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LUBBOCK — Katherine Wells was tapping her phone.

It was the last week of January, and the director for the Lubbock Health Department had a jam-packed schedule. She was working with her team to put in place the new community health plan. Flu cases were on the rise. She had media interviews lined up to talk about stopping the spread.

She refreshed her email again. And there it was — confirmation that someone in nearby Gaines County had tested positive for measles. It was the first for the region in 20 years.

She took a deep breath.

Two months later, with more than 400 cases across Texas, Wells is the first to admit things feel eerily similar to the COVID-19 pandemic. And just like then — when police guarded her home after she received death threats — Wells’ work is facing questions from skeptics.

“People accuse me of creating the measles outbreak to make the health department look more important,” Wells said. She laughed as if she was used to it.

The reputations of public health institutions have taken a beating in the last five years as the pandemic became a political flashpoint. Some people saw public health leaders as heroes for urging people to wear masks, stay away from big crowds and get the vaccine. Others saw them as villains bent on robbing Americans of their freedoms.

Wells has served as the public health director for 10 years. Long before the measles outbreak and COVID, she navigated situations like Lubbock’s high sexually transmited infections and teen pregnancy rates. Lubbock is the largest city in Texas’ South Plains, with nearly 267,000 residents. It’s also largely conservative. More than 69% of Lubbock County voted for President Donald Trump last November.

Lubbock also stands as a critical medical hub for the South Plains, and Wells is the leader. With a dearth of rural hospitals, physicians, and limited care at clinics, people from all over the region flock to Lubbock for health care. This is how Lubbock became entangled in the measles outbreak. Most of the cases have been recorded in nearby rural Gaines County, where 280 cases have been identified. Patients have sought medical care in Lubbock.

Like many public health directors, most people didn’t know Wells until March 2020, when the city and the rest of the country was upended by the COVID pandemic. As she led the city through the crisis, she became a household name — for better or worse.

Dr. Georges Benjamin, executive director of the American Public Health Association, said public health directors work behind the scenes to stop bad situations from happening. They are invisible shields, he said, which can make their work challenging when it’s suddenly pushed into the public eye.

“When something really bad happens, like with COVID, the fundamental trust wasn’t there,” Benjamin said. “They didn’t have a relationship with the community.”

Misinformation has played a large role in eroding trust in public health institutions. Most adults are uncertain whether health misinformation they have heard is true or false, according to a recent KFF survey,. Another KFF survey found that between 81%-84% of Republicans trusted only four people to make the right health recommendations — their doctor, Trump, Secretary of Health Robert F. Kennedy, and Dr. Mehmet Oz, Trump’s pick to lead the Centers for Medicare and Medicaid Services.

Wells’ job is not likely to get easier any time soon.

A Lubbock’s children hospital is now treating children with severe measles who also suffer from vitamin A toxicity. This comes after Kennedy, a vaccine skeptic, directed the Centers for Disease Control and Prevention to update the measles guidance to promote the vitamin’s use, which most health experts object to. The Trump administration is eliminating pandemic-era grants that were used to boost the department’s response to the measles outbreak, including paying for employees. And Wells is navigating what could arguably be an even more delicate line than COVID — managing the outbreak of an eradicated, preventable disease, with a worn-out staff and a growing distrust from the public.

“You can’t fix public health overnight,” Wells said. “It’s not like the fire department. I can’t run in, put the fire out and they’re all proud of me. It’s totally different.”

‘Part of the community’

Since the first measles case, Wells’ life has a new daily routine. First, she meets with the state health department. Then she meets with other public health leaders from around the state. Later her staff about new cases or exposures.

Unlike during the pandemic, however, the health department’s other work isn’t on hold. Wells and her team have pulled double duty, also working on STI rates, waning flu cases and substance use prevention.

Wells herself is working seven days a week. It’s given Wells, and her family, deja vu.

“My daughter’s been so sad lately and I asked her what was wrong,” Wells said. “She finally told me, ‘Mommy, this measles thing feels like COVID again. I don’t get to see you.”

Wells’ work — and sacrifices — are driven by a belief that everyone deserves good health.

“Public health should be part of the community,” Wells said. “Public health is all about talking to community members and figuring out what we need to do to make things better.”

Before moving to Lubbock, Wells lived in Austin and worked at the state health department for 14 years. She moved to Lubbock in 2012, still working for the state health office, with the goal of rebuilding the city’s public health system.

Despite her passion, Wells’ work has been far from easy. When Wells started in 2015, she had 10 staff members and an underfunded department. She created a strong team — one that started preparing for COVID two months before it was detected in the U.S.

