Texas advocates were prepared to seize the moment

Federal health authorities, headed now by U.S. Health Secretary Robert F. Kennedy Jr., are embracing vaccine hesitancy in a way they never have before.

In the nearly six months since being appointed by President Donald Trump, Kennedy has fired the full vaccine advisory committee, substantially changed COVID-19 vaccine guidance and pledged to investigate the childhood vaccine schedule.

Kennedy’s actions have given new stature to a national effort that has found particularly solid footing in Texas: the self-titled medical freedom or medical liberty movement. At the core of that movement is a rejection of government-mandated—or government-recommended—vaccinations, including the COVID-19 vaccine and tried-and-true vaccines such as the childhood shots that protect against measles and polio.

Kennedy and the federal government don’t actually decide most vaccine policy. But because of the health secretary’s prominence, his opinion carries weight with the state politicians who do make the policies.

“I couldn’t have asked for anything better,” said Nina Miller, an Austin-based healthy food blogger who’s skeptical about public health guidance around vaccines, referring to Kennedy’s appointment. “I feel like there could not be a better person for that role.”

Texas anti-vaccine advocates, already sailing hard against public health standards they see as government interference, were pre-positioned to take advantage of the newly favorable winds. If their work is successful, Texas could emerge as a national leader in the movement, providing a blueprint for vaccine opponents in other states.

Public health experts see potential for harm in the movement’s anti-vaccine work, which could set back decades-long efforts to curtail the spread of certain diseases.

Texas’ massive measles outbreak, which started up and wound down almost exactly in line with the legislative calendar, seems to have done little to stem the tide of medical freedom legislation. During the 2025 regular session, state lawmakers pushed through several bills that have long been priorities of the movement, including making it easier for parents to opt their children out of school-mandated vaccines.

To attribute those shifts to Kennedy alone would be to overlook years of groundwork by anti-vaccine advocates in Texas.

“Did Bobby amplify our voices? Yes,” said Jackie Schlegel, the founder of Texans for Medical Freedom. “But none of it would have been possible if we hadn’t been in that building the last 10 years, educating and advocating.”

It’s not just the anti-vaccine advocates themselves who are claiming credit. Vaccine proponents say the same thing: Kennedy has stepped into power in the greater context of anti-vaccine activism that accelerated during the COVID-19 pandemic.

“He just didn’t reappear on the scene in a vacuum,” said Dr. Peter Hotez, a vaccine expert at Baylor College of Medicine. “Now, Mr. Kennedy can come back in and it’s already a well-oiled, well-greased machine.”

While medical freedom advocates and sympathetic lawmakers celebrate their wins, public health experts worry the emphasis on personal liberty will cost lives.

Hotez said outbreaks of vaccine-preventable illnesses, such as the measles outbreak that started in West Texas earlier this year, will become increasingly common if childhood vaccination rates continue to drop.

“This will become sort of a new normal,” Hotez said. “And not only measles. Measles is usually the first thing you see because it’s so highly transmissible, but the others will follow.”

Less than six months into Kennedy’s role as health secretary, Texas is already becoming an example of how much can change when federal leadership gives new credence to what some consider fringe groups. And those groups have no plans of letting this moment pass them by.

The work already done

Some of the most high-profile medical freedom advocates in Texas have been doing their work for more than a decade.

In national and Texas media, they’ve described their 2015 selves as the “mad moms in minivans,” painting a picture of grassroots advocacy that was given short shrift by Texas politicians.

Whether they’ve been taken seriously politically or not, there is no debate that anti-vaccine voices are in the minority among the general public, particularly when it comes to childhood vaccines.

Statewide vaccination data indicates that, for the 2024-2025 school year, just over 93% of Texas kindergartners had received both doses of the measles-mumps-rubella vaccine. The vast majority of parents are thus opting in for standard childhood vaccines. However, the number of children without standard vaccinations has grown across the state and country in recent years.

While anti-vaccine and vaccine-hesitant parents are still in the minority, a small percentage can have a big impact on a community’s health. For measles, for instance, about 95% of a population needs to be vaccinated or have survived a previous infection in order for the community to have widespread protection.

Texas schools as a whole have dipped below that herd immunity rate for measles, and some specific communities have fallen far below that threshold. At Fort Worth’s Mercy Culture Preparatory, where the affiliated pastor has celebrated the low vaccination numbers, the measles-mumps-rubella vaccination rate is 14%.

That level of vaccine opt-out, even in relatively small pockets, doesn’t happen overnight. It’s a process that has felt, to some anti-vaccine advocates, painfully slow.

The movement gained speed during the COVID-19 pandemic, which brought issues such as masking and vaccine mandates to the forefront of public consciousness. With Kennedy now elevating anti-vaccine sentiment, though, the moves have accelerated again.

During this year’s legislative session, medical freedom advocates scored some significant wins, including the passage of a bill that will make the vaccine opt-out form available online. That will give parents easier access to the form, which previously had to be requested and sent through the mail.

Rep. Steve Toth, R-Conroe, said it was significantly easier to pass medical freedom legislation this year compared with previous years, a shift he attributed in large part to disillusionment that grew out of the COVID-19 pandemic and vaccine rollout.

“People are like, ‘Yeah, we need freedom,'” Toth said. “Because basically we got this damn jab shoved down our throat and it wasn’t everything everybody said it was going to be.”

