, saying, “It’s not unusual. We have measles outbreaks every year.”

Measles were declared eliminated in the United States in but there’s been a resurgence of cases as vaccination rates have dropped.

Mary Koslap-Petraco, a pediatric nurse practitioner who treats underserved children in New York state, said that when she heard about the child’s death Wednesday morning, “Quite frankly, I broke down in tears. This was [99%] preventable.”&�Բ�����; 

She placed much of the onus on the anti-vaccination movement, saying they planted “seeds of distrust” that ultimately scared parents.

“I know this family only wanted the best for this child,” she said, “and I’m really sorry that they weren’t able to encounter someone who could help them through this misinformation that they’re hearing to feel comfortable enough to vaccinate their child.”

‘Primed for something like this to happen’ 

Measles is a highly contagious which can be serious and sometimes fatal in children. If one person has it, up to 9 out of 10 people nearby will become infected if they , though spread is preventable through the measles, mumps and rubella vaccine, which is safe and about . The infection is often marked by a high fever, sore throat and rash; more severe complications can include pneumonia and swelling of the brain.

In a statement Wednesday, the Texas Department of State Health Services said the best way to prevent measles is through the vaccine. The department  it was “working with local health departments to investigate cases, provide immunizations where needed, and keep the public informed.”

Texas is one of 18 states that allow school-aged children to of vaccine requirements for medical, religious or “personal belief” reasons.

The majority of measles cases so far are in Gaines County, a small, rural county in West Texas, with one of the state’s highest vaccine exemptions rates: up from just over 4% a decade ago. And the actual number of unvaccinated kids in the county is likely significantly higher, because there’s no data for the many children who are homeschooled, according to reporting from the

Some of the initial cases appeared to be connected to . 

To be exempted for “reasons of conscience,” a parent or legal guardian has to submit a form to the school. Under certain circumstances — like an official emergency or epidemic — these students might not be allowed to go to school.

None of the four public school districts serving Gaines County immediately responded to a request for comment. The county’s small Loop Independent School District of K-12 students had a conscientious exemption for immunizations in 2023-24. The statewide vaccine exemption rate is 2%.

“We know based on a ton of research that these kinds of exemptions cluster,” Lakshmanan said. “They cluster geographically, they cluster in schools, they cluster in neighborhoods, they cluster in faith-based communities. Sadly we are seeing the practical reality of this type of loophole … when we start to see high exemption rates, we are bound and we are primed for something like this to happen.”

Kindergarten measles vaccination rates in Texas generally have fallen to below 95% since the pandemic, though they still remain just above national averages, according to a recent data analysis from  

A number of Texas parents who previously had not vaccinated their children are now changing course. “We’ve vaccinated multiple kids that have never been vaccinated before, some from families that didn’t believe in vaccines,” Katherine Wells, director of public health for Lubbock’s health department, told

Yet, as the outbreak spreads, Texas lawmakers are preparing to consider bills that would further loosen exemption requirements.

“Now is not the time to be playing a game of roulette with children’s lives or Texans’ lives and even contemplate making the exemption process easier,” Lakshmanan said.

A Western Kentucky University student has a confirmed case of measles and may have exposed others, according to the Barren River Health District and the Kentucky Department for Public Health.

The student is unvaccinated against the highly contagious disease, the health departments said.

The student, whose name, gender and other identifying information were not released, recently traveled internationally. This is where they “are presumed to have been exposed to measles.”

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Upon returning, and “while infectious with measles,” the student attended public events on Aug. 28, 29 and 30, the health department said.

People who were at the following locations may have been exposed:

• The Commons at Helm Library (WKU)
  • 1906 College Heights Blvd #11067 in Bowling Green
  • Wednesday Aug. 28, 2024, (7:45 a.m. – 10  am and 8 p.m. – 10:30 p.m.)
  • Thursday Aug. 29, 2024, (7:45 a.m. – 10 a.m.)
  • Friday Aug. 30, 2024, (7:45 a.m. – 10 a.m.)
• WKU student union Starbucks
  • 1906 College Heights Blvd in Bowling Green
  • Wednesday Aug. 28, 2024, 6:30 p.m. – 9:30 p.m.
• Simply Ramen restaurant trivia night
  • 801 Campbell Lane in Bowling Green
  • Thursday Aug.  29, 2024, (7 p.m. – 11:00 p.m.)

