Katherine Wells has been an epidemiologist designed to protect the public from disease outbreaks for 25 years. It wasn't until January that she had measles.

“I mean, we think we’re going to eliminate measles in the United States,” she said.

Now, as the public health director in Lubbock, Texas, Wells is the center of a measles outbreak, infecting more than 700 people in Texas alone, sending more than 90 people to hospitals and killing two other healthy children.

According to the Centers for Disease Control and Prevention, the outbreak is the largest since 2000. The CDC said infections have exceeded the number of cases that occurred during the 2019 New York outbreak, which was previously the largest disease.

"It's frustrating because we have a solution, and it's a very effective vaccine," Wells said.

Wells firmly believes that her best chance to stop a virus infection is to increase vaccination throughout West Texas, and in many counties, kindergarten immunization rates have declined as they have them nationwide.

One of her toughest challenges: Anti-vaccine advocates have flooded the region with false claims about vaccine risks. When we catch up with her talking about her experience, Wells tells the tradeoffs, Wells tells the tradeoffs. She said the false information not only undermined public confidence in vaccines, but also sowed a distrust of public health more widely.

Wells said opposing false information requires money, and the federal government, which used to be a reliable partner of local health officials, took a step back. Wells' cities and states suddenly lost federal public health funding when the U.S. Department of Health and Human Services canceled more than $11 billion in grants nationwide. A Texas spokesman told Tradeoff that despite other types of support the state offers, there is no funding to send to Lubbock.

Well did not give up. “We can’t let this noise destroy what we need to do,” she said. “We still need to focus on our community. Even if we have a one-on-one conversation with individuals, we need to put the vaccine in a weapon.”

Here are the highlights from our conversation with Wells, edited with detail and clarity.

Shocked in the face of the measles outbreak

Public health always happens at 4:30 pm on Friday. That afternoon, my staff told me that we had two cases of measles in the hospital, two. This is not uncommon. You always have doctors seeing rashes and they want to test for measles. So I didn't think too much about it. Next Monday, I was actually on a boat for one of our nonprofits and I was sitting on a board meeting and the woman next to me said, “My husband is a caregiver coach in rural areas and yesterday he told me that there was a lot of measles in Gaines County.” I literally stood up, walked out and started calling.

This is terrible. I'm going, okay, am I overreacting or is this really what? But my intuition says that something is happening. …If you don’t respond well, it’s so contagious, like exponential growth. So you want to get in as soon as possible and figure out exactly how many cases there are. What happened on the ground? Are there any other patients? How do we make sure it stays in one community without spreading to other communities in the area?

About the Ways of Federal Unrest complicating measles battles

We are watching the CDC and HHS colleagues are fired. All of these uncertainties. …I don’t know what to cut, what kind of public health will be at the local level.

However, we have one person working seven days a week to help families affected by measles hit misinformation about vaccines, work with our providers, who are testing with children or adults who need to undergo a child, and talk to businesses that may have measles exposure.

Core public health work is continuing. It's just a great workforce, you know, getting beaten up in the state media, being accused of their jobs doesn't matter. But because they take care of the community, these people are showing up every day, day after day and ensuring that the work that needs to happen during the measles outbreak occurs.

Faced with the "machine" that is eliminating vaccine disinformation

This is definitely a challenge. I almost call it an error message machine. …It’s hard to keep up with messaging. You feel like you hit a bullet point on some kind of misinformation, and they pivot and find another. …You are watching the healthy defenses of your kids pour in and start talking to parents of dead kids – bringing false hope to the community and peddling cod liver oil and vitamin A.

Staying healthy or taking these supplements won't stop your child from getting measles. And we don’t know which child will experience serious complications due to measles. We don't know who will end up in the hospital, and unfortunately, we don't know which child is likely to die.

About how to help people who are afraid of vaccines

Trying to get someone to inject without getting sick to prevent illness is just afraid of the fear of unknowns. I've talked to a lot of parents who said, "Well, there's never been measles, polio or mumps in our community. So, even if the risk of a vaccine is so insignificant, why take the risk if this disease isn't there?" We're seeing more and more doctors in the community willing to talk about the importance of vaccines and more doctors willing to spend time having these conversations with patients.

I think the person who really touched my heart was a mother of five children who had never been vaccinated with her before. …She felt comfortable enough to come in, talked to one of our nurses and had all five children vaccinated with measles with MMR. …So we are in contact with individuals. It's just a slow process. She is just one of many parents who are now entering the public health department because we are that trustworthy messenger - get the vaccine. …exciting. You are very tired. I mean, we haven't had a three-month break for three months in a row, it's just the energy you bring to you again, and there's some hope.

Cultivate communities for the future of public health

This makes me want to take a closer look at public health work. …A decade from now on, I hope the narrative around the vaccine has changed, and we’re back to a place where people can trust science and public health, listen to that information and trust the community.

I still have hope for all of this. There are 2,000 other health department directors in the United States who work day after day. Public health does happen in that place - those who know their own communities and want to make the community better.

Dan Gorenstein is the executive editor and Melanie Evans is trade offa nonprofit news agency that reports on the toughest options for healthcare. You can register for a trade-off Weekly newsletter To get the latest stories in your inbox every Thursday morning. To listen to Katherine Wells for more information, listen to the full trade-off podcast episode below.