The Return of a Preventable Disease: Measles, misinformation and the crisis at the CDC

So why is this happening?

The main reason comes down to vaccination coverage. To prevent measles from spreading, about 95% of the population needs to be vaccinated with the MMR vaccine. That level of coverage creates what’s called herd immunity. It means that if someone does get measles, it’s very unlikely they’ll come into contact with someone else who’s still susceptible, and the outbreak will burn itself out.

But we have slipped below that 95%. The US is under 90% now as a whole, but in communities across the country, the vaccination coverage is actually much, much lower. 

The outbreak in the U.S. started in West Texas, where vaccination rates in some communities are alarmingly low. At certain schools, only about 14% of kindergartners received the measles vaccine before starting school. Across the country, there are many such pockets of susceptibility. If someone with measles enters one of these areas, the virus—because it’s so highly contagious—can quickly set off large, fast-moving outbreaks.

And that’s what happened this year: The first reported Measles outbreaks were in Texas in February. By early October, 42 states had recorded cases. In total, there have been more than 1500 cases of measles in the US, and four people have died.

What it has amounted to is the largest outbreak of measles the U.S. has seen since we declared measles eliminated 25 years ago. 

At the same time, the CDC has been in turmoil all year. There have been layoffs, resignations and funding cuts. The outbreak really began in January and state and local health officials seeking guidance from the CDC on how to respond were not getting the support or information they needed.

And some of that was because there was a presidential transition. But some of it was also because, particularly, in January, the CDC was initially prohibited from even talking to its state and local partners. So that hindered the flow of information. It also hindered the flow of critical tools like vaccines.

That was made worse by having a Secretary of Health and Human Services who was speaking about measles in ways that were incorrect: Trying to minimize the tolls of the disease, trying to minimize the protection that vaccines offer, trying to suggest that there were ways that you could treat measles that were somehow equivalent to the protection that vaccines offer.

To be clear, there are no treatments for measles. Doctors and nurses can clinically manage measles cases, but they don’t have a medicine that can cure you of it. 

And so many people were trying to protect themselves from what was obviously a scary and potentially deadly disease by taking things like vitamin A, which again, is not a treatment for measles. It is sometimes used to treat people who are infected with measles, who are vitamin A deficient, but it is not an approved medicine that is used to cure somebody of measles. 

So, it was really unfortunate because when you're responding to a fast-moving, deadly outbreak or really any kind of outbreak, one of the most important public health interventions you can have is effective risk communication. And the risk communication should have been: “The only way to prevent getting measles is to get vaccinated. Vaccines are safe and effective. This is what we recommend to stop these outbreaks and to protect your family from harm.” Unfortunately, what the American people got was a garbled mess of advice that was non-factual and, in many ways, contradicted what the evidence said.

Tell us a little bit about the Pandemic Center’s Tracking Report and how it might be helping to dispel confusion.

We created the tracking report almost a year ago to keep an eye on major outbreaks—not just in the U.S., but around the world. The list kept growing, and before long, it became too much to track just in our heads. There were so many outbreaks we were being asked to comment on, analyze and provide guidance for that we needed a more organized way to stay on top of it all.

We initially began by tracking the outbreak: gathering data, analyzing what was happening, and trying to understand the dynamics of each individual outbreak. At first, this was an internal document we were compiling.

But someone made a recommendation to us that we should share it. So we decided if other people would find it useful, then we would be happy to share it. We started sending it out pretty close to a year ago.

With the change in administrations, and the upheaval that began at the CDC soon after, the need for the tracker became far greater. People started coming to us because they either didn’t trust the information coming from the CDC, feared that information might disappear or simply couldn’t find a reliable, centralized source online that provided an overview of what was happening across all these diseases.

I want to be clear. I’m not trying to malign the CDC here. I know and respect the many scientists that are there. They have unfortunately experienced a real hemorrhaging of expertise since January. As of today, I don’t have reason to doubt the data that they put up. But we’ve been going to state and local health departments to get information about their measles outbreaks. The numbers we pull together are not inconsistent with the CDC. They’re a little bit more up to date.