Measles “spreads easily when an infected person breathes, coughs or sneezes,” . It can cause serious complications and death, according to WHO, which reported most deaths from measles in 2022 were in unvaccinated children.

Vaccination is the best defense against measles, WHO says.

The Centers for Disease Control and Prevention recommends a first dose of MMR vaccine for children 12–15 months and a second dose between ages 4–6. Teens and adults should also stay up-to-date on this vaccine, , which is generally available at pharmacies.

Symptoms of measles are fever, cough, watery eyes, runny nose and rash.

If you have questions about exposure or your risk, call your healthcare provider or the Barren River District Health Department at 833-551-0953.

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Kentucky Lantern maintains editorial independence. Contact Editor Jamie Lucke for questions: info@kentuckylantern.com. Follow Kentucky Lantern on and .

Unfortunately, since the onset of the COVID-19 pandemic, due to difficulties in accessing health care, vaccine hesitancy and the loosening of vaccine requirements. These put children and communities at greater risk of outbreaks of preventable disease.  

Measles provides a helpful case study. According to the Centers for Disease Control and Prevention, “ that if one person has it, 9 out of 10 people of all ages … will also become infected if they are not protected.” Despite this risk, almost 250,000 kindergartners in the 2021-22 school year may not have been protected against measles. Measles cases have resulted in , productivity loss and direct medical costs; the CDC estimates it can . 

State requirements that children be vaccinated to attend public school have a proven track record in producing high immunization rates. These generally are around grace and provisional enrollment periods, which temporarily allow children who are getting but have not completed their vaccinations to attend school. Yet, during the 2021-22 school year, due to pandemic-related health care disruptions, many states allowed students who did not meet school requirements and lacked valid exemptions to continue to attend class. In part because of these lenient policies, 4.4% of kindergartners nationally on their measles, mumps and rubella vaccine. 

This is particularly concerning because a population . This means that measles is less likely to spread, protecting the 5% percent who are not vaccinated. that have vaccination rates of less than 95% for measles, and prevent outbreaks if they were able to vaccinate kindergartners who do not have valid exemptions. For instance, , mumps and rubella, and . If those children were vaccinated, Vermont’s overall rate potentially would exceed 95% and all youngsters — and their surrounding communities — would be protected.

Unfortunately, state immunization programs are facing that supports data systems, as the result of unspent COVID funding being pulled back during congressional debt limit negotiations. The country can’t afford to waste the , including data modernization, during the height of the pandemic. Now is the time to build on those improvements, making sure states have efficient and effective systems to track vaccine orders, enroll health care providers as vaccinators, provide patients and families with timely information about their immunization status and their need for updates, and address gaps so all children are protected from preventable disease.  

The back-to-school season is a key moment to catch kids up on their vaccines. To do this, schools should reinstate and reinforce vaccine requirements, sending a message to families about the importance of routine childhood immunizations. Schools should also engage community leaders to bolster vaccine confidence, counter disinformation and provide families with timely, accurate, culturally sensitive and evidence-based information about vaccines. Lastly, schools should help families access vaccines through back-to-school immunization drives, which provide an opportunity to identify children who need to catch up, engage their families and connect them to clinical personnel. The CDC provides and tools for schools and health care providers to catch kids up on routine immunizations.

Public health systems are often unnoticed, working behind the scenes to prevent diseases and avoid their health and economic consequences. Americans must keep and prevention to promote good health, reduce absenteeism from preventable diseases and promote positive school environments for learning. Catching kids up on routine vaccinations must be a critical priority for advancing community well-being.