Dont say we didnt warn you. Pediatricians and public health officials have sounded the alarm on declining vaccination rates and the return of the diseases they prevent for more than two decades. Measles, a once-controlled illness, is now present in 17 states.
Recently released data from the Centers for Disease Control and Prevention show that the United States is on pace for about 400 measles cases this year. (There have been nine cases in Floridas Broward County this year, largely linked to local spread among kids at Manatee Bay Elementary.) The national number will surpass the total number of cases in the last four years. Not since the 2019 outbreak in New York (more than 1,200 cases) or the 2014 outbreak at Disneyland in California have more children been infected. Together, these three outbreaks threaten Americas status as a measles-free nation.
Cases of whooping cough, another vaccine-preventable disease, are also rising, with double the number of cases last year than in 2022.
The newest resurgence of measles, the third major outbreak in a decade, is a troubling indicator of the erosion of vaccine acceptance and uptake in our society. It is the expected outcome of what pediatricians like myself face every day a growing and more entrenched group of parents staunchly opposed to childhood immunizations. Only 90.6% of Florida kindergartners were vaccinated for measles before they started school, a drop of 3 percentage points compared to 2016, and worrisome for a disease so contagious that over 95% of the population must be immunized to prevent disease spread.
Even for premature babies, who are at highest risk for hospitalization and death from these illnesses, counseling parents about the importance of vaccination is an uphill climb.
Despite the availability of safe and effective vaccines, measles outbreaks have reemerged in various parts of the country, magnified by factors such as misinformation, complacency and pockets of under-vaccinated populations. Though public health and immunology are sciences rigorously taught in medical school, politicians have replaced professors, fueling public vaccine hesitancy for political gain. A study by the Kaiser Family Foundation found the percentage of Republicans who believe they should decide if their children are vaccinated even if failing to do so harms other children more than doubled to 44% in the last five years.
High vaccination rates are a team sport. They require legions of physicians and health workers providing immunizations to kids and strong regulations that reinforce the importance of vaccination. Unfortunately, state policies are moving us backward. Last year, a court in Mississippi ordered the state to allow parents to decline immunization based on religion even though no major religion forbids immunization. This ruling reversed what had been the states greatest public health achievement of vaccination rates among the highest in the nation.
To prevent the next measles outbreak, we must de-politicize immunizations, invest in national programs that support public health and push for state-based policies that limit exemptions from state immunization requirements.
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In addition to West Virginia, only New York, California, Maine and Connecticut allow medical exemptions from school vaccination rules. Unsurprisingly, these states surpass the national average in measles vaccination rates. Despite unequivocal support from medical groups and hospitals, these laws are hard to pass. I was frequently in the state capitol when New York passed its new rules on immunization exemptions during the 2019 measles outbreak.
Debates about these regulations need to move away from a focus on individual rights and be re-centered on the needs of the growing number of immunocompromised children who rely on the immunity of the population for protection. The image of the angry parent screaming about infringements on personal freedom needs to be replaced with the child cancer patients who will get gravely ill if their class is under-immunized.
Nationally, we must invest more in our public health infrastructure. County health departments, which provide free immunizations to low-income children and track cases of vaccine-preventable disease, have been under-funded for decades. In his budget earlier this year, President Joe Biden requested almost $3 billion in funds to strengthen immunization and education programs at the CDC. Both the House of Representatives and the Senate removed the extra financial support.
Further, the president also recommended creating a national vaccine program for low-income adults. Modeled on the 25-year-old, incredibly successful Vaccines for Children program, this Vaccines for Adults proposal would ensure adults have access to immunizations, an especially urgent need as new vaccines against respiratory syncytial virus are now indicated for seniors. Again, Congress rejected this recommendation.
The spike in vaccine-preventable diseases is an alarming reminder of the jeopardy facing vaccines and public health policies, and the pressing need for state and national action. If we extract politic rhetoric from the science of vaccination, adequately fund our vaccine-delivery system and enact commonsense, evidence-based policy, we will strengthen vaccine acceptance, preventing the next outbreak.
Consider yourself warned.
Dr. Shetal Shah is chairperson of the national Pediatric Policy Council, a practicing neonatologist and executive member of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine.
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Here's what the return of measles really means - Tampa Bay Times
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