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- [00:00]
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- [01:30]
Sam Stein
Hey everyone, it's me, Sam Stein, managing editor at the Bulwark. I'm here with Jonathan Cohn, author of the Breakdown. If you want to be depressed about the state of health in this country, that's the newsletter for you folks. Subscribe. Never an uplifting version, always a disaster. It's just what you want. John, thanks for doing this. Appreciate it. You wrote about the measles epidemic, which, you know, it's kind of been at this like slow burn a little bit in the backdrop of our politics, but it's become a real issue obviously in South Carolina, predominantly, but not just South Carolina. We had this news story over the weekend about a ICE facility that has its own measles outbreak. I want to put up a graph that shows just how bad 2026 is shaping up to be. You can see it there as we Talk compared to 2025, which was already bad. And then I'M just gonna ask you like, exactly how bad is it?
- [02:26]
Jonathan Cohn
It's pretty bad. I know we're not bringing the sunshine here, but I mean, the measles is back. I mean, that's really bad. I mean, it's bad and it's stupid. I mean, we have a vaccine. You know, we used it. Measles was a part of life once upon a time. It circulated. You know, a lot of people think, oh, measles, you know, not so big a deal. You get some rash, get a, you know, they may remember the Brady Bunch episode if you're old enough from the, you know, 1969 where the whole family got it. And you know, most people who get it will be okay after a week or two. It's not, it's not like an easy one. You get the high fever and everything. But, you know, most people get over it, but some people don't, you know, I mean, get blindness, you can get pneumonia, swelling the brain. You know, hundreds of people used to die every year for the measles. And then we got a vaccine. Woo. You know, we got the vaccine, pretty much wiped it out. And you would have cases in this country, but they were always, you know, from. Someone would go abroad and bring it back because, you know, random, you know, somebody who wasn't vaccinated. And since most people were vaccinated, we had herd immunity and it didn't spread. Well, now it's spreading. And you know, we got. Last year we had the Texas outbreak, which was big, and three people died, including two children. That hadn't happened in 10 years. And you know, children dying from a preventable when they didn't have to is really awful. I mean, that should not happen. And of course many more got hospitalized. And now we got this outbreak in South Carolina, it's getting bigger. I mean, they're logging 100 cases a week now. They're seeing it over the border in North Carolina. There's cases other parts of the country, country. And we don't know which are connected to which yet, but this shouldn't be happening.
- [04:01]
Sam Stein
From your reporting, do you get a sense of how the government is monitoring and trying to contain this?
- [04:10]
Jonathan Cohn
So it's weird. You know, first of all, the front line is always the states, right? I mean, state public health authorities are on this and they're doing, you know, they're, they're on top of this. People who run state public health departments mostly. We may talk about this in a second, but you know, most of the people who run state health departments, they're sort of, you know, they're not political people. They're doctors, they're scientists or epidemiologists. You know, they want to get this under control. They rely heavily on technical assistance and support from cdc, which my understanding is, so far they've been getting. It's hard to know for sure. I mean, you know, we saw in the Texas outbreak last year. Later, it turned out that they were real slow to get some of the support they needed. But in general, you know, there's still. There is a kind of. Even now, even after Doge, after Trump, even with Robert F. Kennedy in charge, there is still, you know, the career people at CDC who are still there are really good. They're really dedicated, and they are sort of. The technical support does seem to be getting there so far. At least that's what I'm hearing. I would not be shocked if we learn something else later. But at the top level, I mean, there's no. The messaging, you know, you would want. The measles are back. You know, we should be on top of this. We should be pushing back, saying, everyone get vaccinated. But we instead, we.
- [05:21]
Sam Stein
No, it's the opposite.
- [05:22]
Jonathan Cohn
It's totally the opposite.
- [05:24]
Sam Stein
Yeah. So I want to get to that because there's, like, a nonchalance about it from the top level. We're about to lose our elimination status this year. And there's a quote in your piece that, like, just floored me. It's from a mid January press briefing. Reporter asks the CDC Deputy director, Ralph Abraham, if he is concerned about losing the elimination status. And his response is this. Not really. He said it was the cost of doing business, quote, unquote. In a world of global travel, I'm just a simple dude. I don't really know things. But I'm pretty sure we've had global travel prior to 2025, 2026. I mean, well, we're not in 2026 yet.
- [06:05]
Jonathan Cohn
It only. It feel. It's hard to keep track.
- [06:07]
Sam Stein
It feels. It feels like we haven't left 2025. I do believe we've had global travel prior to the past year and a half. So this seems insane to me that the person who's chiefly responsible for helping with containment efforts is just like, yeah, it happens.
