Texas and Its Measles Epidemics

Peter Hotez reflects on declining vaccination rates in Texas and the potential for future measles epidemics.

across the state in combination with pockets of very low coverage in vulnerable populations is extremely troubling.
Although a detailed analysis has not been conducted on the sociology behind the alarming increase in vaccine exemptions in Travis County and elsewhere, a rapidly growing "anti-vaxxer" movement in the state appears to be contributing to the increase in vaccine exemptions.  At its epicenter is the Austin-based "Texans for Vaccine Choice, " an organization that describes itself as "a political action committee [PAC] dedicated to protecting vaccine choice rights by ensuring the issue remains at the forefront of political discourse, promoting incumbents and candidates who strongly support our values, and drafting legislation to further solidify these rights" [8]. Their website is set up to take parents step-by-step through the exemption process [9]. Dr. Andrew Wakefield, whose outspoken views and writings alleging links between autism and the measles-mumps-rubella (MMR) vaccine have been refuted by the scientific community [10,11], also now resides in Austin, according to The New York Times [12]. Both Texans for Vaccine Choice and Wakefield are heavily promoting the 2016 documentary "Vaxxed: From Cover-Up to Catastrophe, " which was directed by Wakefield and alleges links between vaccination and autism and a cover-up by the US Centers for Disease Control and Prevention (CDC) [13].
In 2015, a study in The Journal of the American Medical Association (JAMA) of a large sample of privately insured children, comprising more than 95,000 children with older siblingsincluding 994 (1%) diagnosed with autism spectrum disorder (ASD) and 1,929 (2%) with older siblings with ASD-found "no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD" [14]. Similarly, in that same year, a large case-control study in Japan investigating the relationship between the risk of ASD onset and early exposure to MMR or thimerosal (a mercury-based preservative used in vaccines) also found no link [15], while a 2014 evidence-based meta-analysis of five cohort cases including more than 1.2 million children and five case-control studies including 9,920 children similarly found no relationship between vaccination and autism, nor any relationship between autism and MMR, thimerosal, or mercury [16].
As both a Texas-based research scientist developing vaccines to prevent poverty-related neglected diseases [17] and as a father of an adult child with autism [18], I am also intrigued by data indicating that the neurobiological changes in children with ASD begin early in pregnancy, well before vaccinations are given [19].
Despite the evidence base refuting links between vaccines and autism, as well as a lack of plausibility for such links, the numbers of vaccine exemptions for reasons of conscience continue to increase. We're at the point at which I believe we might soon see a return of measles outbreaks, possibly far larger than the one that affected a megachurch in Tarrant County, Texas in 2013 [20]. Given that measles peaks in late winter or early spring [1], I predict measles outbreaks in Texas could happen as early as the winter or spring of 2018. Sadly, the Texas anti-vaxxer movement has become conflated with fringe political elements to create a dangerous and toxic mix of pseudoscience and conspiracy theories. This is now manifesting as a powerful yet misleading, propaganda-filled film documentary, together with an emboldened PAC designed to influence the Texas State Legislature towards anti-vaccine platforms. I worry that, as the most second-most populated state in the US, Texas is seen as a battleground for the anti-vaxxer movement.
But future measles outbreaks in Texas and possible measles deaths are not inevitable. In California, faced with measles outbreaks in Marin and Orange counties, the State Legislature made the bold move of closing loopholes that allow for nonmedical exemptions to vaccines [21]. This measure could prove to be lifesaving in the coming years. We now need to enact something similar for the children of Texas in order to prevent imminent deaths from measles and other vaccine-preventable childhood diseases.