by Duaa Eldeib and Patricia Callahan, and photography by Sarahbeth Maney
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In the past six months, two babies in Louisiana have died of pertussis, the disease commonly known as whooping cough.
Washington state recently announced its first confirmed death from pertussis in more than a decade.
Idaho and South Dakota each reported a death this year, and Oregon last year reported two as well as its highest number of cases since 1950.
While much of the country is focused on the spiraling measles outbreak concentrated in the small, dusty towns of West Texas, cases of pertussis have skyrocketed by more than 1,500% nationwide since hitting a recent low in 2021 amid the COVID-19 pandemic. Deaths tied to the disease are also up, hitting 10 last year, compared with about two to four in previous years. Cases are on track to exceed that total this year.
Pertussis Cases Surged in 2024
Cases had been decreasing in the years before the COVID-19 outbreak and dropped further when schools were closed in response to the pandemic.
Source: Centers for Disease Control and Prevention.
(Lucas Waldron/ProPublica)
Doctors, researchers and public health experts warn that the measles outbreak, which has grown to more than 600 cases, may just be the beginning. They say outbreaks of preventable diseases could get much worse with falling vaccination rates and the Trump administration slashing spending on the country’s public health infrastructure.
National rates for four major vaccines, which had held relatively steady in the years before the COVID-19 pandemic, have fallen significantly since, according to a ProPublica analysis of the most recent federal kindergarten vaccination data. Not only have vaccination rates for measles, mumps and rubella fallen, but federal data shows that so have those for pertussis, diphtheria, tetanus, hepatitis B and polio.
In addition, public health experts say that growing pockets of unvaccinated populations across the country place babies and young children in danger should there be a resurgence of these diseases.
Many medical authorities view measles, which is especially contagious, as the canary in the coal mine, but pertussis cases may also be a warning, albeit one that has attracted far less attention.
“This is not just measles,” said Dr. Adam Ratner, a pediatric infectious diseases doctor in New York City and author of the book “Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health.” “It’s a bright-red warning light.”
At least 36 states have witnessed a drop in rates for at least one key vaccine from the 2013-14 to the 2023-24 school years. And half of states have seen an across-the-board decline in all four vaccination rates. Wisconsin, Utah and Alaska have experienced some of the most precipitous drops during that time, with declines of more than 10 percentage points in some cases.
“There is a direct correlation between vaccination rates and vaccine-preventable disease outbreak rates,” said a spokesperson for the Utah Department of Health and Human Services. “Decreases in vaccination rates will likely lead to more outbreaks of vaccine-preventable diseases in Utah.”
Measles Vaccination Rates in Most States Were Below Herd Immunity in 2023
Data is for school year 2013-14 through 2023-24. The CDC recommends a vaccination rate of at least 95% to achieve herd immunity, to help prevent outbreaks and to protect communities. Montana is not categorized as "below herd immunity in 2023" because the state did not report data for school year 2023-24. Source: Centers for Disease Control and Prevention Vaccination Coverage and Exemptions among Kindergartners.
(Lucas Waldron/ProPublica)
Pertussis Vaccination Rates Decreased in Most States Between 2013 and 2023
Note: Decrease means that the rate in school year 2013-14 was higher than the rate in school year 2023-24. If no data was reported for 2013-14, data from the next earliest year was used. Montana is not categorized as a state where the vaccination rate decreased because the state did not report data for school year 2023-24. Source: Centers for Disease Control and Prevention Vaccination Coverage and Exemptions among Kindergartners.
(Lucas Waldron/ProPublica)
But statewide figures alone don’t provide a full picture. Tucked inside each state are counties and communities with far lower vaccination rates that drive outbreaks.
For example, the whooping cough vaccination rate for kindergartners in Washington state in 2023-24 was 90.2%, slightly below the U.S. rate of 92.3%, federal data shows. But the statewide rate for children 19 to 35 months last year was 65.4%, according to state data. In four counties, that rate was in the 30% range. In one county, it was below 12%.
