Measles Makes a Comeback – The Dispatch

According to state and local authorities, the latest outbreak began sometime in late January, with the first reported cases emerging from Gaines County, a rural area in West Texas. The virus quickly spread among the Mennonites, a relatively insular Christian denomination, living in the area. At least 159 cases, 22 hospitalizations, and one death have been reported in Texas so far. Just over the border, in Lea County, New Mexico, at least 10 people have tested positive for the virus. Children and teenagers make up the majority of cases.  

Amid low immunization rates, public health officials are now worried that the outbreak could spread even further. Just 82 percent of kindergartners in Gaines County, for example, have taken the vaccine. And surrounding counties aren’t faring much better. In nearby (and much more populous) Lubbock County, 92 percent of kindergartners are vaccinated against measles—below the high threshold required to check the highly transmissible virus’ spread.

Measles is one of the most infectious diseases in the world: To achieve herd immunity (when enough people are immune to a disease to stop its spread), the Centers for Disease Control and Prevention (CDC) says vaccination or immunity rates must reach 95 percent. Infected individuals spread the virus to around 18 additional people, more than four times than carriers of COVID-19. Measles can linger in the air for hours, infecting people not in close contact with the original disease vector. “A kid with measles in your pediatrician’s office could have left an hour and a half ago, and you and your kids can still get measles [in that office],” Chris Beyrer, an epidemiologist and head of the Duke Global Health Institute, told TMD.

And though measles outbreaks tend to begin in clusters of children with low levels of vaccination, the virus can easily spread to anyone who is not vaccinated or immune in surrounding communities. “I know it’s going to grow. We’re not at a point where we’re starting to see this slow down,” Katherine Wells, the director of public health for the city of Lubbock, told TMD. 

And measles will have plenty of targets in West Texas, where public health officials said many residents lost trust in public health authorities following the COVID-19 pandemic. Beyrer also pointed out that illegal immigrants, who are often relatively alienated from local health systems, have been rendered even more wary of seeking out medical assistance due to recent threats of large-scale deportations.

But help appears to be on the way, as the federal government vows to surge resources to West Texas. On Tuesday, the CDC announced that it was sending disease experts to support local health authorities in collaboration with the Texas State Department of Health. “I’m hoping with some of these new federal resources that are moving in, we could get some good estimates on where we are with our outbreaks based on vaccination rates and other factors in our community,” Wells said. She also noted that federal workers would give a much-needed respite to her employees, who are contending with the outbreak on top of their normal duties. 

But while the on-the-ground response may be helpful, the messages coming from the top of the federal health apparatus don’t seem in a position to help as much. Kennedy has long cast doubt on the safety of the MMR vaccine, and last week, he downplayed the significance of the outbreak. During a televised Cabinet meeting, the health secretary portrayed measles outbreaks as a routine occurrence. “Incidentally, there have been four measles outbreaks this year in this country. Last year there were 16,” he said. “So, it’s not unusual, we have measles outbreaks every year.” He also claimed that many of the children who had been hospitalized were only there for “quarantine.”

The statements were, at best, misleading, experts told TMD. It is technically true that measles outbreaks have periodically occurred in the last few decades, typically within communities with a historic distrust of vaccinations. Between 2018 and 2019, for example, measles had a brief resurgence in a Hasidic Jewish area of Brooklyn. But the number of recent outbreaks, as well as the reported deaths, are both unusual. 

And contrary to Kennedy’s claims, the children hospitalized were committed with conditions like severe pneumonia that required emergency oxygen—not to quarantine. “Hospitalized for quarantine—what?!,” Paul Offit, a pediatrician and director of the Vaccine Education Center at the Children’s Hospital of Pennsylvania, told TMD. “You don’t want to send people to [the] hospital,” with measles, he noted, as they would be around a population of children who are immunocompromised or unable to receive shots. 

Kennedy later sought to clarify his remarks, authoring an op-ed for Fox News Digital that called the measles outbreak a “call to action.” “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons,” he wrote. But he also stopped short of advising parents to vaccinate their children, characterizing the MMR vaccine as a “personal choice” and said that the CDC was working to make vaccines available to “all who want them.” 

Kennedy had more fulsome praise for alternative treatments of dubious effectiveness. “By 1960—before the vaccine’s introduction—improvements in sanitation and nutrition had eliminated 98% of measles deaths. Good nutrition remains a best defense against most chronic and infectious illnesses,” he argued, reflecting his longstanding belief in diet as an alternative to pharmaceutical medical treatments. 