By 2020, Wells had the support of city leaders. She appeared in weekly virtual COVID briefings for the media and public alongside former Mayor Dan Pope and other Lubbock officials. They worked quickly with first responders to create the vaccine clinic in the city’s civic center.

By 2024, the atmosphere was different. There were new faces on the City Council, including a new mayor, Mark McBrayer. As the health department was preparing to open a new facility, McBrayer was working on a no-new-tax revenue rate for the city’s budget. He was considering cuts to the health department’s budget, among others, to achieve this. Amid the threats and public outrage, the grand opening attracted a major crowd — more than were at Wells’ wedding, she said.

The health department’s budget wasn’t cut, but there have been other bumps in the road. More recently, Wells faced pushback over the Community Health Improvement Plan, a report that provides the city with recommendations to improve the health of its residents. It focused on improving accessibility to health care, educating the community, and strengthening coordination amongst servicers.

Some members of the new council hesitated to approve it, calling the plan an excuse to justify expanding government spending on health care. It led to a long meeting with hours of public comment. David Glasheen, one of the council members against it, said it was redundant because hospitals are mandated to provide indigent care. Council member Tim Collins said part of the plan would help the department become nationally accredited, which would help the city get more grants in the future.

Council member and Mayor Pro-tem Christy Martinez-Garcia supported approving the plan. She told The Texas Tribune some of the members were misinterpreting the plan’s purpose.

“Once they understood why this was so important for future opportunities and grants, it helped,” Martinez-Garcia said. “But, it’s something we’re going to have to face moving forward again, because of the political environment of our society.”

Martinez-Garcia’s view of Wells has come a long way since the early days of the COVID-19 pandemic. Martinez-Garcia is the owner and publisher of Latino Lubbock Magazine, one of only two media outlets — along with El Editor — that cater to Lubbock’s Hispanic community. About 38% of Lubbock’s population is Hispanic.

During the weekly press conferences, Martinez-Garcia would press Wells about getting information out in Spanish. It was important, but also personal for Martinez-Garcia. She lost seven family members to COVID-19, because she says a plan wasn’t in place to help the community. Martinez-Garcia said Wells was receptive to the criticism and made changes. She placed vaccine stations in East and North Lubbock, making it accessible to impoverished and out-of-reach communities.

“She was trying to make it as equitable as possible for everybody,” Martinez-Garcia said.

Last month, Wells prepared an article about measles from the health department for Latino Lubbock Magazine. It was written in English and Spanish.

The community health plan was eventually approved, with Glasheen being the lone vote against it. Wells said she didn’t know where the pushback was coming from, but blamed herself for it. She said she didn’t do enough to reach out to the newer members and explain what her department does.

“It looks like we’ll have some opportunities in the future to explain that,” Wells said.

‘Behind the eight ball’

As the health department in a major medical hub, Wells has a responsibility to support the smaller health departments. Her team has worked with the South Plains Public Health District, a multi-county health department that provides vaccines, STI treatments and other basic health care. It includes Gaines County, the epicenter of the measles outbreak. Wells and her team have helped craft news releases, providing staffing and information as needed. Wells said their duty is to talk about the measles to the public and calm fears.

She also said their job is “to talk about what we need to do to respond, who’s at risk and put the vaccinated people at ease.”

Misinformation has inflamed the outbreak. Benjamin, from the American Public Health Association, said vitamin A has no role in preventing measles, and public health leaders have to try and correct the misinformation. Covenant Children’s Hospital in Lubbock said they admitted fewer than 10 pediatric patients who were initially hospitalized due to measles complications but also have elevated levels of vitamin A. This is causing abnormal liver function for patients.

“It’s a therapy if you’re already vitamin deficient,” Benjamin said. “It has to be given carefully, and it’s something doctors do in the hospital because these are very sick people. It’s not something at the grocery store.”

Wells doesn’t see the measles slowing down anytime soon. After researching other measles outbreaks, Wells thinks this one could go on for a year.

“We identified this outbreak with two children in the hospital,” Wells said. “Which means there was measles circulating in certain pockets. So we were behind the eight ball in the initial response.”

Vaccination is the most effective way to stop the disease from spreading, but Wells knows it’s a choice people have to make. The city arranged several drive-up vaccine clinics quickly after the first case was identified. She says public health’s role is to counter the messaging around why people are scared of vaccines.

Now Wells is concerned about what else could come back. The measles outbreak shows the potential other diseases such as mumps and polio could have on unvaccinated populations.

“You see measles first because it’s the most infectious,” Wells said. “It doesn’t mean we’re not going to see outbreaks of other childhood viruses.”

As these public health crises have unfolded, Wells has been quietly working on her doctorate. It could be what sets Lubbock apart during the next pandemic. And last week, she successfully defended her dissertation on building public health systems in Texas, and is now Dr. Wells.

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