“My concern is that there is going to be a large outbreak of not just measles, but other vaccine-preventable diseases as well, that’s going to end up causing a lot of harm, and possibly deaths in children and young adults,” said Dr. Anna Durbin, a professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health who has spent her career studying vaccines. “And it’s completely preventable.”
The dramatic cuts to public health funding and staffing could heighten the risk. And the elevation of Robert F. Kennedy Jr., a longtime vaccine critic, to the secretary of the federal Department of Health and Human Services, several experts said, has only compounded matters.
The Trump administration has eliminated 20,000 jobs at agencies within HHS, which includes the Centers for Disease Control and Prevention, the nation’s public health agency. And late last month, the administration also cut $11 billion from state and local public health agencies on the front lines of protecting Americans from outbreaks; the administration said the money was no longer necessary after the end of the pandemic.
Several city and county public health officials had to move quickly to lay off nurses, epidemiologists and disease inspectors. Some ceased vaccination clinics, halted wastewater surveillance programs and even terminated a contract with the courier service that transports specimens to state labs to test for infectious diseases. One Minnesota public health agency, which had provided 1,400 shots for children at clinics last year, immediately stopped those clinics when the directive arrived, court records show.
A federal judge temporarily barred HHS from enacting the cuts, but the ruling, which came more than a week after the grants were terminated, was too late for programs that had already been canceled and employees who had already been laid off. Lawyers for HHS have asked the judge to reconsider her decision in light of a recent Supreme Court ruling that allowed the Department of Education to terminate grants for teacher training while that case is being argued in lower courts. The judge in the HHS case has not yet ruled on the motion.
But in tiny storefronts and cozy homes, at school fairs and gas stations, many residents in West Texas, near where the measles outbreak has taken hold, appear unfazed.
“I don’t need a vaccine,” one man sitting on his porch said recently. “I don’t get sick.”
“It’s measles. It’s been around forever,” said a woman making her way to her car. “I don’t think it’s a big deal.”
When asked why they weren’t planning on vaccinating their baby, a husband walking alongside his wife who was 27 weeks pregnant simply said, “It’s God’s will.”
Seminole last month. Many residents in West Texas appear unfazed by the measles outbreak.
In word and deed, Kennedy has sown doubt about immunizations.
In response to the measles outbreak, Kennedy initially said in a column he wrote for Fox News that the decision to vaccinate is a “personal one.” HHS sent doses of vitamin A alongside vaccines to Texas, and Kennedy praised the use of cod liver oil. Only the vaccine prevents measles.
About a week later, in an interview on Fox News, while Kennedy encouraged vaccines, he said he was a “freedom of choice person.” At the same time, he emphasized the risks of the vaccine.
Only after the second measles death in Texas did Kennedy post on X, formerly known as Twitter, that the “most effective way to prevent the spread of measles is the MMR vaccine.”
But even that is not the unequivocal message that the head of HHS should be sending, said Ratner, the infectious diseases doctor in New York. It is, he said, a tepid recommendation at best.
“It gives the impression that these things are equivalent, that you can choose one or the other, and that is disingenuous,” he said. “We don’t have a treatment for measles. We have vitamin A, which we can give to kids with measles, that decreases but doesn’t eliminate the risk of severe outcomes. It doesn’t do anything for prevention of measles.”
In the past, Kennedy has been a fierce critic of the vaccine. In a foreword to a 2021 book on measles released by the nonprofit that he founded, Kennedy wrote, “Measles outbreaks have been fabricated to create fear that in turn forces government officials to ‘do something.’ They then inflict unnecessary and risky vaccines on millions of children for the sole purpose of fattening industry profits.”
A spokesperson for HHS said, “Secretary Kennedy is not anti-vaccine — he is pro-safety, pro-transparency and pro-accountability.” Kennedy, the spokesperson said, responded to the measles outbreak with “clear guidance that vaccines are the most effective way to prevent measles” and under his leadership, the CDC updated its pediatric patient management protocol for measles to include physician-administered vitamin A.
Kennedy, the spokesperson added, “is uniquely qualified to lead HHS at this pivotal moment.”
