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Are Measles Making a Comeback?

By: David Ostrowsky

When Dr. Michael Osterholm speaks, people listen – even if many do so begrudgingly.

The ever-serious epidemiologist out of Minnesota, who forewarned of a global pandemic years ago and has garnered the not-so-flattering nickname “Bad News Mike,” has a new dire message about the recent measles outbreak, one to which children are most susceptible, that has started to trickle through pockets of Europe and, more recently, the US:

“We're going to start seeing more and more of these outbreaks,” Osterholm told USA TODAY last month. “We're going to see more kids seriously ill, hospitalized and even die. And what's so tragic about this, these are all preventable.”

In late January, the World Health Organization (WHO) reported that measles cases spiked more than 40-fold in 2023 compared with 2022. Approximately 30 percent of those cases were in Kazakhstan, where there is an exceptionally high number of children who aren’t vaccinated. In England, there were 250 confirmed measles cases, most impacting children younger than ten. Although last year in the US, the number of measles cases reported was lower compared to most pre-COVID years, there have been ominous signs of trouble: Philadelphia has thus far recorded nine cases of measles, Washington State has identified three cases and investigated three others, while several other states have been tracing contacts of a single case. From a global perspective, 49 countries are experiencing what the WHO calls “large or disruptive outbreaks.”

As Osterholms noted, an uptick in severe illnesses, hospitalizations, and even deaths will follow. Per the Centers for Disease Control and Prevention (CDC), approximately a fifth of those who contract measles will be hospitalized due to a range of issues including uncontrollable diarrhea, dehydration, fever, conjunctivitis, skin rash, pneumonia triggering long-term respiratory issues, and possibly even brain inflammation sparking neurological issues. More alarmingly, it is estimated that out of every thousand children who come down with measles, one to three will inevitably die.

But, most maddeningly, as Osterholm also referenced, the vast majority of recent measles cases, which are incredibly contagious as the virus can drift in the air for a couple hours, could have been prevented. A single dose of the measles vaccine is 93 percent effective at stopping the virus, according to the CDC. For that reason alone, nearly every single parent alive has their children vaccinated (in the US, the measles vaccine is given twice, at 12-15 months old and then again at 4-6 years of age); but there’s always a small minority that doesn’t – and that is precisely what appears to be the root cause of the current problem. Generally speaking, for measles to remain in check, at least 95 percent of a given population needs to be immunized; in Europe, the percentage of people who had received a first dose dipped from 96 percent in 2019 to 93 percent in 2022.

“We actually knew this was going to happen, so it’s not news for us,” Dr. Natasha Crowcroft told the New York Times in regard to Europe’s current rise in measles cases. “There are times when there’s absolutely no pleasure in being right, and this is one of those.”

In terms of the aforementioned stateside cases, most unsurprisingly involved young children and adolescents who didn’t receive the measles, mumps and rubella (MMR) vaccine, despite being eligible. (Undoubtedly, measles is far from the only vaccine-preventable disease that looms as a major public health threat; other such diseases include polio, mumps, diphtheria, tetanus, whooping cough, and hepatitis B.) But it is important to note that the rising number of unvaccinated children may not solely be attributed to an increasing body of parents reluctant to comply with vaccine recommendations for their children – a problem that only becomes magnified when their children have returned from international travel. Another chief culprit may be the larger, socioeconomic force in play: the unfortunate reality that broad swaths of the American population, naturally those uninsured and living below the Federal Poverty Level, (never mind millions living in impoverished communities around the globe) simply don’t have access to proper healthcare, a dynamic more broadly known as health inequity. Even more so, it has been well documented that childhood vaccination rates have been on the decline in America since the onset of COVID, further broadening pre-existing gaps in vaccine participation.

This unjust situation speaks to many issues, not least of which is that health insurance remains prohibitively expensive for many Americans who are unemployed, self-employed, employed by companies that provide substandard coverage, or ineligible for Medicare and/or Medicaid. While immunizations, including those for measles, are considered preventive care and thus covered without cost-sharing under private health plans, millions of tax-paying Americans remain without adequate access to such plans. When will that change for the betterment of society?