After COVID, Texas is less prepared for the next pandemic

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From the moment Steve Young canceled the Milam County Junior Livestock Association show, his days as county judge were numbered.

Young didn’t realize that at the time, of course. It was March 2020, a new virus was rapidly spreading around the country, and politics was the last thing this retired lawyer-turned-cattle rancher was thinking about. He was just doing what he felt needed to be done to keep the 25,000 residents of this rural county 90 minutes northeast of Austin safe.

But the blowback was intense, he said.

“People thought it was just wrong to cancel it, and this was a hoax and it was nothing worse than the flu,” he said in a recent interview. “This thing was highly politicized.”

Many in Milam County supported Young as he closed businesses, required masks and turned vacant hospital buildings into a vaccine clinic, eventually offering families $250 to get their teens the shot. But those who opposed him were loud and virulent — he received death threats, and more than one person stormed into the office to yell at him.

Young remembers getting a call from another county official who warned him he was likely costing himself a job.

“I said, ‘I understand that, but we need to do this,’” he said. “This is more important than a reelection. And if they don't like it and they want to run against me, then let them have it. In fact, if the guy wants to start tomorrow, tell him to come on.”

After two years of battling COVID-19 and the community, Young lost his seat to the former county Republican Party chair.

It’s a story that played out across Texas, in small towns, big cities and all the way up to the governor’s mansion, as elected officials and public health workers became the punching bag for an angry, fearful public unused to government restrictions. Some, like Young, were chased out of public service. Others, like Gov. Greg Abbott, walked back their early support for public health mandates.

Texas entered the pandemic at a disadvantage, with an unhealthy and uninsured population, an underfunded public health system and workforce shortages across the health care system. While some hoped the pandemic might force improvements, five years after the first Texan died from COVID, many of these long-standing issues have worsened.

Today, Texas spends less per person on public health than it did before the pandemic. Fewer Texans are getting themselves or their kids vaccinated. Local officials have less power to protect their constituents during a health crisis.

Dozens of state and local health officials, health care workers, epidemiologists and academics say the hard-earned lessons from COVID have been drowned out by a growing distrust of science, expertise and authority.

All of this leaves Texas less able and, likely, less willing to robustly respond to the next pandemic, at a time when measles and avian flu are spreading.

“A large group of people in the United States think that everyone in authority, not just the government, are stupid liars, and if you’re smart, you’ll do the exact opposite of what they tell you to,” said Dr. John Hellerstedt, who led the Texas Department of State Health Services during COVID. “This sets us up for catastrophic failure in the face of the next inevitable emergency.”

Before COVID, most people were content to ignore public health, blissfully ignorant of the machine that quietly kept them and their community healthy by investigating disease outbreaks, inspecting restaurants, treating sexually transmitted diseases and vaccinating children. The fiscal conservatives at the Texas Legislature were too, typically allocating just enough funding to keep state and local public health authorities from collapsing.

In 2020, Texas spent about $20 per person on public health, 39th among the states and Washington, D.C. Local public health agencies operated with bare bones staffing, outdated technology and reduced services. The state agency that filled in the gaps was similarly strapped. Even with constant reminders that something larger was looming — the Ebola scare in 2014, the threat of Zika in 2015, periodic outbreaks of tuberculosis — there simply wasn’t the funding or the time to meaningfully prepare for a widespread crisis.

“You're struggling to do contact tracing on outbreaks of HIV. You’re struggling to reduce maternal mortality. You’re struggling to carry out the ordinary functions of public health,” Hellerstedt said. “It was impossible to think as a government agency you’d have the time or ability to truly model something like a global pandemic response.”

In 2019, Hellerstedt came to the Texas Legislature with a prediction as ominous as it was prescient. The state’s “very, very outdated” disease tracking software was at risk of failure, he warned. Without an upgrade, it would “threaten the timeliness of public health’s infectious disease response,” the agency said in its budget request.

