Texarkana is a city that straddles the Texas-Arkansas border, meaning its residents' access to health care depends on which side of the state line they live on. (Photo by DenisTangneyJr/Getty Images)
In 2000, measles was declared eradicated in the United States thanks to a successful national vaccination program that stopped transmission of the virus in the country, but even now measles has not been eradicated globally. The continued spread of measles in other countries and gaps in vaccination rates in the United States make the country vulnerable to outbreaks like the one currently underway in Texas. The current outbreak has already resulted in two deaths, and cases are increasing due to the extremely contagious nature of measles and low vaccination rates in affected areas.
In this excerpt adapted from his book Booster Shots (Penguin Random House, 2025), pediatrician and infectious disease expert Dr. Adam Ratner examines a historic measles outbreak in Texarkana, a city on the Texas-Arkansas border. During the outbreak, where people lived on the border determined their fate.
As its name suggests, Texarkana straddles the border between Texas and Arkansas. In the 1960s, about two-thirds of the population lived in the Texas portion of the city, with the remainder living in the Arkansas portion. This division generally did not affect the city's day-to-day life, as residents of both counties frequented the same local businesses, churches, and events.
Still, separate public schools and public health services existed on both sides of the border. Texarkana became a natural laboratory for studying how policy choices could affect public health.
In late June 1970, a 5-year-old Texarkana boy who had fled the area was diagnosed with measles. He became the first confirmed case of an outbreak that lasted more than six months and affected more than 600 people, mostly children. But what was most notable was that measles outbreaks were becoming more common everywhere.
In 1970, on the Texarkana side of the border, less than 60 percent of children ages 1 to 9 were protected from measles.
What was unique about Texarkana was that State Line Avenue separated two jurisdictions with very different approaches to measles vaccination. Texas did not have a mandatory measles vaccination requirement for school entry and generally avoided mass vaccination campaigns.
Less than 60 percent of children ages 1 to 9 on the Texas side were immune to measles, either from vaccination or previous illness. In contrast, Arkansas retained
Sourse: www.livescience.com
