The wrong suspects
Measles cases this year are more than twice last year's. Texas is investigating the pediatricians who vaccinate children, and the children who depend on those doctors will pay.
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read by an AI voiceAmerica had confirmed 4,852 cases of measles this year by Oct. 29, according to the Centers for Disease Control and Prevention. That is more than twice the total for 2025 and more than three times that of 2019, which the agency said had the most cases in a single year since 1992. Pennsylvania alone has confirmed nearly 1,500. The CDC counts three deaths nationally, fewer than Pennsylvania reports on its own, and says the number may change. A regional health commission is due to decide this month whether the United States keeps the measles elimination status it has held since 2000.
Last December a pediatrician who has treated children in central Texas for 20 years received a letter from the attorney general's consumer protection division. It demanded ten years of her vaccine purchase records, The New York Times reported. It also wanted her vaccine policy, and said citing the CDC's schedule would not be sufficient. It asked her not to tell others, because the request "relates to an ongoing confidential investigation that would be jeopardized and impeded by disclosure." Answering it had cost her nearly $15,000 in legal fees by October, and sent her digging for receipts for $18 vaccines given a decade ago. The Times used only her middle name, Rachel, to protect her from retaliation. She has begun to reconsider whether to keep practicing. That letter will hurt children. Investigating the doctors who vaccinate, in the two worst measles years in more than three decades, pushes doctors and families away from the vaccine that stops the disease.
Ken Paxton, Texas's attorney general, has given his reasons. They deserve a hearing. In January his office announced an inquiry into whether pediatric practices, insurers, vaccine makers and others engaged in "deceptive or unlawful conduct by failing to disclose financial incentives connected to their administration of childhood vaccines." "Doctors' wages, bonuses, and even employment often hinge on the number of vaccinations they administer," it said, and children are being "expelled from pediatric practices and denied medical care based on their vaccination status." Texans, Mr. Paxton said, deserve "full faith in the recommendations of their medical providers." In August he opened a second inquiry, into the American Academy of Pediatrics, whose top corporate donors, his office said, are drug companies that would lose money if the CDC's revised schedule recommended fewer vaccines. Recommendations should be driven by science, he said, "not by financial gains or bribes from Big Pharma." Mr. Paxton lost the Nov. 3 election for the United States Senate to James Talarico, in a race the Associated Press called that night.
Parts of that are fair. Parents are entitled to know whether money shapes medical advice. Some insurers pay doctors for quality care, which can include vaccinating children. A child turned away from a practice is harmed too. Neither problem needs ten years of receipts, or a request for silence. But the office's own words reach further than disclosure. Its January release describes a scheme that has illegally incentivized doctors to recommend childhood vaccines "that are not proven to be safe or necessary." That is a claim about the vaccines, not the money. And the money is thin. Pediatricians call the incentives nominal. They buy vaccines up front, then haggle with insurers to be repaid. In a 2007 survey of a random sample of 1,280 pediatricians and family physicians, about half of those who answered said their practice had put off buying some vaccines for financial reasons in the previous three years. One in nine said it had seriously considered, in the previous year, whether to stop vaccinating privately insured children altogether.
Mr. Paxton's line about full faith is the right test. Vaccination runs on the faith he says Texans deserve, and that faith is thin. In a survey of more than 440,000 American adults, the share who trusted physicians and hospitals a lot fell from about seven in ten in April 2020 to four in ten by January 2024. Those who trusted more were far more likely to report a flu shot or a COVID vaccine. The survey was of adults, and it shows an association rather than a cause. Still, a state that hints to parents that their pediatrician takes bribes spends the little faith that is left. Neither the January release nor the August one mentions measles.
Texas knows the cost. Last year's West Texas outbreak ran to 762 cases and put 99 people in the hospital. Two school-aged children died. Neither had been vaccinated. Neither had a known underlying condition. Nationally, measles vaccine coverage among kindergartners has slipped from 95.2% to 92.4% in six school years, leaving about 280,000 of them at risk. A pediatrician who quits, or stops stocking vaccine, is one fewer door a family can walk through. A parent who wonders what the doctor is paid will be slower to say yes.
The office can keep its question and still stop most of the harm. It can say how many practices it has written to and what it has found, and lift its request for silence from small practices. Insurers can publish what their quality incentives pay for vaccinating each child. If the sums are as small as pediatricians say, that answers the charge against insurers. If not, parents should know. Health systems that employ pediatricians can say whether any doctor's pay or job depends on how many shots are given. That is the office's own charge.
The Times's story opens on a bustling Monday morning in Rachel's office. She was delighted when a woman she had cared for as a child came in with a newborn. The CDC counts measles every week. It has no column for the shots that were never given. In Pennsylvania, of 1,467 confirmed cases this year, five were in people who had been vaccinated.
- Measles in the United States, 2026 and 2025The CDC's measles page, updated Oct. 30, 2026, says that as of Oct. 29, 2026, 4,852 confirmed measles cases were reported in the United States in 2026: 4,834 from 47 jurisdictions and 18 among international visitors. It lists 43 new outbreaks in 2026 (an outbreak is 3 or more related cases); 96% of cases (4,666 of 4,852) were outbreak-associated, 1,384 of them from outbreaks that began in 2025. It lists 3 deaths in 2026, a number it says is subject to change. For 2025 it gives 2,289 confirmed cases (2,263 from 45 jurisdictions and 26 among international visitors) and 48 outbreaks. MMR coverage among kindergartners fell from 95.2% in the 2019-20 school year to 92.4% in 2025-26, which the CDC says left approximately 280,000 kindergartners at risk.
