In early February, Texas health officials reported that measles was spreading among an insular religious community in Gaines County, Texas, where nearly 14 percent of schoolchildren have an exemption (granted in some states for reasons of conscience, including for religious beliefs) from the required childhood vaccinations. The disease has since been detected in a bordering New Mexico county. And this week, the case count grew to at least 99 people. Last year, the US saw 285 measles cases nationwide the fourth-highest total since 2000. The outbreak has escalated and will likely soon exceed 100 cases, just as the USs foremost vaccine skeptic, Robert F. Kennedy Jr., has ascended as its top health care official.Kennedy promises to probe the safety of childhood vaccines, and in his first actions as the new US Health and Human Services (HHS) secretary, Kennedy has already put vaccine advisory meetings on indefinite hold. He has helped cultivate a culture of skepticism toward medical science as the most prominent voice promoting a debunked link between childhood vaccinations and autism and other health issues a view that corresponds to the re-emergence of measles over the past decade.Kennedy is no longer an outside agitator but the government official ultimately responsible for squashing public health threats in the US. So far, he has not commented on the Texas outbreak. But what happens next will be the first big test case for how Kennedy will lead the US health department during an active public health emergency. How would the response to an outbreak normally look? When there is a disease outbreak that requires government action (i.e., not your standard sniffles), local governments are the first responders. County officials are typically the first to receive reports of a disease spreading and they will start ramping up testing and other kinds of surveillance to assess the situation. That was what happened in Texas: One Gaines County school district reported the first measles to their local community in late January. Within a week, the Texas state government stepped up once the outbreak had climbed to six cases, and began providing support for the local response. Thats also typical: While local authorities are on the front line, the state provides technical expertise, they may offer funding for communication and interventions (such as vaccine drive-throughs), and they otherwise serve as the top authority on how the response should be handled. The feds usually stay in the background with an outbreak the size of the current measles occurrence. They can offer expert or laboratory support, for example. But otherwise, they are supporting players, unless the outbreak poses a unique threat to the rest of the nation or becomes a large multi-state crisis. For now, the current outbreak is limited to a small geographical region, and the states appear well aligned on how to respond. But it is possible that further spread could demand federal officials get more involved a development that would be worth watching closely, given its new leadership.The good news: So far, RFK Jr.s HHS isnt complicating the response.The outbreak was already underway before Kennedy was confirmed and, though its easy to forget after the pandemic, local authorities are taking the lead as they should. Texas health officials and their counterparts in New Mexico, now that cases have begun to spread there have set up mobile vaccination and testing sites, encouraging unvaccinated people to get their shots now. Because local officials are among the community they serve, they may be considered more trustworthy (and in turn they can ultimately be more effective).If those efforts are allowed to continue unencumbered, that will be a hopeful sign that the RFK-led health department will not actively sabotage public health efforts when there is an acute crisis underway. After some observers pointed out that the CDC measles tracker had not been with the new outbreak, the web page was refreshed on Friday with a pledge to continue updating it every Friday. So far, there is no sign that local officials have requested support from the federal government and been denied it.Not exactly. Such outbreaks are still relatively rare and, when they do occur, they usually stay localized. But America is trending in the wrong direction when it comes to this ancient disease, which can cause painful skin rashes and be deadly for young unvaccinated children.The US declared measles eliminated in 2000. But it has regained a foothold as vaccination rates have dropped. In 2019, there was the largest outbreak in decades when more than 1,200 people became ill, mostly in New York. Now nearly 100 individuals are sick along the border of Texas and New Mexico larger than any outbreak last year and it is still only February.Nationally, the measles vaccination rate has slipped just below the 95 percent target that experts say is necessary to maintain population-level immunity. In some states, the situation is more dire: 14 states had vaccination rates below 90 percent for the 20232024 school year, per the health policy think tank KFF. But in individual communities, rates can slip even lower, creating the right conditions for an outbreak to explode; measles, after all, is one of the most contagious diseases known to man. In the Gaines County school district most affected by the outbreak, the vaccination rate is under 50 percent.The vast majority of Americans still believe the measles vaccine is safe and effective, and its benefits outweigh any risks. But as our collective faith in science deteriorates, vaccination rates are also declining.See More: