Measles.

By Donald G. McNeil Jr.

We've been following the measles outbreak story in News Items, but superficially. To really understand what's going on, you need someone who really understands what's going on.

Happily, we know Donald G. McNeil Jr., who spent much of his remarkable journalistic career reporting on pandemics for The New York Times. We asked him if he could give us an update on what's happened and what might happen next. Happily, if that’s the right word, he did just that.

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Thanks to growing skepticism about vaccines, the measles outbreak that began in Texas in January has been in the works for decades. The question now is how big and how bad it will get.

I do expect it to last for months. I don’t expect it to cause hundreds of deaths, as the virus routinely did in the 1950’s, before a vaccine was invented. Despite recent declines, we are still a highly vaccinated country – 93 percent of kindergarteners have had their shots. (In Britain, by contrast, only 85 percent have.) Seniors like me, born before 1957, are almost universally immune because we had the rash as children. How big it gets will depend on how many “pockets” of low immunity it reaches and how effective our containment efforts are.

Just because an outbreak reaches a vulnerable pocket doesn’t mean it spreads to everyone nearby. We saw that in New York in 2019: a measles strain that spread from Ukraine to Israel reached the Hasidic Jewish neighborhoods in Brooklyn in which only about 80 percent of children were immunized. It infected more than 900 in Brooklyn and in Hasidic enclaves upstate. But, as crowded as New York City is, it didn’t spread through the whole population the way Covid did a year later, because most New Yorkers were immune.

However, the United States has more and more pockets of unvaccinated children. They are in Anabaptist communities – including Mennonites in West Texas and Amish enclaves in 32 states. They are in ultra-Orthodox Jewish communities in New York and New Jersey. They are in liberal places like Vashon Island near Seattle and Waldorf/Steiner schools in more than 100 cities. They are in conservative counties in Idaho, Alaska, Utah, Oregon and Arizona. They are in fundamentalist churches that believe in faith healing.

The Texas outbreak is still growing, although it is not doubling as fast as it was in February. It has reached 223 Texans, 33 New Mexicans and two Oklahomans. We’ve all heard the scary odds of complications: About one case in 20 causes pneumonia, about one in 1,000 causes encephalitis and one to three victims per 1,000 die. This outbreak has already killed one child and possibly also one adult.

Also, Ontario, Canada is suffering an outbreak almost as large which is now just across Niagara Falls from New York state.

How far either travels will depend partly on luck, but also on our national response: how fast we track cases and move vaccine and vaccinators into the virus’s path (assuming we have enough vaccine – more on that later).

Normally, any big outbreak, such as the 2014-15 “Disneyland outbreak” or the Brooklyn one, triggers an all-hands-on-deck reaction from the director of the CDC, the Surgeon General, the secretary of Health and Human Services and other public health leaders. This time, though, our response has been torpid. The CDC has no permanent director and the HHS secretary overseeing it is Robert F. Kennedy Jr., the country’s most famous vaccine skeptic.

The anti-vaccine movement has a long history; it emerged in England in 1853 in response to compulsory smallpox vaccination and has waxed and waned ever since. It was almost non-existent when I was young because one vaccine after another was wiping out child-killers like diphtheria, tetanus, whooping cough, polio, measles, mumps and rubella. By the 1990’s, however, young parents had never seen those diseases and a surge in autism – still unexplained -- had begun. In 1998, a British surgeon, Andrew Wakefield, published a now-debunked study suggesting measles vaccine triggered autism. The “natural healing” movement -- which is underwritten by some unscrupulous marketers who raise fears about immunizations so they can sell vitamins and food supplements as “immune boosters” -- jumped on it, and vaccine skepticism was reborn. The Covid epidemic strengthened it further as the “Disinformation Dozen,” including Kennedy, spread anti-vaccine hoaxes.

Although Kennedy denied being an anti-vaxxer during his testy Senate confirmation hearings, he has repeatedly cast doubts on different vaccines in interviews, public appearances, emails and books. His initial response to the Texas outbreak was to minimize it, saying it was “not unusual” and the 20 children hospitalized were “mostly for quarantine.” Both statements were false. Since then, instead of emphatically urging Americans to vaccinate their children, he has called it a “personal decision.” He has also pushed oddball treatments: cod liver oil; budesonide, a steroidal asthma medicine, and clarithromycin, an antibiotic. He cited the work of two Texas doctors recently profiled by Children’s Health Defense, the anti-vaccine group he founded, and said he wanted a clinical trial of their drugs. (Five years ago, one of those doctors claimed budesonide and clarithromycin were the “silver bullet” cure for Covid; he was later disciplined by a Texas medical board, according to factcheck.org.)

Leading doctors strongly disagree with Kennedy, saying those nostrums are useless and carry unnecessary risks. (Vitamin A protects against death from measles in poor countries where children are malnourished, but deficiency is rare in this country because vitamin A is in fruits, vegetables, fish, milk and cereal.) Experts also fear that parents will be misled into thinking vitamins or cod liver oil are protective, just as some Americans were fatally misled during Covid into taking hydroxychloroquine or ivermectin instead of getting shots.

The next few months are unpredictable but a clash now seems inevitable between Kennedy and mainstream medical experts. His apparent indifference is also troubling; soon after the Texas child died, he posted photos of himself on a hiking trip.

My biggest fear if measles cases do expand is a national vaccine shortage. I explain the math in detail here, but in brief it’s this: There are normally about 12 million doses available in the country each year, and if everyone needing one or two shots suddenly sought them, the demand would be well over 100 million. (That includes almost 8 million babies and youngsters needing their first two, more than 9 million unvaccinated or under-vaccinated children and teenagers, 40 million adults born between 1957 and 1968 who got a weak older vaccine and 75 million born between 1968 and 1991 who got only one dose, plus medical professionals seeking boosters before facing measles patients.) Local shortages in Texas have already been reported. Canada ran short last year. Someone in authority needs to take charge of the supply, since children need at least one protective shot more than adults need boosters. If that doesn’t happen, we could see deaths surge.

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One last thing: Donald is the author of ‘The Wisdom of Plagues’, a “fascinating, ferocious fusillade against humanity’s two deadliest enemies: disease and itself” (The Economist). It’s a great book.

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