- [06:22]
Jonathan Cohn
So let's say he's wrong, right? I mean, it is not the cost of doing business. That is false. We, five years ago, we were, you know, we weren't about to lose elimination status. You know, we had enough protection 10 years ago. There's no reason. I mean, I quoted a couple of people, other people in the article. Jennifer Nuzzo. Nuzzo, actually, you know, one of the few. I always forget how she pronounces her last name. But she's at Brown, very well respected epidemiologist. And you know, what she said was there is no reason why a country like the United States should be having measles, you know, constant measles outbreaks anymore. That just should not be so it is not the cost of doing business. It is the cost of falling vaccination rates and an administration that at best is happy to let that happen. And you listen to people like Abraham who was against, you know, was sort of undermined, you know, when he was in Louisiana, you know, pulled back on vaccine promotion by the state even just to even like just doing clinics and things. And Obviously you have RFK Jr. With his long history of suggesting vaccines are unsafe there. And you know, again falls, you know, just picking up on constantly misrepresenting and lying about the evidence. And you know, they, I think that is the attitude right now at the top, which is that let the measles, you know, it's not the end of the world. You know, he made some comment not too long ago that, you know, we used to have measles all the time and people didn't write about in the news. Well, yeah, because we didn't have a vaccine and there was nothing you could do about it. But I, you know, I think that is, the attitude is, the attitude is, you know, they don't like vaccines, they're at best skeptical. They keep insisting there's dangers.
- [08:02]
Sam Stein
And you know, what's the latest data we have on vaccine uptick? I mean, how bad has it gotten in terms of administering the measles vaccine? Do we have actual hard numbers on it?
- [08:12]
Jonathan Cohn
We do. I mean, measles vaccination rates have been falling. I don't have the numbers on my head. The two things I know is that, you know, the threshold for herd immunity is generally considered to be 95%. And what we are seeing is we're seeing that level fall and it's not an even falling. So what you see is that in some communities and in some schools pools, it's falling far below that. And that's where the problem becomes because that's when you get these pockets where it's going to spread because, you know, you get one case. I mean, this is literally one of the most contagious diseases on the planet. So, you know, one person gets measles in a community where people aren't protected. It's going to spread quickly and again in a world where that was not a very common because we've had this for a while. We've had communities that don't vaccinate for one reason or another. Sure. But as long as they're like isolated, they're not going to spread. But now you got a lot of these communities. Well, it's going to jump. Right? People travel, go to a hotel, they go to, you know, they go to amusement parks. Right. Theaters, you name it. Indoor, any kind of indoor, you know, shopping malls. That thing's going to spread.
- [09:15]
Sam Stein
Bulwark Takes is sponsored by Seoul. I've been trying to build a nighttime routine that actually helps me unwind. Not just doom scroll until I'm exhausted. Adding a sole out of office gummy has been a game changer. Helps me quiet my mind and get cozy. Helps me ease into the evening with intention. It's such a simple shift but it's made my nights feel so much calmer and I've noticed a more restful sleep. SOL makes feeling good simple. They make delicious hemp derived CBD and THC products with precise dosing, clean ingredients and formulations designed for predictable feel good effects. SOL is the alcohol alternative that puts you in control of your mood. Their best selling out of office gummies deliver a customizable calming buzz. From a 1.5 milligram microdose for a gentle lift to the 15 milligrams dose for a deeper, more elevated experience. It's the easiest way to unwind without the grogginess or next day regret of alcohol. Give yourself the gift of a healthier unwind. Right now Seoul is offering our audience 30% off their entire order. Go to getsold.com use the code bulwark takes. That's getold.com promo code bulwark takes for 30% off. No. And it's the difference here now I think and this is to branch out into the political is that back in the day there were communities like you said that resisted vaccination. You know, they were oftentimes lefty communities that didn't want to, you know, they wanted. They were like real Maha ancestors. They didn't want put anything foreign or different in their bodies. They felt like natural immunity was the way to go. What you didn't have back then, which is a new phenomenon is political leadership and top health officials saying actually this is the proper practice. And I remember back 10 years ago, I think it was Governor Stitton Oklahoma was kind of vax skeptical openly and it was a big Scandal. People were like, what is he doing? Like, he's the governor of a state. Like, why is he talking like this? This is deeply irresponsible. And now it's, like, become a point of pride for some state officials to act this way. And never is that more true than down in Florida, where you have the state surgeon general openly insisting that it is a matter of personal choice and freedom and that to push vaccine mandates is to, I don't know, violate someone's sacred right to their own body. So let's play the clip of this. This is an old clip. What I want people to look out, to listen for is not just what he says. Listen to the applause. The applause is what really surprised me. So let's play the clip.
- [11:53]
Jonathan Cohn
What I'm most excited about is an announcement that we're going to make, that we're making now, which is that the.
- [12:02]
Sam Stein
Florida Department of Health, in partnership with.
- [12:04]
Jonathan Cohn
The governor, is going to be working to end all vaccine mandates in Florida law.
- [12:12]
Sam Stein
All of them. All of them. All of them. Every last one of them. Yeah, every last one of them. All of them. Every last one of them.
- [12:47]
Jonathan Cohn
Every last one of them is wrong.
