Lessons from history, reported in our new book, The Fed and the Flu: Parsing Pandemic Economic Shocks, are playing out in Texas and 19 other states as measles outbreaks continue to expand, principally sickening unvaccinated children. The CDC maintains a webpage on “Measles Cases and Outbreaks,” updated each Friday. On Friday, March 28, the CDC reported,
As of March 27, 2025, a total of 483 confirmed* measles cases were reported by 20 jurisdictions: Alaska, California, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York City, New York State, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, and Washington.
In the first quarter of 2025, those 483 cases included 5 outbreaks (defined as 3+ cases).
In all of 2024, by contrast, there were a total of 285 confirmed measles cases in the US and 16 outbreaks.
The World Economic Forum confirms that measles cases are on the rise globally as a result of falling vaccination rates. A 95% vaccination rate is required to prevent outbreaks.
“Measles cases are rising – here’s what can be done,”
https://www.weforum.org/stories/2025/03/measles-cases-rising-health-vaccines/
We offer a reading list below, divided into four parts:
- The fight against measles: How far we’ve come and what we know
- US measles response under HHS Secretary RJK Jr.
- Measles and the choices people make
- DOGE’s impact on public health, measles included
We think current measles outbreaks and decisions surrounding them are indicative of where we are heading with regard to public health in the US. We leave it to readers to review what Trump 2.0, RFK Jr., Musk, DOGE, and the looming budget fight will mean for US healthcare and measles outbreaks in Texas and elsewhere. Please give the list a scroll and read what catches your interest.
The fight against measles: How far we’ve come and what we know
First, let’s take a quick look at the historical context with regard to the fight against measles in the US, courtesy of a chart from the Center for American Progress.
(Source: “Childhood Vaccination Has Saved Millions of Lives, but Rising Hesitancy Could Reverse Decades of Progress,”
https://www.americanprogress.org/article/childhood-vaccination-has-saved-millions-of-lives-but-rising-hesitancy-could-reverse-decades-of-progress/)
Epidemiologist Katelyn Jetelina’s February 26 post on measles is still a good place to start. Jetelina notes the risks that measles infections entail and the relative risks of vaccination vs. infection. Further, she answers readers’ questions. (You do not have to subscribe to see the post.)
“A child is dead from measles” (Katelyn Jetelina, Your Local Epidemiologist),
https://open.substack.com/pub/yourlocalepidemiologist/p/a-child-is-dead-from-measles
From infectious disease epidemiologist Caitlin Rivers comes “a new series [tracking] measles alerts that might not make major headlines…. Paid subscribers now receive brief, skimmable reports twice weekly (Tuesdays and Fridays) on new cases nationwide.” Rivers explains how to follow up with your local health department if there is a measles alert in your area. (Keep in mind that local health departments face drastic funding cuts that will impact services.) Caitlyn Rivers’ Substack may be of interest for those readers who would like to keep up with where measles outbreaks are happening.
“Tracking measles: March 25,” https://caitlinrivers.substack.com/p/tracking-measles-march-25
US measles response under HHS Secretary RJK Jr.
Heading the US response to measles outbreaks in 2025 is HHS Secretary Robert F. Kennedy Jr., a vaccine sceptic who finds himself at variance with infectious disease experts on a number of points regarding measles and how best to manage outbreaks.
“Robert F. Kennedy Jr. describes major measles outbreak as ‘not unusual’ during Cabinet meeting” (AP video)
https://apnews.com/video/robert-f-kennedy-jr-describes-major-measles-outbreak-as-not-unusual-during-cabinet-meeting-da87118388624025bdc22192537dc107?utm_source=copy&utm_medium=share
On the last day of February, Secretary Kennedy announced plans to send 2000 doses of the two-dose MMR vaccine to Texas, along with other assistance. (Texas has 8 million children and a vaccination rate for measles/mumps/rubella of a little over 94%. Vaccination rates are lower in places impacted by outbreaks.)
“US Health Secretary Kennedy calls for end to deadly Texas measles outbreak,”
https://www.reuters.com/business/healthcare-pharmaceuticals/us-cdc-says-vaccination-remains-best-defense-against-measles-after-death-texas-2025-02-28/
Physician Benjamin Mazer responds to RFK Jr.’s claim that measles outbreaks are “not unusual.”