Late last month, leaders at the CDC ordered staff to bury a risk assessment that emphasized the need for vaccines in response to the measles outbreak — in spite of the fact the CDC has long promoted vaccinations as a cornerstone of public health. While a CDC spokesperson acknowledged that vaccines offer the best protection from measles, she also repeated a line Kennedy had used: “The decision to vaccinate is a personal one.”
Among the approximately 2,400 jobs eliminated at the CDC was a team in the Immunization Services Division that partnered with organizations to promote access to and confidence in vaccines in communities where coverage lagged.
The National Institutes of Health, which is also under HHS, recently ended funding for studies that examine vaccine hesitancy. In early April, researchers, the American Public Health Association and one of the largest unions in the country sued the NIH and its director, Jay Bhattacharya, along with HHS and Kennedy, alleging they terminated grants “without scientifically-valid explanation or cause.” The government hasn’t filed a response in the case.
The NIH cancellation notices stated that the agency’s policy was not to prioritize research that focuses on “gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.”
“These grants are being canceled in the midst of an outbreak, a vaccine-preventable outbreak,” said Rupali Limaye, an associate professor at George Mason University who has spent the past decade studying vaccine hesitancy. “We need to better understand why people are not accepting vaccines now more than ever. This outbreak is still spreading.”
That vaccines prevent diseases is settled science. For decades, there was a societal understanding that getting vaccinated benefited not only the person who got the shot, but also the broader community, especially babies or people with weakened immune systems, like those in chemotherapy.
An investment in public health and a sustained, large-scale approach to vaccines is what helped the country declare the elimination of the measles in 2000, said Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials.
But she has watched both deteriorate over the last few months. Nearly every morning since notices of the federal funding cuts began going out to local public health agencies, she has woken up to texts from panicked public health workers. She has led daily calls with local health departments and sat in on multiple emergency board meetings.
Freeman has compiled a list of more than 100 direct consequences of the cuts, including one rural health department in the Midwest that can no longer carry out immunization services. That’s vital because there are no hospitals in the county and all public health duties fall to the health department.
“It’s relentless,” she said. “It feels like a barrage and assault on public health.”
Vaccines were available at the health department in Lubbock, Texas, last month.
More than 1,600 miles away from Washington, D.C., in Lubbock, Texas, the director of the city’s health department, Katherine Wells, sighed last week when she saw the most recent measles numbers. She would have to alert her staff to work late again.
“There’s a lot of cases,” she said, “and we continue to see more and more cases.”
She didn’t know it at the time, but that night would mark the state’s second measles death this year. An earlier death in February was the country’s first in a decade. Both children were not vaccinated.
Kennedy said he traveled to Gaines County to comfort the family who lost their 8-year-old daughter and while there met with the family of the 6-year-old girl who died in February.
He also visited with two local doctors he described as “extraordinary healers,” he said in his post on X. The men, he claimed, have “treated and healed some 300 measles-stricken Mennonite children” using aerosolized budesonide — typically used to prevent symptoms of asthma — and clarithromycin — an antibiotic. Medical experts said neither is an effective measles treatment.
State health officials have traced about two-thirds of the measles cases in Texas to Gaines County, which sits on the western edge of the state.
Seminole, one of the county’s only two incorporated towns, has emerged as the epicenter of the outbreak, with Tina Siemens acting as a community ambassador of sorts.
Seminole has become the center of the measles outbreak.
Siemens, a tall woman with glasses and a short blonde bob, runs a museum that combines the area’s Native American history and Mennonite community with traditional skills like calligraphy and canning fruit.
On a recent Tuesday, atop the museum’s dark coffee table, notes scrawled onto white paper listed the latest shipments of vitamin C and Alaskan cod liver oil.
The supplies, Siemens said, were for one of the local doctors who met with Kennedy.
As measles tears through the community, Siemens said families have to decide whether to get vaccinated.
“In America, we have a choice,” she said, echoing Kennedy’s messaging. “The cod liver oil that was flown in, the vitamin C that was flown in, was a great help.”
