Imagine a world where a once-controlled childhood disease is making a terrifying comeback, putting the most vulnerable among us at grave risk. That's the reality we're facing with the resurgence of whooping cough (pertussis) across the United States.
States like Texas, Florida, California, and Oregon are witnessing a startling rise in cases, leaving health officials scrambling for answers. But here's where it gets controversial: Is this surge simply due to natural cycles of immunity, or are human choices—like declining vaccination rates and policy changes—playing a bigger role than we'd like to admit?
According to interviews with state and federal health experts, the perfect storm of falling vaccination rates, fading immunity, and delays in public health tracking systems is fueling these outbreaks. And this is the part most people miss: Babies too young to be fully vaccinated are bearing the brunt of this crisis. As Demetre Daskalakis, former head of the CDC’s immunization program, explains, while pertussis cases naturally rise and fall due to waning immunity, the severity of outbreaks can be drastically reduced with high vaccination coverage and clear communication to at-risk communities.
Before the first pertussis vaccine emerged in the early 1900s, whooping cough was a leading cause of childhood death in the U.S. Today, children receive a series of DTaP shots starting at 2 months, while teens and adults get a Tdap booster every 10 years. Both vaccines also protect against diphtheria and tetanus. Until recently, 80% of toddlers were fully vaccinated by age 2, keeping case rates in check. But since the COVID-19 pandemic, vaccine coverage has plummeted, and the rise in nonmedical exemptions has widened immunity gaps—a dangerous trend that allows the disease to spread unchecked.
Take Texas, for example. In 2024, the state reported 1,928 pertussis cases. By October 2025, that number had skyrocketed to over 3,500. Nationally, the first three months of 2025 saw 6,600 cases—four times the previous year's rate and 25 times that of 2023. This isn’t just a regional issue; outbreaks from Louisiana to South Dakota to Idaho prove this surge is everywhere.
Here’s a bold statement: Some argue that policy changes are making matters worse. In Texas, a new law allows parents to claim nonmedical vaccine exemptions by simply downloading forms online, bypassing health departments entirely. Phil Huang, Director of Dallas County Health and Human Services, predicts this will further depress school-level vaccination rates. He’s already seen a dramatic drop in vaccinations during the back-to-school season, a time when his clinic is usually packed. Huang also suspects fear of immigration enforcement, particularly among Hispanic families, is deterring vaccinations in a county that’s 40% Hispanic.
Adding to the complexity, the acellular pertussis vaccines introduced in the 1990s—while causing fewer side effects—don’t provide immunity as long as the older whole-cell versions. This means many adults who received the acellular vaccine as children have lost immunity and may unknowingly spread the infection to babies.
The harsh truth? Whooping cough is deadliest for infants under one. Some stop breathing during coughing fits, and many require hospitalization. About 1 in 5 develop pneumonia, and roughly 1% die. That’s why the CDC urges pregnant women to get the Tdap vaccine during every pregnancy, passing critical antibodies to their babies before birth. While the “cocooning” strategy—vaccinating everyone around the baby—has fallen out of favor, vaccinating pregnant women and infants at 2 months remains the best defense.
Modern PCR testing has also uncovered more cases, but experts agree that increased transmission is undeniable, as evidenced by rising infant hospitalizations and large state outbreaks. And here’s a growing concern: antibiotic resistance. Macrolide-resistant pertussis, though rare in the U.S., is becoming more common abroad, particularly in China and Peru. With limited treatment options, especially for infants, this is a ticking time bomb.
So, what’s the solution? Health experts say it’s multifaceted. Clinicians must be more vigilant, obstetricians should discuss Tdap with every pregnant patient, and pediatricians need to ensure teens and adults are up to date on boosters. States like Texas have issued health advisories, but staffing and funding shortages are hampering efforts. Huang notes that even immunization registry data now arrives monthly, not daily, making real-time tracking nearly impossible.
As the holidays approach, families with newborns must take extra precautions: keep vaccinations current, avoid sick visitors, and seek immediate care for any infant with a cough or breathing pauses. But here’s the question we all need to ask ourselves: Are we doing enough to protect the most vulnerable, or are we letting policy, fear, and complacency stand in the way? Let’s start the conversation—what do you think?