The Legislature appropriated $3.5 million to upgrade the technology. But it was too little, too late.

Before the agency had a chance to implement the changes, COVID hit, and decades of underfunding public health suddenly became a very expensive choice. There weren’t enough employees to do contact tracing. There weren’t clear protocols for acquiring and dispersing personal protective equipment, or setting up testing, or reporting results. And, as Hellerstedt predicted, the state’s disease tracking software quickly became overwhelmed at the moment it was needed most.

The state scrambled to build a new system on the fly, as local agencies relied on homespun trackers to monitor mounting case counts. In Cameron County, on the Texas-Mexico border, public health administrator Esmeralda Guajardo created an Excel spreadsheet and staff went in by hand to reconcile misspellings and double surnames.

“We had to piecemeal a lot of stuff because we didn't have the resources,” she said. “But we wanted to make sure that we weren’t duplicating the case counts, because, of course, that affects the trust that people have with us.”

As Guajardo quickly realized, these case counts were more than just numbers. For a panicked and increasingly restive public, their rise and fall represented hope and devastation. For government officials, the numbers offered cover for difficult decisions: Gov. Greg Abbott justified his stay-at-home orders as based on “data and doctors.”

Every time the state corrected the counts or suddenly released a backlogged deluge of positive test results, it introduced another crack in the public’s trust and willingness to comply with the rules. The longer the restrictions went on, the more that crack widened into a chasm.

“People wanted to know that if they complied, the result would get better. They didn’t want to think we didn’t have control over this,” said Mark Owens, a political science professor at The Citadel who ran the UT Tyler/Dallas Morning News poll at the time. “Everyone wanted it to go away, and when they complied and it didn’t, they got frustrated.”

Public health agencies, once behind-the-scenes workhorses, became an outlet for the public’s growing anger over business closures, nursing home restrictions, and rapidly changing guidance. In Lubbock County, health director Katherine Wells’ received death threats, requiring police to guard her house.

“We’d report the numbers and people would be so angry, saying, ‘Oh you’re just fear-mongering, you’re evil, you’re trying to pick a fight,” said former Milam County public health director Robert Kirkpatrick. “No, sir, I’m just doing my job.”

As the death toll rose in hard-hit Cameron County, the distrust began to bleed into everything the public health agency did. Guajardo watched as longtime employees left for less intense, better paying jobs that didn’t have to interface with an angry public, and she couldn’t blame them.

“We learned so much going through the pandemic, but then so much of that institutional knowledge walked out the door,” she said.

There was, initially, widespread support for mask-wearing, school closures and business shutdowns. But it didn’t take long for that moment of unity to crumble along partisan lines, as Texas’ elected officials joined the call to lift restrictions and reopen the economy.

In Texas, things came to a head in May 2020, when Dallas salon owner Shelley Luther was jailed for reopening her business in violation of the state’s shutdown orders. Luther, who is now a state representative, framed the ongoing restrictions as a violation of her personal liberties. U.S. Sen. Ted Cruz and Lt. Gov. Dan Patrick, as well as President Donald Trump, rallied to her cause.

“We have the constitutional right to be able to work to provide for our families, to pay our mortgages and I don’t feel it’s right to close us down for this long period of time,” Luther told local news outlets at the time.

Facing pressure from the right, Abbott quickly removed the enforcement mechanism from his orders and allowed some businesses to reopen sooner than expected. He later went even further, forbidding cities, counties and school districts from implementing their own mask mandates.

A group of local leaders, incensed by what they saw as an undermining of their public health authority, sued, but the Texas Supreme Court sided with Abbott, saying he had the authority to tell local officials what to do — and what not to do — during a public health crisis.

Abbott did not respond to an interview request.

Many of these policies have since been enshrined in state law. Legislators have banned cities and counties from enacting mask mandates, closing businesses or schools, or requiring COVID vaccines, and prohibited the mandatory closure of churches and gun stores during an emergency declaration. While some of these laws apply only to COVID, public health experts say the playbook and political fault lines are in place to restrict the response to future disease outbreaks, as well.