Tina Siemens
Dr. Philip Huang, director and health authority for the Dallas County Health and Human Services Department, is working to keep the measles outbreak from reaching his community, just five hours east of Seminole. He wrote letters to the public school superintendents and leaders of private schools that had large numbers of unvaccinated or undervaccinated students offering to set up mobile vaccine clinics for them.
“Overall, the rates can look OK,” he said, “but when you’ve got these pockets of unvaccinated, that’s where the vulnerability lies.”
Huang has had to lay off 11 full-time employees, 10 temporary workers and cancel more than 50 vaccine clinics following the HHS cuts. The systemic dismantling of the CDC and other federal health agencies, he said, will have a grave and lasting impact.
“This is setting us back decades,” Huang said. “Everyone should be extremely concerned about what’s going on.”
Across the country, pediatricians are petrified, said Dr. Susan Kressly, who serves as president of the American Academy of Pediatrics, the largest professional organization of pediatricians in the country.
“Many of us are losing sleep,” Kressly said. “If we lose that progress, children will pay the price.”
She’s carefully watching the spread of several vaccine-preventable diseases, including an increase in whooping cases that far outpace the typical peaks seen every few years. Although the whooping cough vaccine isn’t as effective as the ones for measles and protection wanes over time, the CDC says it remains the best way to prevent the disease.
Babies under the age of 1 are among the most at risk of severe complications from whooping cough, including slowed or stopped breathing and pneumonia, according to the CDC. About one-third of infants who get whooping cough end up in the hospital. Newborns are especially vulnerable because the CDC doesn’t recommend the first shot until two months. That’s why experts recommend pregnant mothers and anyone who will be around the baby to get vaccinated.
The number of whooping cough cases dropped significantly during the pandemic, but it exploded in recent years. In 2021, the CDC reported 2,116 cases; last year, there were 35,435.
The numbers this year appear set to eclipse 2024. So far in 2025, 7,111 cases have been reported, which is more than double this time last year. Cases tend to spike in the summer and fall, which adds to experts’ concern about high numbers so early in the year.
States on the Pacific Coast and in the Midwest have reported the most cases this year, with Washington leading the country with 742 cases so far, more than five times as many as at this time last year.
The Washington child who died of whooping cough had no underlying medical conditions, according to a spokesperson for the Spokane Regional Health District. The death was announced in February but occurred in November.
While Washington’s overall vaccination rate for whooping cough has remained relatively steady over the last decade at around 90%, pockets of low vaccination rates have allowed the disease to take root and put the wider community at risk, said Dr. Tao Sheng Kwan-Gett, a pediatrician and chief health officer of the Washington State Department of Health.
This is the time to strengthen the public health system, he said, to build trust in those areas and make it easier for children to get their routine vaccines.
“But instead, we’re seeing the exact opposite happen,” he said. “We’re weakening our public health system, and that will put us on a path towards more illness and shorter lives.”
Washington was one of 23 states and the District of Columbia that sued HHS and Kennedy following the $11 billion cuts, which rescinded approximately $118 million from the state. Doing so, the state said in court records, would impact 150 full-time employees and cause an immediate reduction in the agency’s ability to respond to outbreaks.
Washington’s Care-A-Van, a mobile health clinic that travels across the state to provide vaccinations, conduct blood pressure screenings and distribute opioid overdose kits, was a key element in the department’s vaccination efforts.
But that, too, has been diminished.
An alert on the department’s website cataloged the impact.
“Attention,” it began.
As a result of the unexpected decision to terminate grant funding, “all Care-A-Van operations have been paused indefinitely, including the cancellation of more than 104 upcoming clinics across the state.”
The department had anticipated providing approximately 2,000 childhood vaccines as part of that effort.
The frustration came through in Kwan-Gett’s voice. Many people think that federal cuts to public health mean shrinking the federal workforce, he said, but those clawbacks also get passed down to states and cities and counties. The less federal support that trickles down to the local level, the less protected communities will be.
“It really breaks my heart,” he said, “when I see children suffering from preventable diseases like whooping cough and measles when we have the tools to prevent them.”
Agnel Philip contributed data analysis.
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