Texas child is first reported US measles death in a decade as outbreak hits more than 130

The COVID Pandemic Harmed Trust In Childhood Vaccines And Public Health. What That Means For Future Outbreaks

Last month, for the first time in two decades, a 6-year-old child in the U.S. Died due to measles. Just a few weeks later, a second person died. Both were unvaccinated, making them part of a worrying trend that public health experts have seen increase since the COVID-19 pandemic.

The pandemic upended life in one way or another for just about everyone in the U.S. And across the globe. Five years later, experts worry that vaccine misinformation and barriers to health care that emerged during the pandemic have weakened trust in one of our most valuable public health tools — vaccines — with devastating consequences we're only just beginning to see.

"This is a tragic and devastating loss," Dr. Sue Kressly, pediatrician and president of the American Academy of Pediatrics, tells TODAY.Com. "Even one death from a preventable disease is one too many."

Not only are we witnessing the resurgence of previously eliminated diseases, like measles, but the country may also be much less equipped to handle whatever the next inevitable pandemic threat may be, the experts tell TODAY.Com.

So far this year, the U.S. Has seen more measles cases than any entire year since 2019. Bird flu is raging through poultry and cattle, and a long-time critic of well-established vaccines is in charge of the Department of Health and Human Services.

While the vast majority of students still receive their state-required vaccines on time, recent research from the Centers for Disease Control and Prevention shows a growing minority is missing out on those potentially life-saving immunizations.

New research also suggests measles vaccination rates among kids may be even lower than previous estimates — possibly low enough to threaten measles' status as an "eliminated" disease in the U.S.

Now is the time to focus on "how we can strengthen vaccine confidence and remove barriers to getting vaccines to every child in every community so they can benefit from the vaccine success story," Kressly says.

A worrying trend in childhood vaccination rates

"Vaccines really are an American success story," Kressly says.

The vast majority of people in this country support vaccines, Kressly emphasizes, and the majority of children receive their recommended vaccines on schedule.

But there have been notable declines in the number of children who are fully vaccinated, especially since the pandemic began.

For instance, recent research from the CDC shows that children born in 2020 and 2021 are less likely to have received all recommended vaccines than those born in 2018 and 2019.

Other CDC research confirms that the rate of vaccine exemptions among kindergarteners has risen in recent years. During the 2023 to 2024 school year, vaccination coverage of kids in this age group was only 93%, compared to 95% during the 2019 to 2020 school year.

Vaccine exemptions, which allow kids to attend school without all their state-required immunizations, can be medical, when a health condition prevents a child from receiving a vaccine, or non-medical, sometimes called "philosophical" or "religious" exemptions. While all states allow exemptions for medical reasons, not all parts of the country allow for non-medical exemptions. And even among states that that allow non-medical exemptions, exact policies vary.

The CDC research also found that 3.3% of kindergarteners received an exemption for at least one state-required vaccination, the highest percentage ever reported, the authors state. And more than 7% of kindergarteners did not have documentation that they received two doses of the measles, mumps and rubella (MMR) vaccine, possibly putting them at risk for measles.

And the number of states with a greater than 5% exemption rate for the MMR vaccine has been steadily increasing. That matters because public health officials' target is 95% vaccinated in order to maintain elimination of measles. Just two states were below 95% in 2020, then 10 in 2022 and up to 14 in 2023.

New research, published this week in the American Journal of Public Health, indicates measles vaccination rates may be even lower than that in some parts of the U.S. The researchers sampled 20,000 parents of kids under the age of 5 between July 2023 and April 2024.

Their results showed that only about 72% of those parents reported that their kids had received at least one dose of the MMR vaccine, which is far less than CDC estimates.

This lack of coverage presents a risk — potentially a life-threatening one — for the kids who aren't vaccinated, of course, Kressly says. But it's also a threat to people in the community who simply can't get vaccinated.

For instance, cancer patients often cannot get vaccinated, and their treatment may reduce the immune system's ability to protect them from pathogens. People who've had organ transplants are similarly at risk, Kressly explains.