- Earlier years, and the elimination reviewThe CDC's Morbidity and Mortality Weekly Report of Oct. 11, 2019 said the 1,249 cases reported by Oct. 1 that year were the most in a single year since 1992. The CDC's data page gives 1,274 cases for all of 2019, then 13 in 2020, 49 in 2021, 121 in 2022, 59 in 2023 and 285 in 2024. Measles was declared eliminated from the United States in 2000. The Pan American Health Organization's commission judges whether endemic transmission has been re-established, which it defines as uninterrupted circulation of the same virus genotype and lineage for 12 months or more in a specific area; for the United States the analysis period runs one year from the onset of the outbreak reported on Jan. 20, 2025. PAHO said on March 2, 2026 that the review of the United States and Mexico would take place at the commission's regular annual meeting in November 2026. Noel T. Brewer wrote in STAT on Aug. 6, 2026 that the commission would announce in November.
- Pennsylvania, and why death counts differPennsylvania's Department of Health reported on Nov. 4, 2026 that 1,467 measles cases had been confirmed across 45 counties so far in 2026, with 283 hospitalizations, 6 confirmed measles-associated deaths and 5 cases among vaccinated people; its Oct. 28 release had put the outbreak's start in late April. Reuters reported on Oct. 14, 2026 that the department had reported 1,222 cases this year, 225 hospitalizations and five measles-related deaths. Fox 29 reported that the Franklin County coroner announced on Oct. 12 the death of a 39-year-old woman on Oct. 10 and said it met the state's definition of a measles-associated death, which requires death within 30 days of symptom onset. The station reported that the CDC counts a measles death only when the National Center for Health Statistics lists measles as the underlying cause, records that can take weeks to arrive. The department's Nov. 4 release confirmed a sixth death and said its investigation had not yet found that the reported October death of a Franklin County resident met the criteria.Sources: Pennsylvania Department of Health, sixth measles-associated death and statewide update (Nov. 4, 2026), Pennsylvania Department of Health, statewide measles update (Oct. 28, 2026), Reuters via GV Wire, Pennsylvania reports 1,222 measles cases (Oct. 14, 2026), Fox 29, sixth measles-related death reported in Pennsylvania
- The West Texas outbreak of 2025The Texas Department of State Health Services announced on Aug. 18, 2025 the end of the West Texas measles outbreak. Its outbreak page, last updated Aug. 12, 2025, reported 762 confirmed cases since late January and 99 patients hospitalized over the course of the outbreak, a cumulative figure. It reported two deaths, both in school-aged children who lived in the outbreak area, and said the children were not vaccinated and had no known underlying conditions.
- The attorney general's January 2026 investigationThe office's release says the investigation will examine whether pediatric medical providers, insurance companies, vaccine manufacturers or other entities engaged in deceptive or unlawful conduct by failing to disclose financial incentives connected to childhood vaccines, and that the attorney general is issuing over 20 civil investigative demands to large medical providers, insurers and drug makers, including entities like UnitedHealthcare and Pfizer. It says doctors' wages, bonuses and employment often hinge on the number of vaccinations given, and that children are expelled from pediatric practices over vaccination status. It names no statute. The August release dates this investigation to January 2026.
- The August 2026 investigation of the American Academy of PediatricsThe office announced on Aug. 5, 2026, as KPRC and Fox 7 Austin reported that day, an investigation into the academy over concerns that it "may be promoting and recommending childhood vaccines for financial gain." It issued a civil investigative demand to determine the basis of the academy's vaccine recommendations. The release says the academy's top corporate donors are pharmaceutical companies that would suffer financially if the CDC's revised schedule recommended fewer vaccines, and that on Aug. 19, 2025 the academy published its own immunization schedule. Mark Del Monte, the academy's chief executive, said its recommendations are "rooted in decades of peer-reviewed science" and that the investigation "serves only to undermine public health." Mr. Paxton won the Republican runoff for the US Senate on May 26, 2026, Texas Standard reported.
- One pediatrician's letterThe New York Times reported on Oct. 5, 2026, in an article by Christina Jewett republished by The Boston Globe and InsuranceNewsNet, that a central Texas pediatrician, identified by her middle name, Rachel, to protect her from retaliation, received a letter in December from the attorney general's Consumer Protection Division demanding her vaccine purchase records over the past 10 years and citing possible violations of the state's deceptive trade practices law. The office later sent a follow-up to its 28-item demand, dismissing some initial responses as frivolous or improper. She said responding had cost nearly $15,000 in legal fees. The Times reported that it is unclear how many practices the investigation has contacted, that some insurers offer incentives for quality care that can include vaccinating children, which pediatricians call nominal, and that the attorney general's office did not respond to a request for comment.
- Two surveys, on the money and on trustFreed, Cowan and Clark (Pediatrics, December 2009) mailed a survey from July to September 2007 to a random sample of 1,280 US pediatricians and family physicians; response rates were 70% among pediatricians and 60% among family physicians. In the previous 3 years, 49% said their practice had delayed buying specific vaccines for financial reasons; 11% said it had seriously considered in the previous year whether to stop providing all vaccines to privately insured children. The authors concluded that large-scale withdrawal of immunization providers did not seem imminent. Perlis and colleagues (JAMA Network Open, July 2024; NIH among the funders) analyzed a nonprobability internet survey of 443,455 US adults from April 2020 to January 2024. Those reporting a lot of trust in physicians and hospitals fell from 71.5% to 40.1%, and greater trust was associated with self-reported influenza vaccination (adjusted odds ratio 5.09) and SARS-CoV-2 vaccination (4.94). Both measure what adults reported, not children's vaccination.