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In-depth reporting covering the ongoing measles outbreak in Texas.

Lessons from the last major measles outbreak in 1989: San Antonio became a national model for vaccine programs

Dr. Fernando Guerra of the San Antonio Metropolitan Health District testifying before Congress in 1991.
Screengrab
Dr. Fernando Guerra of the San Antonio Metropolitan Health District testifying before Congress in 1991.

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The West Texas measles outbreak has been labeled as the worst in more than 30 years.

To be precise, it was 36 years ago that Texas and the nation faced a historic measles outbreak. It lasted from 1989 to 1991.

"So it was a really scary time," said Dr. Julee Morrow, a pediatrician at Fort Worth’s Cook Children's Hospital at that time and now remembers what the outbreak was like.

"It was a tough time. It was a very concerning time. It was concerning for us," Morrow said. "We were trying to manage taking care of patients in the office, plus taking care of these children in the hospital. And there were lots of calls, lots of questions."

The period from 1989 to 1991 saw one of the worst measles outbreaks in the nation since the vaccine was introduced in the mid '60s.

During that time, there were over 55,000 thousand reported national measles cases and 123 measles-related deaths.

In Texas alone, 10 deaths were reported for 1989. The next year, the toll was 12 — according to a report by Dr. David Smith, the Texas health commissioner at the time.

Dr. Adam Ratner, author of “Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children's Health," said the problem was Reagan budget cuts to Carter’s immunization programs.

“Those were rolled back under Reagan, and what we saw was sadly predictable," Ratner said. "A drop in vaccination rates and then this huge multi-city and multi-state outbreak.”

President George H. W. Bush restored that funding in 1992.

Ratner said he sees that mistake Reagan made— cutting funding to vaccines—happening again now with Trump’s cuts to the CDC’s vaccine programs.

“That has got to be a politically motivated and vindictive move that doesn’t make any sense," he said.

During the 1990 measles outbreak, the hardest hit areas were inner-city, low-income communities. But the exception was San Antonio. The city’s vaccination success was noticed and in a 1992 congressional hearing, Rep. Henry Waxman asked the city’s public health director Dr. Fernando Guerra about it.

“Can you tell us why the program in San Antonio has been successful when the problems of San Antonio are so close to the problems in other areas of the country where we’ve lagged behind in getting children immunized for measles?" Wexler asked.

"Mr. Waxman I would say we have tried through the shared responsibilities in the public and the private sectors in the delivery health care system to keep immunization as a concern for the entire community," Guerra responded.

Guerra explained that San Antonio Metropolitan Health District consistently worked with the city’s hard-to-reach households and made vaccinations available wherever and whenever they could.

“We at times even do door-to door-campaigns in some of the housing projects where we have observed that the immunization rates are quite low," Guerra said.

Guerra’s relentless approach became the national model—and within a decade, measles was declared eliminated from the United States.

"I can't believe that we're doing this again," said Morrow, on watching the outbreak of 1989-1990 play out again today in Texas. “And I have a feeling that we are going to see spread for quite a while. This is something we're going to be dealing with for quite a while."

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David Martin Davies can be reached at dmdavies@tpr.org and on Twitter at @DavidMartinDavi