"While they're dealing with horrible illnesses and fighting for their lives, they're depending on their neighbors to get vaccines so they can benefit from the community," she says.

"They aren't necessarily visible to us, but they are among us and are our friends and our neighbors and our community members," Kressly continues. "If we all work together as a community to strengthen our collective immunity, then everybody wins."

The pandemic's lingering effects

Multiple things contributed — and are still contributing — to mistrust in vaccines and a decline in vaccination rates, experts say.

"What the COVID pandemic did was expose and widen existing cracks in multiple systems in society," Dr. Megan Ranney, emergency medicine physician and dean of the Yale School of Public Health, tells TODAY.Com.

First, in the early days of the pandemic, there were the basic logistical challenges of getting to the doctor in person. Many people delayed routine appointments, and others lost access to specialized at-home care.

While those challenges affected just about everyone, COVID-19 had a disproportionately large effect on some groups of people, such as Black, Latino and Indigenous people, as well as those who are uninsured and living in rural communities.

"Families struggled to have access to many needed services during the pandemic," Kressly says. "And it didn't just go back to what the baseline was before then. There are lingering logistical and access issues," such as a persistent shortage of primary care providers and funding hits to local health clinics.

Ultimately, those challenges have led to a widening of pre-existing disparities in access to crucial care, including vaccines.

Another piece of the puzzle is the proliferation of vaccine misinformation and disinformation that fuels vaccine hesitancy, Kressly says. "Families are having a hard time sorting out what is the most trusted source and what is the best information as they want to make the best decision for their child," she explains.

Before COVID, people would opt not to get vaccinated due to faulty risk perceptions, Rupali Limaye, Ph.D., associate professor at George Mason University and an expert in vaccine behavior and decision-making, tells TODAY.Com.

They might say, "I'm not susceptible to this because I've never heard of it," or, "Even if I get measles, it's not that bad," Limaye explains. There were also persistent falsehoods about vaccine ingredients or a thoroughly disproven link between vaccines and autism that convinced some people to skip the shots.

"Since COVID, we still have those reasons (people report for not getting vaccinated), but now we have added more reasons, unfortunately," Limaye says. "And one of the main reasons has really been misinformation."

Today, the spread of vaccine misinformation is part of a larger science denialism movement in the country, she explains, which has led to a loss of trust in public health and medical establishments.

Vaccines "got swept up" in the larger anti-mask and anti-lockdown movements until they, too, were seen by some as "just another way for the government to tell you to do something," Limaye says. "So now (vaccination) becomes a symbol of oppression. It becomes a symbol of 'attacking my liberty.'"

Misinformation, combined with a climate of extreme political polarization, lack of access to primary care doctors and declining trust in health care professionals created a "perfect storm" for vaccine hesitancy, Limaye says. "All of these together is really leading to people that have more concerns about vaccines than we've ever seen in the past."

That lack of trust "leaves people prey to unscrupulous actors who then come in and promote snake oil at best, harmful solutions at worst, that then make the health of individuals and communities worse," Ranney says.

In their only on-camera interview, the parents of the 6-year-old Texas child who died due to measles told fellow parents not to get the MMR vaccine, NBC News reported this week. Instead, they credited unproven alternative remedies, like cod liver oil, for the recovery of their other children. (The family did not respond to NBC News' request for comment.)

On the ground, the situation is frustrating for experts because they have to spend time combatting misinformation about long-established scientific facts, rather than talking about proactive health advice. It's also a missed opportunity for parents and patients.

"If I, as a physician, am having to spend 20 minutes talking about a vaccine that millions upon millions of people have gotten and that we know is safe and that we know protects you from potentially deadly diseases, that's 20 minutes that I don't get to spend with you talking about good nutrition or your mental well being," Ranney says.

While there are important debates and discussions to be had in medicine, "whether the measles vaccine is safe and whether it works is not one of those things," Ranney adds.

The resurgence of diseases and new pandemic threats

"I really worry that we are currently seeing an outbreak of measles, which is 100% preventable," Limaye says. And in terms of another pandemic, "it's not if, it's when," she says.

