The insidious US measles resurgence should terrify us all
For most Americans, measles is an unfamiliar threat. If you're my age, you might remember getting it as a kid — the mild annoyance of lying in a dark room, protecting your sensitive eyes and trying not to scratch your rash.
But here's a more recent measles story, one of many I experienced throughout my 45-year nursing career.
A 9-month-old boy lies unconscious on a ventilator in the intensive care unit (ICU). He had traveled with his family to Kenya to meet his grandparents. He is the youngest sibling and the only one who didn’t get his measles vaccines. Now his mom sits by his hospital bed, watching a machine breathe for her baby.
"All I want him to do is to wake up," she told me.
Measles is one of the most contagious known diseases. It can kill, leave survivors blind or deaf, or with permanent brain and lung damage. It was all but eliminated in the U.S. decades ago, but it's now coming back. As of April 18, the Centers for Disease Control and Prevention (CDC) had reported at least 125 cases in 18 jurisdictions, more than doubling the total of 58 cases in all of 2023.
Our national numbers are relatively low, but we can't be complacent. The disease is not globally contained, and in the U.S., it poses a grave threat in susceptible communities, where low vaccination rates have left too many people — children and adults — in danger.
If our vaccination defenses are strong, measles does not have many places to go. But it can find pockets and hang on because every community has vulnerable people, including those too young to be vaccinated, pregnant women and the immunocompromised.
That's why the Adult Vaccination Access Coalition — a national alliance of health care providers, vaccine innovators, pharmacies, public health organizations and patient and consumer groups — is urging Congress to act quickly to help keep America's immunization success story from sliding backward toward failure.
Congress needs to fully fund the Centers for Disease Control and Prevention's National Immunization Program — bringing it to $1.6 billion, up from roughly $680 million. That money would help state and local health departments strengthen the nation's vaccine infrastructure, giving everyone access to the vaccines they need at any age, improving disease surveillance and emergency outbreak response, and conducting vaccine research, education and outreach, among other things.
If this all sounds like too much to spend, think of the alternative. Every year in the U.S., we spend $26.5 billion treating adults for diseases that vaccines could have prevented. The 2017 measles outbreak in my home state of Minnesota cost more than $2 million in response and treatment, not to mention the indirect costs for parents and children out of work and school. Those bills could have been avoided.
Adult immunization rates are already too low. Less than 22 percent of adults in the U.S. have received all age-appropriate vaccines. Unvaccinated adults can unknowingly sicken immunocompromised people and children who are too young to be immunized. Barriers to adult immunization, including the inability to pay due to gaps in insurance coverage, have contributed to low vaccine rates.
And this is the frightening part: As measles cases rise, the number of children and adults getting vaccinated in the U.S. is falling. Vaccine skepticism is not as easily traceable as infections and deaths, but it's growing.
You see it among policymakers, media figures, political candidates and even public health officials such as Florida Surgeon General Joseph Ladapo. In February, he sent a letter to parents about a measles outbreak in Florida, giving them permission to keep unvaccinated children out of school rather than recommending they get vaccinated. His letter, which defied long-held CDC advice, was a troubling example of how confusing and contradictory public health messages can make a difficult situation even worse.
Congress made vital emergency investments in vaccine infrastructure over the last four pandemic years. Now it's time to build on these investments to prepare for future disease threats, prevent severe illness and reduce hospitalizations, sickness and deaths.
Disease protection through vaccination should be like clean air and water and safe roads — something everyone, everywhere, should be able to count on for healthy lives.
When I read about outbreaks, my thoughts are with the state, local and tribal public health officials, and doctors and nurses on the front lines. A disease like measles puts everyone in full incident-command mode, dropping everything to trace infections, map the spread and save the sick.
Our young ICU patient survived but endured severe pneumonia and was on a ventilator for 15 days. His lungs won't ever be the same. Neither will his traumatized mother. I shudder to think of the price paid by that one child, that one family, compared with the negligible cost of vaccination.
Patsy Stinchfield is president of the National Foundation for Infectious Diseases.