One of the roles we’ve played is highlighting when leadership communication doesn’t align with the data. For example, while the CDC’s website provides information on measles cases, statements from the Secretary of Health and Human Services have at times offered explanations that don’t fully match what the data show.

Very early on, Secretary Kennedy would talk about the outbreak peaking or being over. When we were looking at the data, we did not share the Secretary’s interpretation of the data. And I think another reason why people have come to us is that they’re looking for not just how many cases is the U.S. seeing and how many states are reporting cases, but is it getting better? Is it getting worse? How worried should we be about it?

What are the answers to those questions? What does your tracker say?

Measles continues at a steady clip, is what I will say. In any given week, case numbers might appear to decline slightly, but then a new outbreak emerges in another state and adds to the total, and that’s exactly what we’re seeing now. So, I will just say that I fully expect onward transmission of measles to continue, and I remain concerned that the United States is going to lose its measles elimination status. Now, that’s not the most important thing. The thing that I worry most about is people losing their life from this virus and they don’t have to.

How can people protect themselves as this spreads?

If you're up to date on your vaccines, I think you can take this off your worry list. If you’re not, then think about getting up to date. The best thing to do is to check when your last vaccine was, and if you’ve gotten two doses or if you’ve had measles in the past, you’re probably fine. Talk to your healthcare provider if you have one. 

My biggest worry, though, is for people making decisions about their kids, or making decisions about themselves if they haven’t been vaccinated. Those are the people who remain at greatest risk.

How do you break through all the misinformation about vaccines? What would your effective messaging be?

The best data we have show that people aren’t likely to listen to me. They’re more likely to listen to their loved ones. That’s why it’s so important for all of us to have conversations with family and friends about staying up to date on vaccinations— not just for measles, but also for flu season and COVID boosters.

Part of the challenge we face with vaccines and infectious diseases stems from their very success: Because vaccines have been so effective, people rarely see these illnesses in their communities anymore, and it’s easy to forget how serious their toll can be.

When people ask me about getting vaccinated, I tell them that my grandfather died of polio while my grandmother was pregnant with my mother. So for me, the power of vaccines is deeply personal — they work, and they save lives. If the polio vaccine had existed then, my mother would have grown up with a father. Making it personal helps people understand what’s at stake.

For me, my mother always talked to my brother and I about growing up with intense pride because she, as a child, was part of the polio vaccine trials. She always talked proudly about how she was a polio pioneer, and she spoke about that proudly, both because she got to participate in a historically significant trial that really changed human life—but also because she saw what it was not to have the vaccine.

I don’t want a situation in which we have to burn ourselves on the stove in order to learn that it’s hot. I think we can talk about what these diseases have done in the past and what the remarkable, successful vaccines have enabled. But it can’t just be something that only a few people are talking about.

For these reasons, people are turning to your tracking report for reliable information.

People are probably turning to us more often now because of the chaos and upheaval within our federal health agencies, and that’s an important role for us to play.

But I have to say that we will never replace the CDC. There is no meaningful public health or emergency preparedness in the U.S. without a strong, well-resourced, and supported Centers for Disease Control and Prevention. We need federal health agencies to coordinate responses across the country, guided by evidence.

While independent experts play a crucial role, it’s not enough. The combined efforts of the private sector, local communities, and academia can’t come close to what a robust federal public health response can and should provide.

Do you think the CDC can recover?

It’s going to be really hard. I’m deeply worried. We have lost so many people there who are so good, and the people who remain are so deeply traumatized by what’s been happening at the agency, not just as of late. Not just with the incredibly disturbing shooting that happened, you know, 500 rounds of ammunition sent into the buildings of the CDC, but also just the cuts and the antagonism and the insults that have been lobbed at them really for years, but in particular since January. So I am really, really worried.

Ultimately, will we have a CDC? We’re going to have to. There’s a reason why it was created in the first place. The question I have is, how much unnecessary loss of life, loss of life expectancy and human suffering will we have to incur before we remember why we built it in the first place?