One of the effects of climate change is that we will be interacting more with animals as we encroach on their habitats, which makes it easier for a spillover event to occur, she explains.

The recent mpox outbreaks are another "good reminder that there are infections out there in animal populations that infect humans," Dr. David Heymann, infectious disease epidemiologist and former assistant director-general for health security at the World Health Organization, told TODAY.Com previously. "We just have to be aware that there's a whole animal kingdom out there with organisms that can come into humans."

Limaye says bird flu is on her mind right now, and other experts previously voiced to TODAY.Com concerns that bird flu could begin to transmit between humans more readily.

"It might take years, or it could take weeks. And it only has to happen once for it to become a much more widespread problem," Dr. Stuart Ray, professor of medicine and oncology at Johns Hopkins University School of Medicine, told TODAY.Com in February.

This type of major change in the way a virus spreads is often a "precedent for a pandemic," Ray said.

Whether the next public health challenge is bird flu or something else entirely, "we're going to continue to see pathogens emerge," Limaye says. "We are going to be dealing with more pandemics, and we are just woefully and inadequately prepared for them," Limaye says.

And the changes we're seeing now — like the deletion of health information pages from the CDC site, postponing a long-standing CDC vaccine advisory committee meeting and canceling the meeting to choose the strains to be targeted in next year's flu shot without explanation — are only "going to further destroy and fracture trust" in those institutions, Ranney says.

After a court order, some CDC pages were restored. The flu shot strains were chosen in a closed-door meeting without input from the FDA's vaccine advisory committee. The CDC vaccine advisory committee meeting, which was scheduled for late February and "postponed to accommodate public comment," according to an HHS spokesperson, is rescheduled for mid-April, Reuters reported.

In late March, the HHS announced plans to cut about 10,000 jobs and reduce or shutter several departments, including those focused on responding to infectious disease outbreaks. Some departments would move from the HHS to the CDC, such as the Administration for Strategic Preparedness and Response, which had been responsible for sending out rounds of free COVID tests to U.S. Households until this year.

HHS also stated the CDC would be pulling back $11 billion in funding for pandemic-related aid, including COVID testing and vaccinations. Local health departments told NBC News they feared the cuts would affect projects that help with infectious disease risks not limited to COVID, like disease data tracking and vaccine outreach programs.

Individual doctor-patient relationships remain crucial

Even when basic public health measures become politicized, patients still tend to trust their individual doctors — especially if there is already an underlying relationship there, Kressly says. "We have the most impact when we have a trusted relationship," she adds.

Vaccine requirements for school attendance have helped increase coverage, too, she says, which is especially beneficial in protecting the kids who can't get vaccinated for medical reasons.

Outside of the pediatrician's office, Limaye stresses the importance of seeking out evidence-based information when making health decisions, which is challenging when myths spread so widely on social media.

There's a sort of "contagion effect" to misinformation, Ranney explains. "If your best friend or your cousin starts to question some health recommendations, you trust (those people), so then you start to question them, too," she says. When that happens, there are specific techniques you can use to help combat vaccine misinformation in your conversations with friends and family, Limaye told TODAY.Com previously.

Highlighting the stories of people who have been impacted by vaccine-preventable illnesses is crucial, too, she says, "so people understand this isn't just a statistic. This is a person. This is a family."

5 Things Every Parent Should Know About Childhood Vaccines

In the wake of the 2025 measles outbreak and lingering vaccine hesitancy, here are 5 things to know about the safety, efficacy, myths, and more related to childhood vaccinations.

A plethora of factors influence a parent's or a caregiver's decision to vaccinate. Although numerous data and publications indicate the safety and efficacy of vaccines, hesitancy to vaccinate remains among the top threats to global health, even more so in the wake of the COVID-19 pandemic.1 Skepticism and uncertainty about vaccine composition, whether vaccination is truly necessary, concerns about a link to autism, and cultural and religious beliefs carry a lot of weight in this discussion.2 In the midst of growing controversy, here are 5 things parents should know about childhood vaccinations.