The Legislature also reined in the amount of time the state can remain under a public health disaster or emergency authorization. These declarations, intended to allow the state government to respond more nimbly to a crisis, can now only remain in effect for 30 days, after which the Legislature or a legislative committee would have to renew it monthly.

“It's just this weird, circular, extra, and I think, hindering level of bureaucracy that I am afraid is not going to be helpful for us in the next pandemic,” said Allison Winnike, a Houston-based lawyer with the Network for Public Health Law. “Our public health system will have its hands completely tied.”

Some of the post-COVID legislation has been beneficial to public health, Winnike and other experts say. Legislators created a position for a state epidemiologist, strengthened data reporting requirements and funded the Texas Epidemic Public Health Institute, which helps state and local leaders anticipate and prepare for the next pandemic.

But the state now spends less per capita on public health than it did before the pandemic, dropping down to fourth worst among states and D.C. Experts worry that the lasting distrust and disempowerment of public health will ripple through future disease outbreaks.

“I do understand that everything’s political, but public health is truly for everyone,” Winnike said. “It’s one of the basic things to have the conditions to live a healthy life and be protected from disease in your community. And I wish that was what we were bringing forward into the next pandemic.”

For years, Dr. Peter Hotez watched in horror as more and more Texas families declined to get their children vaccinated, and wondered what, if anything, would reverse this trend.

Then came the pandemic. For a brief moment, Hotez thought this might be the turning point. And it was — just not in the way he’d hoped.

“Unfortunately, it got politicized in a way that did the opposite, and has exacerbated anti-vaccine activism in the most horrific way imaginable,” said Hotez, a vaccine expert and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.

Like everything with COVID, the vaccine didn’t start out so political. “Operation Warp Speed,” the effort to quickly develop a COVID vaccine, launched under the first Trump administration. In December 2020, Abbott proudly got the shot on camera, touting how “safe and easy” it was.

But as the vaccine rolled out, and employer vaccine requirements with it, some began to chafe against what they saw as an infringement on their medical freedom. Conservatives began to coalesce around opposition to the vaccine, and by the end of 2021, Texas had sued the Biden administration at least four times over vaccine mandates for health care workers, federal contractors, large employers, and the National Guard. Texas also barred any state funds from being used to promote the vaccine.

As vaccination rates began to diverge along partisan lines, COVID-related hospitalizations and deaths did, too. By fall 2021, death rates in counties that voted for Trump were four times as high as counties that voted for Biden, Pew Research found.

In Texas, this politicized resistance created what Hotez calls the “great COVID tragedy,” the death of more than 40,000 people after vaccines became widely available, 85% of them unvaccinated. These waves of casualties did little to change opinion — by December 2022, the vast majority of unvaccinated Texans said they were not likely to get vaccinated in the next three months, and the largest percentage said nothing would make them more comfortable with the idea of getting the shot.

Hotez can understand why Texans were anxious about getting a newly developed vaccine, and resistant to mandates. But it didn’t stop there.

“In their zeal to push back against vaccine mandates, which you can kind of understand, they went to the next measure and falsely discredited the effectiveness and safety of vaccines,” he said.

Pushback to the COVID vaccine brought a deluge of new people into the anti-vaccine movement, moving this once-fringe political faction into the mainstream of the Republican party. After growing slowly for several years, the number of Texas families opting out of getting their children immunized spiked after 2020.

The consequences have been swift: Texas is currently experiencing its largest measles outbreak in 30 years, one of several vaccine-preventable conditions that’s on the rise as immunization rates drop.

“One of our hospitals has the highest number of COVID patients in the hospital right now than we’d had in probably a year,” Dr. Ron Cook, the Lubbock public health authority and a family physician, told The Texas Tribune in February. “We have the lowest uptake of flu [vaccines] and the highest flu levels. We have lower uptake of pertussis, and we have the highest level [of whooping cough] in nine years, which can be devastating, especially for little ones.”