As part of that argument, Kennedy endorsed the use of Vitamin A to reduce measles mortality. But the study he cited, purporting to show Vitamin A’s effectiveness, was based on an analysis of many global populations with widespread Vitamin A deficiency. In America, many foods like bread and milk are fortified with Vitamin A already. In fact, health experts have warned that taking too much Vitamin A can be toxic and even lead to birth defects.

“What you want to do is not to treat measles,” Beyrer said. “What you want to do is prevent measles with a safe and effective vaccine.” In Texas, local authorities are focused on preventing measles’ spread through vaccination rather than treating the virus on the individual level. “Our goal is to keep people from getting measles,” Wells told TMD. And the vaccine is safe and effective, having been tested for any links to autism in a dozen studies, in seven countries, involving tens of thousands of children. None found evidence that the MMR vaccine caused autism.

But if the vaccine is safe and effective, why are many people choosing not to take it? In part, the MMR shot has been a victim of its own success. “When you have good vaccine coverage, you don’t see these diseases,” Beyrer said. “That is an ongoing challenge, because you are trying to convince people to take what they perceive to be a risk for something which they don’t perceive to be a risk.” For the last four years, fewer than 95 percent of kindergartners nationwide have received the MMR vaccine, below the threshold for herd immunity.

And the eradication of measles around the turn of the 21^st century roughly coincided with the rise of Andrew Wakefield, a doctor who authored a 1998 article in The Lancet claiming to find a link between vaccines and autism. But the paper was later fully retracted due to findings that Wakefield had intentionally misdiagnosed some of the children in the study with symptoms of autism to lay the groundwork for lucrative lawsuits against the vaccine makers. 

Wakefield lost his medical license. He did not, however, lose his cachet among those who were deeply suspicious of vaccines; he became a popular anti-vaccine campaigner, appearing at anti-vaccination events with Kennedy. “In any just society,” Kennedy once told supporters, “we would be building statues to Andy Wakefield.” A concerted anti-vaccine movement, led by figures like Wakefield, led to gradually increasing vaccine hesitancy in the last few decades.

The anti-vaccine movement, often rooted in New Age thinking, might be seen as separate from the beliefs of traditionalist religious communities like Mennonites or Hasidic Jews. But the line between activists and relatively insular sects can be blurry. In 2021, Kennedy told a crowd of roughly 1,500 Amish people in Lancaster County, Pennsylvania, that the “cure for measles” is chicken soup and Vitamin A. “He did everything he could to lower vaccine rates,” said Offit. Similarly, the distribution of a “Vaccine Safety Handbook” by activists, which advocated against vaccines and pedaled conspiracy theories about the American medical establishment, played a part in sparking the 2019 measles outbreak in Brooklyn. 

But what can be done beyond responding to outbreaks as they pop up? Local public health experts argue that expanding access to vaccines was critical. “For people in Gaines County, you have to drive about 40 miles [to Lubbock] to get a vaccination,” Duke Appiah, an epidemiologist at Texas Tech University in Lubbock, told TMD. For people who are only mildly skeptical of vaccines, distance and barriers to health care might be enough to stop them from getting the jab, he said. 

The latest outbreak may also be a wake-up call. In her region, Wells said, many people who had previously been wary of the MMR vaccine are now making the choice to vaccinate their children. “Now that we’re seeing these cases in our community, I think that their risk assessment is changing,” she said. But vaccine uptake still appears to be low among members of the Mennonite community at the heart of the outbreak, she noted.

But despite his tepid endorsement of the measles vaccine, Kennedy has already made policy moves that could sow further distrust in immunizations more broadly. HHS has already suspended an effort to develop an oral COVID vaccine and is currently reevaluating a contract with Moderna to research a bird flu vaccination. A planned February 26 meeting of the CDC’s Advisory Committee on Immunization Practices was also postponed, without a new date being set. The annual meeting, which advises Americans on their vaccine schedule, was set to give recommendations on a number of shots—from a new meningitis vaccine to maternal RSV vaccines to the annual flu shot. 

During his confirmation hearing, Kennedy claimed that he was not seeking to take away anyone’s access to vaccines. But that’s “factually not the case,” Beyrer argued. “He’s already having an impact on our ability to have an effective flu vaccine next year.”

Right now, Texas public health officials are stressing the need to vaccinate to stop the spread from becoming much worse—and they want to remind the public that measles is no joke. “Children are being hospitalized and getting really, really sick from this,” Wells said. And for now, that number is only going up. 

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