As Measles Cases Surge, Texas School Data Reveal Hidden Gaps in MMR Vaccination Coverage

School vaccination rates may help signal measles outbreaks, according to findings from researchers at the University of Maryland Center for Vaccine Development and Global Health in Baltimore. They urge public health systems to look beyond the state and county level to focus on vaccination rates against measles, mumps, and rubella (MMR) in at-risk school districts and schools.

"Schools play a pivotal role in driving outbreaks,” the researchers wrote, “serving as prime environments for infectious diseases like measles due to the proximity and social interaction among school-aged children.”¹

The data underscore epidemiologic gaps and the social and behavioral drivers behind them. Low coverage in certain schools may reflect barriers beyond access—such as mistrust in health authorities, misinformation spread online, or hesitancy fueled by past controversies surrounding vaccines like MMR.

The Study and Findings

The UMC researchers mapped Texas kindergarten MMR vaccination coverage at both the county and school district levels rather than relying solely on county-level data. County-level statistics often mask a deeper level of variation, especially at an individual school level.¹

In addition to public school districts, they also assessed private school locations, using school-specific data from the Texas Annual Report of Immunization Status of Students—a survey completed by schools based on student health records.¹

"Mapping reveals that school districts and private schools with alarmingly low vaccination coverage are often located within counties where the overall coverage meets or approaches the 95% target," the researchers explained.¹

When comparing county-level vaccination coverage to individual schools, the data revealed substantial within-county variation—for example, overall coverage of 82% in Gaines County encompassed school-specific rates ranging from 46.2% to 94.3%, while Terry County’s 95.5% countywide coverage masked school-level rates spanning 46.2% to 97.1%.¹

In response to these findings, the researchers urge a more comprehensive public health response that both combats vaccine misinformation and improves access to vaccination. They advise compassionate, non-judgmental counseling when educating and informing parents when discussing vaccination. In-school programs may also help increase touchpoints for care and make access to vaccination information more convenient.¹

“By taking these steps to raise MMR coverage,” the researchers concluded, “particularly in schools where it is dangerously low, we can deprive measles of the vulnerable hosts it requires, bring this prolonged outbreak to a conclusion, and ensure any future outbreaks are swiftly contained.¹

Controversy Surrounds the MMR Vaccine

Measles rates reached an 25-year high in 2025, rising to 1563 cases (as of October 8, 2025) across over 35 states. The outbreak originated in the South Plains region of Texas, where vaccination rates are traditionally low. In the 2025 outbreak, unvaccinated individuals account for 92% of all reported measles cases.²

Despite the well-established efficacy of the MMR vaccine—marked by the eradication of the disease in the United States in 2000—the medical community, health care institutions, and public health systems are on the receiving end of misinformation, disinformation, and growing skepticism. This is observed through the actions of the Advisory Committee on Immunization Practices (ACIP), who voted to restrict access to critical vaccines against COVID-19, hepatitis B, and MMR.^3-5 The committee also recommended and is calling for the separation of the combined MMR vaccine, particularly for children under the age of 4.

Experts warn of various consequences of separating and/or delaying childhood vaccinations. Furthermore, MMR vaccine manufacturers report that there is no established evidence that supports separating the combined vaccine. Doing so would require initiation of new saline placebo-controlled clinical trials,⁶ which was cited as “incredibly unethical” by Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, who also says these trials would be unlikely to be approved by ethics and regulatory boards.⁶

“You would be exposing, basically, infants to potentially lethal diseases,” she said. “Those trials won’t happen.”⁶

An additional concern raised by the manufacturers and other health experts is cost, as combination vaccines play a critical role in making vaccination easy and affordable. Thereby impacting vaccination rates and compromising herd immunity.⁶

“For herd immunity—or community immunity—we generally look for about a 95% vaccination rate,” Crystal Hodge, PharmD, BCIDP, BCPS, said in an interview with Pharmacy Times. “We understand that not everyone can be vaccinated, since the MMR vaccine is a live vaccine and not appropriate for certain individuals. But to protect the greatest number of people, the community vaccination rate needs to be around 95%.”⁷

As policymakers and health officials work to rebuild public confidence in vaccines, the data remind us that addressing coverage gaps requires understanding the communities behind them.

Pharmacists, who often serve as the most accessible health care touchpoint, remain central to these efforts through patient education and vaccine advocacy. Ultimately, curbing the resurgence of measles will depend on both clear communication and coordinated action to restore trust in one of the most effective vaccines ever developed.

REFREFENCES

1. Fitzpatrick M, Wells C, Pandey A, et al. School-level gaps in MMR coverage as the fuel for measles outbreaks. Annals of Internal Medicine. October 7, 2025. Accessed October 10, 2025. Doi:10.7326/ANNALS-25-0161

2. Measles Cases and Outbreaks. CDC. October 8, 2025. Accessed October 10, 2025. https://www.cdc.gov/measles/data-research/index.html

3. Gerlach A. Measles outbreak in west Texas marks largest surge in 30 years. Pharmacy Times. February 27, 2025. Accessed October 10, 2025. https://www.pharmacytimes.com/view/measles-outbreak-in-west-texas-marks-largest-surge-in-30-years

4. Halpern L. ACIP meeting: Combined MMRV vaccine, hepatitis B vaccine restricted for some age groups. Pharmacy Times. September 19, 2025. Accessed October 10, 2025. https://www.pharmacytimes.com/view/acip-meeting-combined-mmrv-vaccine-hepatitis-b-vaccine-restricted-for-some-age-groups

5. Halpern L. ACIP meeting: COVID-19 vaccines to be administered through shared clinical decision-making. Pharmacy Times. September 19, 2025. Accessed October 10, 2025. https://www.pharmacytimes.com/view/acip-meeting-covid-19-vaccines-to-be-administered-through-shared-clinical-decision-making

6. Schreiber M. Alarm as CDC calls for separate MMR vaccines despite measles outbreak. The Guardian. October 9, 2025. Accessed October 10, 2025. https://www.theguardian.com/us-news/2025/oct/09/cdc-separate-mmr-vaccines

7. Gerlach A. Measles outbreak update, Florida Surgeon General announces plan to remove vaccine mandates in schools. Pharmacy Times. September 10, 2025. Accessed October 10, 2025. https://www.pharmacytimes.com/view/measles-outbreak-update-florida-surgeon-general-announces-plan-to-remove-vaccine-mandates-in-schools