“RFK Jr., America’s Leading Advocate for Getting Measles,”
https://www.theatlantic.com/health/archive/2025/02/rfk-measles-vaccines-texas-outbreak/681860
In a March 2 op ed published on FOX News, RFK, Jr, announced assistance in containing the Texas measles outbreak, encouraged parents to “consult with their healthcare providers to understand their options to get the MMR vaccine,” and urged good nutrition as a “best defense” against infectious diseases.
“ROBERT F. KENNEDY, JR.: Measles outbreak is call to action for all of us,”
https://www.foxnews.com/opinion/robert-f-kennedy-jr-measles-outbreak-call-action-all-us
“In this MedPage Today video, Paul Offit, MD, of Children’s Hospital of Philadelphia and a member of FDA’s Vaccines and Related Biological Products Advisory Committee, responds to claims about measles and vaccines made by HHS Secretary Robert F. Kennedy Jr. in recent interviews.”
“RFK Jr. Falsely Claims Measles Vax Causes Deaths ‘Every Year’,”
https://www.medpagetoday.com/infectiousdisease/vaccines/114662
Just last week, Dr. Peter Marks, the FDA’s top vaccine official, was forced to resign. He called out HHS Secretary Kennedy in his resignation letter: “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.”
“FDA’s Top Vaccine Official Forced Out,”
https://www.wsj.com/politics/top-vaccine-official-out-at-fda-f39a5a16
HHS Secretary RFK Jr. has touted vitamin A as a treatment for measles, based on the positive impacts it has had on measles infection outcomes in parts of the world where a significant percentage of children are vitamin A deficient. Epidemiologist Katelyn Jetelina and Kristen Panthagani, MD, PhD, explain the evidence regarding vitamin A and measles infection outcomes. (Hint: It’s a deficiency that makes us more vulnerable to more severe cases of measles, and not many children in the US are vitamin A deficient — 0.3%.)
“Vitamin A and Measles: What the data show (and how to talk about it),”
https://yourlocalepidemiologist.substack.com/p/vitamin-a-and-measles-what-the-data
Below are two links to the history of RFK Jr. and a measles outbreak in Samoa.
“As RFK Jr. faces U.S. Senate, questions linger about a measles outbreak in Samoa, half a world away,”
https://www.cbsnews.com/news/rfk-jr-samoa-measles-outbreak/“RFK Jr. misled the US Senate on measles deaths, Samoa’s health chief says,”
https://fox59.com/news/health/ap-health/ap-did-rfk-jr-mislead-the-senate-on-measles-deaths-in-samoa-the-island-nations-health-chief-says-yes/
Measles and the choices people make
A Texas public health official warns against measles parties, predicts that the outbreak will continue to grow, and notes that some vaccine-hesitant parents are now getting their children vaccinated.
“Texas Official Warns Against ‘Measles Parties’ Amid Growing Outbreak,”
https://www.wired.com/story/measles-parties-texas-outbreak/
Some parents fear a rare adverse vaccine reaction more than they do the risks of infection:
“Amid West Texas measles outbreak, vaccine resistance hardens,”
https://www.washingtonpost.com/health/2025/03/02/measles-outbreak-texas-vaccine-hesitancy-death/
Physician Summer Davies treated the child who died of measles in rural Gaines County, Texas, where vaccination rates are especially low. She observed that the child who died “could have lived a long, happy life, and it is really heartbreaking when it’s something you know you could have prevented or that is preventable and ended in something like this.”
“Texas child is first confirmed death in growing measles outbreak” (doctor who treated the child interviewed)
https://www.washingtonpost.com/health/2025/02/26/measles-texas-unvaccinated-death/
Since the COVID-19 pandemic, vaccination rates for Texas kindergartners have dropped from almost 97% to below the 95% required to prevent outbreaks. They hover now at just above 94% but are much lower in rural Gaines County.
“Measles cases reported in Texas as vaccine rate against the disease has fallen,”
https://www.texastribune.org/2025/01/30/texas-measles-vaccinations-schools/
Two maps are worth a look and even a comparison: The first maps state laws regarding the vaccination of school children, and the second maps where measles is spreading.
“State Non-Medical Exemptions from School Immunization Requirements,”
https://www.ncsl.org/health/state-non-medical-exemptions-from-school-immunization-requirements“Where U.S. Measles Outbreaks Are Spreading,”
https://www.nytimes.com/interactive/2025/health/measles-outbreak-map.html
Taking too much vitamin A for too long is toxic, and some Texas children who have been given too much of it show now abnormal liver function.