The best way to stay protected against preventable disease is to get vaccinated.Image credit: didesign - stock.Adobe.Com

1. School Requirements

Vaccination laws generally apply to public schools, but also often pertain to private schools and even homeschooling in many states. Certain exceptions can be granted on religious or medical bases, among others, to allow students to attend.3

Two of the more common requirements are polio, varicella, diphtheria, tetanus, and pertussis (DTaP, whooping cough) and measles, mumps, and rubella (MMR). Additionally, several states include the meningitis vaccine prior to seventh grade, while others require vaccination against hepatitis A and hepatitis B at earlier ages. Rhode Island also requires the 3-series human papillomavirus vaccine (HPV) be completed before entering ninth grade, with the first and second vaccine being administered before seventh and eighth grade.

2. Safety, Efficacy, Adverse Effects

Every year, millions of children, adolescents, and infants are vaccinated against preventable infectious diseases. One of the FDA's primary responsibilities is making sure these vaccinations are safe and effective for public use. Each available vaccine undergoes extremely careful and extensive evaluation from the FDA.4

Additionally, recommended vaccines are under continuous study and remain closely monitored. These vaccines teach the immune system how to recognize and counteract numerous pathogens and have nearly eradicated devastating illnesses, such as polio.5

Notably, the series of DTaP vaccinations has demonstrated 100% efficacy against tetanus, 97% efficacy against developing diphtheria, 95% against Haemophilus influenzae type b (when infants are given 2-3 doses), 94% against hepatitis A, 90% for hepatitis B, 100% for HPV, 96% for measles, 86% for mumps, 89% for rubella, and 69% to 88% effectiveness against meningitis.

Severe reactions to a vaccine are rare, occurring in 0.01% to 0.1% of cases. Although more serious reactions are possible, these risks for vaccine-related harm are substantially less likely than the risk of contracting a serious illness after foregoing a vaccine. Allergic reactions occur anymore between 1 case per 100,000 doses to 1 in 1 million. Less severe adverse events may occur, including injection-site soreness, minimal swelling, and mild fever.4,5

For more data on vaccine efficacy, safety, and adverse effects, visit The Journalist's Resource webpage.

3. Common Myths

There are a lot of misconceptions that circulate about vaccines, including the beliefs that vaccines contain harmful ingredients, that contracting a disease or herd immunity is better than vaccine-granted immunity, and that vaccines cause diseases, will alter DNA, or are not sufficiently tested. Chief among these concerns is that vaccines can lead to autism.5

Some substances in vaccines are harmful or toxic in large doses; however, vaccine composition includes these ingredients in safe, small doses far lower than what people are naturally exposed to. Examples include formaldehyde, mercury, and aluminum. Their concentration in vaccines falls well below the levels found in common household items or everyday foods, and even bolster individual immunity and better preserve vaccines without added safety risks. Although these ingredients can sound alarming, milk, tuna, cosmetics, health products, medicines, and other products often contain trace amounts of these substances, too.

Vaccines often administer an inactivated disease strain. There are some that use living, or activated, organisms; however, this is not the same as giving someone a disease. While some mild reactions can occur, and actually indicate the vaccine is working, these are not harmful.

Although natural immunity can occur for preventable diseases, the risk for additional complications can be avoided when someone is vaccinated. Furthermore, if someone foregoes a vaccination for themselves or their children due to belief in herd immunity, it is important to realize that herd immunity only occurs when a large portion of a community already has immunity against a disease. When herd immunity becomes ineffective, infants, immunocompromised individuals, and pregnant women all stand at increased risks.

4. Autism

Claims connecting vaccines and the development of autism date back to 2 debunked studies conducted by Andrew Wakefield. Wakefield hypothesized that the MMR vaccine was a catalyst for intestinal inflammation, which allowed dangerous proteins to enter the blood stream, harm the brain, and subsequently cause autism.6

Each study is now known to be critically flawed. The first, conducted in 1998, found that 8 children in England developed autism in the month following their MMR vaccine. Yet, Wakefield did not compare incidence rates between unvaccinated and vaccinated children. At the time, approximately 90% of English children were receiving MMR vaccines in the same time frame that autism was typically diagnosed, which could explain why their diagnosis came so close to their vaccination. Furthermore, although Wakefield claimed that intestinal inflammation contributed to autism, these symptoms occurred after the children showed signs of autism, not before.

