As a measles outbreak escalated in Texas, a school nurse in Ohio picked up her phone and called the parents of a student in the building who had an exemption from the vaccine that protects people from the deadly disease.
“I’m worried about measles and I’m worried about your child,” Kate King told the middle school student’s parents, noting that a dozen cases had been confirmed in the state, a total that has since doubled. “Is there anything I can do to help you reconsider immunizing your child?”
By the end of the call, the parents had agreed to have their child receive the measles, mumps, and rubella, or MMR, vaccine at a school-based clinic earlier this month.
King repeated that routine more than a dozen times, convincing nearly all the families of students who had exemptions at World Language Middle School to vaccinate their children against measles—a disease that has sickened more than 700 people in the United States so far this year, primarily those who were unvaccinated, and killed two, marking the first U.S. deaths from measles in a decade.
King declined to disclose the precise numbers of students at her school who previously had exemptions and how many still do after her efforts, citing privacy laws. But she said just a small fraction of families declined to vaccinate their children after discussing it with her.
“I’m a pretty confident person and I’ve been a school nurse for a long time—and a nurse for a longer time—but I still kind of went into that with a little trepidation, not really knowing what would happen,” said King, who is also president of the National Association of School Nurses. “We know that parents trust not only nurses, but especially school nurses, and we also know that nonjudgmental contact with people who are vaccine-hesitant makes a really big difference. This really underscored those points in practice.”
Funding cuts complicate schools’ efforts to vaccinate students
King’s effort—a partnership with the Columbus, Ohio, health department—is one step schools and districts are taking to ensure as many children as possible are up to date on their vaccines. But nationwide, childhood vaccination rates have been declining in recent years, and there are now active measles outbreaks in six states, including Ohio.
It’s also a step some districts want to take but can’t after the U.S. Department of Health and Human Services’ abrupt cancellation of $11 billion in public health funding has hamstrung the ability of many local health departments to staff vaccine clinics.
The funds that were cut were originally allocated to states and local health departments during the COVID-19 pandemic, but have more recently been repurposed for other efforts, like immunizations and disease surveillance. The Trump administration in March eliminated the funding, and said it would “no longer waste billions of taxpayer dollars responding to a nonexistent pandemic that Americans moved on from years ago,” according to a statement from the Department of Health and Human Services. (The cuts are temporarily on hold in 23 states and the District of Columbia after they challenged them in court.)
The funding terminations are part of a broader reduction in staff and funding at the U.S. Centers for Disease Control and Prevention and HHS under Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic who has repeatedly peddled false information about vaccines, including during the ongoing measles outbreak.
For some communities, including in states that have secured a pause on the funding cuts, the decision to cut federal health funding has had immediate consequences, as they’ve had to abruptly cancel dozens of vaccination clinics slated to immunize hundreds of children and community members.
A mobile health clinic in Yakima, Wash., that provides school-based clinics canceled 35 of its upcoming clinics, during which it planned to provide more than 2,000 childhood vaccines, 900 COVID-19 shots, and 500 flu vaccines, according to a post on its web page.
Amy Norton, the Yakima school district’s director of health and wellness, said in an email that the district was notified at 6:30 p.m. on March 26 that the mobile health clinic was suspending operations, the night before a clinic was scheduled at the district’s wellness center. Three additional clinics scheduled for April through June were canceled.
“YSD is currently in contact with local health providers to find a way to provide additional resources and options for families in the Yakima Valley,” Norton wrote.
More than 50 planned clinics in Dallas County in Texas—about five hours east of the epicenter of the current West Texas measles outbreak—were suddenly canceled in April due to the funding cuts. Many of the vaccination clinics were scheduled at schools and in areas with low immunization rates, according to Newsweek.
“There are people, especially in underserved, rural, hard-to-access areas who right now, even if they want to get a vaccine, do not have the access to do so,” King said. “That is something I am very, very worried about.”
Measles is a highly contagious, but preventable, illness that was at one point eradicated in America due to high vaccination rates but has resurfaced in recent years as vaccination rates have dipped. Measles can cause fever, cough, runny nose, and a rash that spreads from the head to the rest of the body. It can lead to serious short- and long-term complications, including pneumonia and encephalitis.
Childhood vaccination rates have been declining
School-based vaccination clinics are a proven strategy for increasing vaccination coverage among children and adolescents—which can reduce the spread of diseases in the broader community.
Providing the services at school means parents don’t have to take time off work to take their kids to the doctor or clinic for shots—they can sign a waiver and the child can be immunized during the school day without missing much, if any, class time. A school is also a trusted and familiar place for many families, increasing the likelihood they will agree to the shots, King said.
At her school in Columbus, the importance of the extra effort to vaccinate students is particularly acute, as about half of students are new to the country when they enroll.
Different countries may have different childhood vaccination schedules, King said. More commonly, families don’t have access to their children’s vaccination records before they leave their home countries, meaning they often have to redo certain vaccines to have official records they can submit to schools.
All 50 states have vaccine requirements for children entering school, though nearly all allow parents to opt their children out of those vaccines for personal and religious reasons.
Overall, childhood vaccination rates in America are on the decline.
In the 2023-24 school year, vaccination coverage among kindergartners in the United States decreased across all reported vaccines from the year before, while exemptions from one or more vaccines among kindergarteners increased to 3.3 percent from 3 percent the year prior. Exemptions increased in 40 states and the District of Columbia, with 14 states reporting exemptions exceeding 5 percent of kindergarteners for one or more vaccine.
Some 92.7 percent of kindergarteners in 2023-24 had received the MMR vaccine, down from 95.2 percent in 2019-20, with wide variability from community to community. The CDC recommends striving for 95 percent vaccination coverage to minimize the chance of measles outbreaks and achieve herd immunity.
“People choosing not to get vaccinated is one thing,” King said. “But when we now are moving toward people who want to have their children vaccinated and can’t, we’re really taking away their access to health care for their children. That is very, very scary and very concerning.”
