Takeaways from AP's report on how flat funding set stage for Texas measles outbreak, might fuel more

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

The easily preventable disease, declared eliminated in the U.S. in 2000, ripped through Texas communities in part because health departments were starved of the funding needed to run vaccine programs, officials say.

Nationwide, immunization programs have been left brittle by years of stagnant funding by federal, state and local governments. Health departments got an influx of cash to deal with COVID-19, but it wasn't enough to make up for years of neglect.

In Texas and elsewhere, this helped set the stage for the measles outbreak and fueled its spread. And now, new federal funding cuts threaten efforts to curb it .

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

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

Decreasing vaccine rates provide kindling for disease outbreaks

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

Keeping vaccination rates high requires vigilance, commitment and money.

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

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

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

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

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

Funding issues extend far beyond Texas

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

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

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

Recent federal funding cuts are making things worse

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

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

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

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

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