The second of the Wakefield studies investigated the relationship between the measles vaccine and autism. Intestinal biopsy samples of children with and without autism were evaluated, with investigators looking for the presence of the measles virus. The virus was observed in over 80% (75/91) of children with autism vs just over 7% (5/70) of samples from children without autism. However, these conclusions were challenged because the researchers did not distinctly identify whether this was the vaccine-granted virus or that of natural measles (which was still circulating at the time in England). Children in these groups also were not matched according to their immunization status, nor for the time period between vaccination and sample collections. Extremely sensitive testing techniques also meant there was a higher risk for results that were falsely positive. Additionally, for the best results, those performing the laboratory tests should be blinded as to which group the samples are coming from; this blinding was not stated in the study, nor was there any mention of matched cohorts.

Both studies have since been retracted and Wakefield's medical license revoked because of his falsified claims. Several studies have since invalidated his findings.7

For more information on studies disproving the link between vaccination and autism, please visit the Children's Hospital of Philadelphia webpage.

5. Current Measles Outbreak

Texas has been experiencing a significant measles outbreak. Since late January, 327 cases have been confirmed, with well over 50% of cases occurring in children 0 to 4 years (n = 105) and 5 to 17 years (n = 140).8

Officials tracking vaccination statuses reported that 325 of these cases were in unvaccinated individuals or those with no record of the measles vaccine in the 2 weeks leading up to symptom onset. That 2-week marker is an important measure because, after receiving the vaccine, it typically requires 14 days for immunity to develop. The Texas Department of State Health Services noted the best way to stay protected against measles is to be vaccinated. Vaccinations can be received during pharmacy visits, from a health care provider, or via the Vaccines for Children programs.

Thus far in 2025, 40 measles-related hospitalizations have occurred, as well as a fatal case in 1 school-aged child.

For more on vaccine efficacy, risks, and detailed information behind different types/forms of vaccination, please visit the FDA website.

References

1. Munz K. Vaccine hesitancy: COVID-19 to influenza. AJMC®. October 22, 2024. Accessed March 21, 2025. Https://www.Ajmc.Com/view/vaccine-hesitancy-covid-19-to-influenza

2. Why are some parents failing to vaccinate their children. Children's Defense Fund. July 2, 2019. Accessed March 21, 2025. Https://www.Childrensdefense.Org/blog/why-are-some-parents-failing-to-vaccinate-their-children

3. State school vaccination laws. CDC. Accessed March 21, 2025. Https://www.Cdc.Gov/phlp/php/publications/vaccination-laws.Html

4. Vaccines for children – a guide for parents and caregivers. FDA. Updated November 4, 2024. Accessed March 21, 2025. Https://www.Fda.Gov/vaccines-blood-biologics/consumers-biologics/vaccines-children-guide-parents-and-caregivers

5. Vaccines: the myths and the facts. AAAAI. Updated January 10, 2024. Accessed March 25, 2025. Https://www.Aaaai.Org/tools-for-the-public/conditions-library/allergies/vaccine-myth-fact

6. Vaccines & Autism: The Wakefield Studies. Children's Hospital of Philadelphia. Reviewed February 5, 2024. Accessed March 25, 2025. Https://www.Chop.Edu/vaccine-education-center/vaccine-safety/vaccines-and-other-conditions/autism

7. Link between autism and vaccination debunked. Mayo Clinic Health System. March 24, 2024. Accessed March 25, 2025. Https://www.Mayoclinichealthsystem.Org/hometown-health/speaking-of-health/autism-vaccine-link-debunked

8. Measles outbreak – March 25, 2025. Texas Department of State Health Services. Accessed March 25, 2025. Https://www.Dshs.Texas.Gov/news-alerts/measles-outbreak-2025

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