The Dallas Morning News reached out to five additional state lawmakers who have authored or supported medical freedom legislation. Those five lawmakers either did not respond or were not made available for comment.

As public health skeptics ride the wave of support, there could be more changes still to come.

Rekha Lakshmanan, chief strategy officer at the Texas-based pro-vaccine organization The Immunization Partnership, felt the acceleration in Austin this year.

“There’s this attempt to chip away, chip away and chip away,” Lakshmanan said. “And then when they’ve got the cover from leadership at the federal level, then it’s sort of like gloves have come off.”

Looking to the future

Michelle Evans, the political director of Texans for Vaccine Choice, sees the shifts at the federal level as “a sea change.” And Texas medical freedom advocates have no intent of letting their sails down now.

Both medical freedom advocates and vaccine proponents are split on whether Texas is already a trendsetter on actual anti-vaccine policy. But they agree the state has a robust anti-vaccine engine with a fierce and well-connected advocacy arm, particularly in Texans for Vaccine Choice.

Because of that, it’s likely that anti-vaccine folks in at least some other states will look to Texas as a template. And that means that, just as the changes at the federal level impact Texas, the changes in Texas also matter for the rest of the country.

“Texas is a large state. It definitely serves as a tipping point, which means that there’s a lot of responsibility on both sides,” Lakshmanan, at The Immunization Partnership, said. “I do really think that what we start to see happen here in this state can impact other states as well—good, bad or indifferent.”

When Evans, at Texans for Vaccine Choice, imagines the Texas she wants to see in a few years—with the acknowledgment that big changes take time—she hopes vaccination will have become a fully private issue.

“I would love for my vaccination status, your vaccination status, every Texan’s vaccination status to be completely irrelevant to their participation in society,” she said. “So nobody feels like they have the right to ask you what your vaccination status is.”

With the momentum her movement has, Schlegel wants to see the full unwinding of all vaccine mandates: on college campuses, in workplaces, for health care workers.

“We’re going to continue to advocate to ensure that these decisions are left to you and your chosen medical provider,” Schlegel said, “and not these bureaucratic entities who are dictating what field you can go into or the workplace.”

If there’s a short list of places where the medical freedom vision could come to pass, Texas is on it.

A tug-of-war

The problem with the medical freedom movement’s vision, according to public health experts, is that vaccination is not just an individual decision. Instead, each person’s decision also affects their community.

That’s because vaccination for many illnesses only works if the vast majority of people are vaccinated. If there are some people who are not vaccinated, an illness can still take root in a community.

That would put people who cannot get vaccinated at particularly high risk, including babies, pregnant women or people who are immunocompromised.

“Do you have a responsibility to vaccinate yourself in the midst of an epidemic, to protect not only yourself, but those with whom you come in contact? Yes, you do,” said Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia. “But the medical freedom movement says, ‘No, you don’t.'”

Evans said she doesn’t share the concerns about the public health impacts of her movement. She acknowledged that she isn’t a scientist or public health expert, but also questioned whether vaccination really works and said she feels the science “is not 100% settled.”

Miller—the Austin-based healthy food advocate who runs a blog called Good Food Fighter and was active in Kennedy’s presidential campaign—similarly brought up concerns about ineffective vaccines, as well as vaccine injuries, both of which she said are understudied.

Those arguments—that vaccines might not be effective and that vaccines may cause harm—are central to anti-vaccine messaging.

The arguments seize on rare cases of injury, public health experts note, and point to slivers of the population for whom some vaccines are less effective. But more importantly, experts say, those assertions ignore the bigger picture of vaccines’ role in wiping out illness on a global scale.

A study led by the World Health Organization found that, across the world over the past 50 years, vaccinations have saved more than 150 million lives. More than 100 million of those lives were infants, according to the study, and the measles vaccine alone accounted for 60% of the infant lives saved.

In the U.S., the evidence of the measles vaccine’s efficacy is in younger generations’ lack of familiarity with the illness.

Before the vaccine was rolled out in the 1960s, nearly every child in the country caught measles by the age of 15. Widespread vaccination led to the illness being declared eliminated in the U.S. in 2000—taking measles from a rite of passage to a relative rarity.

Now, with measles vaccination rates dropping, outbreaks are again cropping up.

Schlegel, when asked the same question about the public health impacts of the medical freedom movement, pointed to the ideal of personal liberty. She sees that, she said, as a higher issue.

“What concerns me is we have a run-amok government that believes that they are best-suited to make these decisions,” Schlegel said. “We are always going to stand with the parents and the individuals. … We live with the consequence of that decision, therefore, we must be the ones to ultimately decide whether a medical procedure is right or wrong.”

Travis McCormick, a legislative consultant and the founder of Make Texans Healthy Again, similarly did not deny the public health rationale. Instead, he sees a larger concern.

“I understand the argument for herd immunity,” McCormick said. “But I think at the end of the day, a parent’s priority is their own child, and that should be respected.”

That is the crux of the tension: While public health experts push for collective protection, medical freedom advocates pull for individual rights.

Texas’ medical freedom movement has gained ground in the tug-of-war, with wins at the state Legislature and bolstered by the support of a prominent federal figure. The question now is whether the movement’s leaders can keep those wins coming and make Texas into a national example—for better or for worse.

2025 The Dallas Morning News. Distributed by Tribune Content Agency, LLC.