“Some measles patients in West Texas show signs of vitamin A toxicity, doctors say, raising concerns about misinformation,”
https://www.cnn.com/2025/03/26/health/texas-measles-vitamin-a-toxicity/index.html
DOGE impact on public health, measles included
DOGE funding cuts for public health departments across the nation and for public health initiatives directly impact immunization efforts, even in the Texas County that is battling an outbreak.
“Health officials say federal cuts will hurt Texas’ measles response,”
https://www.texastribune.org/2025/03/26/texas-measles-public-health-funding-cut/
Public health scientist Jesse Steier explains the scope of the cuts and their impacts:
These cuts are part of a massive overhaul at HHS announced this week, with 10,000 employees being cut across health agencies nationwide. The CDC is losing 2,400 employees, while the NIH is cancelling hundreds of grants, including a $577 million program to develop antiviral drugs against viruses with pandemic potential. Research grants are being terminated left and right, with particular targets including Covid-19 research, climate change studies, and diversity initiatives. Health initiatives scrapped. Decades of progress threatened. The scope of these cuts is breathtaking — a systematic dismantling of our public health infrastructure when we should be building on what we’ve learned.
Local health departments were already operating on shoestring budgets, held together by dedication more than dollars. Now they’re losing even those meager resources. I can’t imagine a world without properly functioning local health departments, but we’re about to witness firsthand what happens when the foundation of our health system crumbles.
“A form letter canceled my project to support local health departments,”
https://www.statnews.com/2025/03/28/covid-public-health-funding-canceled-hhs-doge-local-departments/
The $11 billion in Covid funding being clawed back from state health departments was used not just for Covid but far more broadly, too, to better preparedness, surveillance, and response to infectious disease outbreaks, especially in underserved areas. Kristina Iodice, a communications director for Colorado’s Department of Public Health and Environment, explains:
“We are concerned that this sudden loss of federal funding threatens Colorado’s ability to track COVID-19 trends and other emerging diseases, modernize disease data systems, respond to outbreaks, and provide critical immunization access, outreach, and education—leaving communities more vulnerable to future public health crises,” Iodice said.
“CDC is pulling back $11B in Covid funding sent to health departments across the U.S.,”
https://www.nbcnews.com/health/health-news/cdc-pulling-back-11b-covid-funding-sent-health-departments-us-rcna198006
States are assessing impacts, but estimating the damage to infectious disease prevention and surveillance efforts may take some time. Here are examples:
“DOGE cuts grant money for NC Department of Health and Human Services,”
https://www.wect.com/2025/03/26/doge-cuts-grant-money-nc-department-health-human-services/“DOGE says it’s cutting nearly half a billion dollars from Kentucky, Indiana health departments,”
https://www.wave3.com/2025/03/27/doge-says-its-cutting-nearly-half-billion-dollars-kentucky-indiana-health-departments/“Trump Administration Abruptly Cuts Billions from State Health Services,”
https://www.nytimes.com/2025/03/26/health/trump-state-health-grants-cuts.html
Recent NIH funding cuts include curtailing vaccine-related research.
“NIH cuts funding for studies on vaccine hesitancy and acceptance,”
https://medicalxpress.com/news/2025-03-nih-funding-vaccine-hesitancy.html”
The CDC continues to see attrition of senior leadership.
“5 high-level CDC officials are leaving in the latest turmoil for the public health agency,”
https://www.atlantanewsfirst.com/2025/03/25/5-high-level-cdc-officials-are-leaving-latest-turmoil-public-health-agency/
Finally, a take from Bloomberg Businessweek: “Trump’s overhaul of the CDC has scientists worried about flu, measles and even Ebola.”
“The US Is Withdrawing from Global Health at a Dangerous Time,”
https://www.bloomberg.com/news/articles/2025-03-02/the-consequences-of-trump-s-cdc-overhaul-who-exit-worry-scientists?sref=TG2o5EVv
I hope that you’ve found items of interest in today’s reading list. As always, I’m interested in your thoughts. Feel free to share this post if you’re so inclined. This newsletter is free and welcomes new readers. (Subscribe below.)
David R. Kotok, March 30, 2025
(The above was first published on The Kotok Report website and via LISTSERV. For details, visit https://kotokreport.com/.)