As measles cases continue to grow in Texas and New Mexico, with a second death, an unvaccinated adult, reported on Thursday, some Texas cities are seeing shortages amid soaring demand for the highly effective vaccine and as the top US health official, Robert F Kennedy Jr, sows disinformation and mistrust about vaccines.
Ann and Paul Clancy were picking up medications at their local Walgreens in Austin, Texas, on Wednesday and decided to ask the pharmacist about getting the measles, mumps and rubella (MMR) vaccine.
The pharmacist said that they were “totally out, and she didn’t know exactly when they would be getting more”, Ann said.
The Clancys wanted to get vaccinated because they have followed the outbreak in the news, including the first measles case detected in Austin last week – an unvaccinated infant who had traveled recently and was not considered part of the wider outbreak of cases.
In addition to keeping themselves safe, the Clancys want to protect their grandchildren and family members with health vulnerabilities.
The pharmacist also mentioned that even doctors’ offices were “having a hard time keeping enough vaccines for kids who needed them”, Ann said.
There are now 198 known cases, 23 hospitalizations and one death from measles in Texas, and 30 known cases and one death in New Mexico.
When customers call Walgreens locations in Austin, they are still able to book appointments for the MMR vaccine – but pharmacists say the doses are out of stock, and that’s true all over the city.
None of the Austin-area Walgreens had MMR vaccines in stock on Thursday, pharmacists said.
Vaccines at CVS pharmacy locations in Austin were also scarce. At least one pharmacy had a few doses left on a first-come, first-served basis. But at another location, the pharmacist said on Friday, “Basically, every location within a 30-mile radius is out.”
At least one CVS in Lubbock – where most of the hospitalized measles patients are being treated – had also run out of stock on Thursday. Some pharmacies in Fort Worth also ran out of the vaccines or had just a handful of doses left on Friday.
Pharmacies at H-E-B, the grocery chain, in Austin are now limiting MMR vaccines to those most at risk, including people born before 1989 who may have only received one dose.
The distributor at Walgreens temporarily ran low on MMR vaccines “due to the spike in demand”, said Carly Kaplan, director of pharmacy communications at Walgreens. But “additional shipments have been arriving this week,” Kaplan said.
“We’re seeing increased demand for the MMR vaccine, but we do still have doses available across our Texas pharmacies and clinics,” said Amy Thibault, lead director of external communications at CVS Pharmacy. “We’re working to get additional vaccine to Texas as quickly as possible.”
H-E-B did not respond to the Guardian’s press inquiry by publication time.
Because measles is such an infectious disease, and the outbreak is already so advanced, it’s difficult to trace contacts and conduct ring vaccinations, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
Instead, officials should focus on “getting the word out about the importance of vaccinating” and countering misinformation about home remedies, like vitamins, that don’t prevent measles, Hotez said.
In areas with lower vaccination rates, “measles can accelerate”, Hotez said. “Measles is a great exploiter of unvaccinated and undervaccinated populations.”
Williamson county, which contains the northern part of Austin, had a 94.87% rate of MMR vaccination among kindergartners in 2023, according to data from the Texas department of health and human services.
That’s close to the 95% goal that creates population immunity, also called herd immunity, which protects those who are too young to be vaccinated or who don’t respond well to vaccines because they are immune-compromised.
But Travis county, which contains most of Austin, had a rate of 89.61% in 2023 – down from 95.5% in 2020.
The anti-vaccine movement started in the early 2000s and picked up steam in the 2010s, but vaccine hesitancy really surged during the Covid pandemic.
“Now you’re seeing it spill over, once again, into childhood immunizations,” Hotez said. In Texas, “we’ve had a steep rise in personal belief exemption requests – now we’re getting over 100,000.”
The US Centers for Disease Control and Prevention (CDC), which falls under the US Department of Health and Human Services, is investigating a repeatedly debunked link between vaccines and autism, according to Reuters.
Kennedy has been a major figure in the anti-vaccine movement, as the former chairman of the anti-vaccine organization Children’s Health Defense and the author of several anti-vaccine books.
In an op-ed on Sunday, Kennedy highlighted the importance of vaccines but stopped short of recommending vaccination, instead framing it as a “personal” choice. He wrote about patients dying “with, or of, measles” in the 19th century, casting doubt on the virus’s lethality.
Kennedy, who has no medical background, also amplified the role of vitamin A in measles treatment, but the vitamin does not prevent measles. Nor does cod liver oil, which Kennedy promoted in interviews this week.
It’s unusual for a US health secretary to address outbreaks, Hotez said. Usually state and local health departments take the lead, with the CDC advising or coordinating responses across states.
“The fact that he decided to insert himself, in that role, is interesting, but then to spread disinformation – that really is outrageous,” Hotez said.
Offering remedies such as vitamin A over vaccines “gives people this false sense of security”, Hotez said.
“It’s dangerous because people could make the incorrect decision not to get their kids vaccinated, falsely believing that there are alternatives that actually don’t work – and the result is, if there is a measles epidemic, their child could be hospitalized or worse.”
To halt the outbreak, Hotez said, officials need to stage a major vaccination campaign, “both in terms of setting up vaccine clinics and making them accessible and doing the necessary advocacy around it”.
Experts from the US Centers for Disease Control and Prevention (CDC) arrived in Texas on Tuesday and Wednesday, a CDC spokesperson said.
The agency has provided 2,000 doses of the MMR vaccine to officials in Texas and neighboring jurisdictions, and “[the] CDC continues to recommend the MMR vaccine as the best way to prevent measles for children and adults”, the spokesperson said.
But the agency’s advice on vaccines now diverges from past approaches to infectious disease outbreaks in a key way.
“The decision to vaccinate is a personal one,” the CDC spokesperson said.
One in five unvaccinated measles patients usually need to be hospitalized, and nearly one-fifth of children develop pneumonia. One in 600 babies who are not yet eligible for vaccines suffer from a fatal neurological complication, and about one in 1,000 children develop encephalitis, or brain swelling, which can lead to seizures, loss of hearing and intellectual disabilities.
Measles can also cause immune amnesia, where patients’ immune systems “forget” previous infections and vaccinations.
One dose of the MMR vaccine is 93% effective at preventing measles, and two doses are 97% effective. The vaccine is usually given at one year of age, but it can be given as early as six months to protect very young children from the risks of measles.
The CDC on Friday issued a health alert on the “expanding” outbreak, urging providers to be alert to cases and highlighting MMR vaccination.
“We’ve had, now, two deaths and the epidemic is not waning,” Hotez said. “It still has a lot of momentum behind it, and I don’t see it abating anytime soon, unfortunately,”
Paul Clancy hopes that vaccines become a much bigger priority in Texas’s response before more people are sickened or die.
“They should put the measles vaccination into overdrive, and then they should be setting up vaccination stations,” he said. “Because the measles spread – maybe it’s not going to go as quick as the [Covid] pandemic, but if they don’t do something about it, it will be [like] the pandemic.”
