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America's Measles Crisis Will Get Worse Before It Gets Better

Plus, why Trump's turnaround on vaccine safety was very late—but still helpful.
A nurse gives a woman a measles, mumps, and rubella virus vaccine at the Utah County Health Department on April 29th, 2019, in Provo, Utah.

A nurse gives a woman a measles, mumps, and rubella virus vaccine at the Utah County Health Department on April 29th, 2019, in Provo, Utah.

As of Friday, 704 Americans in 22 states have been sickened with measles in 2019, according to the Centers for Disease Control and Prevention (CDC). This is the largest number of measles cases the country has seen since the disease was declared eradicated—meaning it hadn't actively circulated among Americans for a year—in 2000. And officials expect things to get worse before they get better.

Although officials are working on containing them, the largest and longest-lasting outbreaks right now, both in New York State, are expected to continue. "We should expect to see additional cases associated with [the New York outbreaks] this year," Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said during a call for reporters.

There's no cure for measles and it can be deadly, killing one or two children for every 1,000 who are infected. So far this year, nobody in the United States has died from the illness, but about 9 percent of people sickened have had to be hospitalized, Robert Redfield, the CDC's director, said during the same call.

During outbreaks, public-health officials push people to get vaccinated: The measles, mumps, and rubella, or MMR, vaccine is 97 percent effective at preventing people from catching measles, according to CDC data. The vast majority of American children are vaccinated, but in certain pockets of the U.S., unusually high numbers of people aren't immunized, creating the perfect conditions for an outbreak to take hold.

The outbreaks in New York have primarily hit Orthodox Jewish communities, which groups have been targeting with misinformation about vaccines' dangers, leading some parents not to vaccinate their children, the New York Times reports. "The public-health community, the community organizers, and the rabbinical associations are all working together to correct misinformation and get folks vaccinated," Messonnier said. "I think that these outbreaks can end with all of those groups working together, but we will expect to see additional cases before this is over."

For many months, the virus also circulated among Eastern European Americans in southern Washington State, where vaccine skepticism is unusually widespread, Vox reports. Washington's outbreak was officially declared over last week, Messonnier said.

As these communities and others endured the country's worst resurgence of measles in decades, President Donald Trump made a surprising comment on Friday: "They have to get the shots. The vaccinations are so important. This is really going around now." It was the first time he'd said anything about the months-long measles outbreaks.

His statement contrasted with previous comments he has made about vaccines. Throughout 2014, Trump tweeted about his belief that getting shots on schedule could cause autism in children. In 2017, just before he took office, Trump reportedly was considering creating a commission on vaccines, seemingly to re-litigate whether they are safe. A major independent panel had already concluded that they are, in 2013.

When asked if it might be helpful for Trump to retract his previous statements about vaccines, the secretary for health and human services, Alex Azar, instead praised Trump's recent remarks and seemingly defended the president's past beliefs.

"The president, last week, was very firm that people need to get their shots," Azar said, during the same call with CDC officials. "Vaccinations are so important. As you know, some years ago, there was debate about this issue."

But Trump's anti-vaccination tweets extended far past when there might have been legitimate scientific debate about the benefits and risks of immunizations. One of the best-known scientific papers linking the MMR vaccine and developmental disorders in children was retracted in 2010 because editors found that "several elements" of it were incorrect. Even then, scientists called the retraction "long overdue." Then came the 2013 Institute of Medicine report on the safety of America's recommended vaccine schedule, which, at the time, included two dozen vaccines to be delivered before kids' second birthdays. In 2014, a meta-analysis of 10 previous studies, including six specifically addressing the MMR vaccine, found no link between vaccines and autism.

Still, Trump's positive remarks are helpful, suggests Noel Brewer, a psychologist who studies how people make decisions about their health at the University of North Carolina. Research suggests having leaders speak out clearly and consistently about vaccines helps boost vaccination rates during outbreaks. That's why working with rabbinical associations is expected to help in New York, and why Brewer says: "I'm really glad that the president spoke out in favor of vaccination. It is one of the simplest interventions that we have, is to have leaders speak out in a positive way about vaccination."

"I also think it's important for vaccine advocates to just simmer down," he adds. "[Trump] said something positive. Let's be grateful."