AUSTIN, Texas (AP) — Texas this year has been the center of the nation’s largest measles outbreak in more than two decades, as a mostly eradicated disease has sickened more than 700 in the state, sent dozens to hospitals and led to the death of two children who were unvaccinated.
But even as the outbreak slows, a bill approved by state lawmakers and sent to Republican Gov. Greg Abbott would make it significantly easier for parents to enroll their children in school without standard vaccinations for diseases such as measles, whooping cough, polio and hepatitis A and B.
Supporters say the bill streamlines an already legal exemption process that allows families to avoid vaccines for reasons of conscience, religious beliefs or medical reasons. It would let them download the required forms from a website instead of contacting state health officials and waiting for one to come in the mail.
The bill does not change which vaccines are required. However, critics say easing the exemption process opens a door to further outbreaks with potentially deadly results.
“If this bill becomes law, Texas is likely to see more illness, more death and higher health care costs for families and business,” Rekha Lakshmanan, chief strategy officer for Texas-based nonprofit Immunization Project, told state senators before the bill won final approval.
“The outbreak (in Texas) is not a coincidence. It is the canary in the coal mine screaming at the top of its lungs,” she said.
The exemption bill — as well as other bills passed by the Texas House on lawsuits against vaccine makers and removing immunization restrictions on organ transplants — are a snapshot of efforts across dozens of conservative states to question vaccines or roll back requirements.
At the national level, this wave has been buoyed by still-lingering pushback from the COVID-19 pandemic and the Trump administration’s embrace of Robert F. Kennedy Jr., who was one of the nation’s leading anti-vaccine advocates before being appointed secretary of the U.S. Health and Human Services Department.
The most recent federal data shows U.S. kindergarten vaccination rates have dipped since the pandemic — 92.7% in the 2023-24 school year compared to 95% before COVID-19 — and the proportion of children with exemptions rose to an all-time high. And last week, the “Make America Healthy Again” federal report on the nation’s health and wellness questioned the necessity of vaccine mandates for schoolkids.
The national Association of Immunization Managers, an organization of state and local immunization officials, has been tracking nearly 600 vaccine-related bills across the country in 2025, and the majority would not be considered pro-vaccine, said Brent Ewig, the group’s the group’s chief policy officer.
“We saw a spike in vaccine-related bills during the pandemic. The last few years it had been tapering off. With recent actions at the federal level, there has been a spike again,” Ewig said.
The Texas measles outbreak and vaccine requirements
Measles has been considered eliminated from the United States since 2000. The Texas outbreak started in late January in West Texas’ Mennonite communities that have been resistant to vaccines and distrustful of government intervention, and the highly contagious virus quickly jumped to other places with low vaccination rates.
Like many states, Texas requires children to obtain vaccines to protect against 11 diseases to attend public and private schools and child care centers. The state’s vaccination rates for the 2023-24 school year ranged between 93.78% for chicken pox to 95.78% for hepatitis B.
But parents can obtain exemptions for religious or personal reasons, or if a doctor determines it would not be safe because of a medical condition.
Exemption rates in Texas have been rising for nearly two decades, with a dramatic spike over the last five years. According to the Texas Department of Health Services, the agency received exemption requests for nearly 153,000 students in the 2023-2024 fiscal year, up from 136,000 the previous year and nearly double the 77,000 requested in 2019.
Texas’ vaccine rollback
The bill on vaccine exemption paperwork would make it easier for parents to obtain the needed form by letting them download it to a computer or smartphone. The current system where parents ask state health officials to mail a paper copy to their home can sometimes take weeks. The form would still need to be notarized before it is turned in to a school and a student is enrolled.
Advocates say the changes would help parents thread the bureaucratic process and get their children enrolled in school quicker.
“This bill is not about whether vaccines are good or bad, it’s about government efficiency and keeping kids in schools,” said Jackie Schlegal, founder of Texans for Medical Freedom, which advocates for “vaccine freedom of choice.”
Critics argue that simplifying the exemption form process makes it too easy for unvaccinated kids to enroll in a school, endangering the health of other kids and families.
“For years Texas has struck a delicate balance of parents’ right and public health and safety,” Lakshmanan said. “This bill is more than just a form … We can support parents without putting other families at risk.”
Still waiting for a Senate vote is a bill that would allow vaccine makers who advertise in Texas to be sued if their vaccine causes a person to be injured. That bill has been opposed by the Texas Association of Manufacturers.
The author of that bill is first-term state Rep. Shelley Luther, who was briefly jailed in 2020 for opening her Dallas salon in violation of governor’s emergency order during the pandemic. Abbott quickly weakened his enforcement of coronavirus safeguards and a court ordered her released.