Only 39% of adult Texans got their flu shot in 2022-2023, the lowest rate since 2017. There was a slight improvement in 2023-2024, the latest data available, but Texas remains below the national average. The U.S. is experiencing its worst flu season since 2017.

Influenza can easily mutate into something much more dangerous than the seasonal flu, especially with H5N1, or avian flu, currently spreading among animals. If avian flu mutated in a way that was widely transmissible between humans — “That’s how pandemics arise,” said Catherine Troisi, an epidemiologist at UTHealth Houston School of Public Health.

“It’s really helpful in preventing the emergence of a totally new influenza virus we haven’t seen before if people are vaccinated against seasonal flu,” she said.

This vaccine hesitancy doesn’t just increase the odds of another pandemic, Troisi said, but also how quickly we could stop it once it's here.

“Let’s say that H5N1 does become more transmissible from person to person. We probably could have a vaccine ready pretty quickly,” she said. “But would anybody take it? That’s the big question.”

When Hellerstedt looks back on Texas’ handling of an unprecedented global pandemic, he sees successes. Hospitals stayed open, staffed and largely able to keep up with increased demand. The state helped get millions of vaccines into arms. There was good communication between local, state and federal partners.

The failure, he says, was communication with the public. As guidance changed, restrictions were lifted and reinstated, and a novel vaccine was rolled out, leaders at every level of government failed to bring the public along, explaining what they knew and how they knew it and, most importantly, what they didn’t know and what might change once they figured it out.

Better communication wouldn’t have cut the number of deaths in half, he said. “But we would still have the confidence of the American people in the only institutions that have the authority and the capability and the capacity to shepherd them through an emergency,” he said. “And the loss of that is a very serious risk to our national security.”

Hellerstedt thinks Texas, under Abbott, did better than most. Unlike Young in Milam County, Abbott survived reelection, despite challenges from the right and left, and has regained some of the popularity he lost during the pandemic.

But the real test will be in Texas’ handling of the next public health crisis, which is already here.

Measles is spreading rapidly across West Texas, with well over 200 people infected over the course of 50 days and one young child dead. Based on Texas’ declining vaccination rates, the worst is yet to come, experts say.

As leaders in West Texas scramble once more to stand up contact tracing, testing and vaccine sites, and quarantine plans, they find themselves still without the resources they need to address a disease outbreak.

The state and federal government have stepped in to help, but top leaders, including Abbott, have hardly addressed the outbreak in public, let alone encouraged vaccination. Conservative Fort Worth Rep. Nate Schatzline posted a video on X lauding the low vaccination rates at his children’s school, celebrating that they “honor the wishes of moms and dads over any type of health official.”

This leaves local health officials to battle both measles and the lasting distrust of a pandemic-weary public. There’s been some increased uptake at vaccine clinics since the death was reported, Cook, in Lubbock, said, but there’s also been rampant misinformation, public resistance and even the threat of mass infection events like measles parties.

“We have plenty of vaccines, we’re figuring out the logistics, but if we can’t get people to take it, this is just going to get worse,” he said. “People forget how bad this can be … We still have COVID deaths. We still have flu deaths. And now, measles deaths.”

Unlike COVID, there’s a safe, effective measles vaccine already on the market, which will prevent this from becoming a pandemic. But, public health experts say, there will be a next pandemic at some point, possibly sooner than we realize. And no matter the crisis, be it a regional outbreak or a global pandemic, Texas will need the trust and cooperation of the public to manage it.

It’s clear from this outbreak, public health experts and front-line responders say, that trust has been tested and, in too many cases, has disappeared entirely.

“I’m afraid if we have another pandemic, it would be worse,” Guajardo said. “Not because of the pandemic itself, but because of people choosing to believe what they want.”

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