- [12:49]
Sam Stein
And drips with disdain and slavery. So that's Joseph Ladapo. He's the surgeon General of Florida. And ironically, he does have the responsibility to tell people what they should put in their body. He's the chief medical professional for the state of Florida. His job is to advise people on how to best protect themselves, what best practices are. And if you take his logic to the nth degree, I mean, does he. Does he think that people should just be able to take whatever drugs they want? Does he think that that's, like, a smart thing to do? Would he advise people they can drink themselves, you know, to death? I mean, it makes no sense to me. Of course his responsibility is to protect people and to provide sound medical advice, but that's where we are. And the standing ovation. Could see the shadows of the people on the flags behind him because they were standing and applauding him. Goes to show you that there's a real constituency here for this stuff. Now, more recently, you can see some of the lawmakers in the state of Florida have some ambivalence about this, and maybe you could talk to that because you do have roots in the state and the state did have an effect on you, Jonathan. So what the hell is going on here?
- [13:58]
Jonathan Cohn
Yeah, my home state. So, I mean, this is the position. I mean, this is basically the position Kennedy has at hhs, too, or at Least the public position. This is the way it is being presented. As we, you know, when they, you know, when they recently pulled back on the vaccine guidelines and pulled all these shots off the list of recommended shots for children, they're like, you know, this should be up to, you know, shared, you know, decision making. You and your doctor can decide. It's not our job to be telling you what to do. And, you know, it's what they, they were like, we were telling you too much, we should pull back. Well, no, I mean, the reason we have public officials to protect health is that these are really complicated questions and we need a reliable set of authorities to guide us to interpret this evidence. Say this is what the United States government recommends, is what your state government recommends. And, you know, until very recently, it was just sort of assumed, you know, that would be a sort of mainstream scientific view, which, you know, for all these vaccines have been tested, they understand that they're effective against these diseases that are really harmful. And that's why we recommend you get them. And just to his point, just to remind people, these are. When he talks about vaccine mandates, what kind of mandates are we talking about? Well, typically we're talking about mandates to go to send your kid to public school. Those are the mandates that people think about. Or to be a health care worker. Well, that's because you're in settings, you know, you are sending your child or you are working in a setting where there are going to be people who are vulnerable to this. Remember, there are people who cannot get vaccines because they're immunocompromised. Right. I mean, you know, there are babies who are born who are very young in that period before they get the vaccines, and they've lost whatever immunity they've gotten from their mothers. They are vulnerable. And there are breakthrough cases sometimes. Some of these vaccines, most vaccines are not perfect. You can get cases now and then. So you're making, I mean, and this idea that this is all about you and you don't affect anybody else. Well, no, what, you know, the, the premise of this and this goes back, you know, there's a famous Supreme Court case from Massachusetts about this, and it's been upheld constantly, even, you know, liberal courts, conservative courts, is that, you know, you do have some obligation when you go to school, when he's in your kid to school, or you're part of the, you know, you are exposing other people. This is public health. That's what you do when you protect public health. So, you know, but this is, this is different now. I mean, Putting somebody like this in charge. Surgeon general of Florida, largest states, it's wild.
- [16:22]
Sam Stein
But you, but you pulled up an article that said the lawmakers in the state are not necessarily going to follow through on this.
- [16:27]
Jonathan Cohn
Right. So the legislature is back now and they're debating and the committee, I'm not the world's leading expert on state politics in Florida anymore, but I think it was the health committee and the state senate or the state House, I can't remember which chamber voted to advance a bill that, well, they called a medical freedom bill. And it sounded like, but it didn't actually remove any mandates. What it did was it made it easier to apply for exemptions. So, you know, just, you know, two things know about which is exemptions are already a bit of, you know, if you care about public health or bit where and then they're giving them out like candy, you know, in a lot of places and they become a kind of catch all. You know, you don't have to actually show that your religion, you know, it's a religious exemption. You don't have to show that. You know, you could go to some, you know, online church basically, or whatever and get a recommendation at the same. You know, I do think it. But this demonstrates the fact that I think these legislators, lawmakers in Florida are torn because I think a lot of them understand that these vaccines are important and useful and generally popular. Most people still want their kids vaccinated, most people support vaccination. But this has become such a political badge of honor on the right. And that's what's new here. You know, that this feedback loop where not only, you know, it used to be you were talking about before there were people on the left who were anti vaccine, there was a lot of people on the left who are anti vaccination. And now you're seeing that pop up on the right. Well, what I think is different on the right and we really didn't see this on the left before, is that at this point there are people who are turning against vaccines because that's what my political tribe believes. You know, that's what Donald Trump is saying. That's what Robert F. Kennedy Jr. Is saying. Therefore, I believe that, you know, the sort of the political identity is driving the feelings about vaccines, which I think is quite dangerous because historically vaccines were not a partisan issue.
- [18:10]
Sam Stein
The only thing I would say it's not pushback, but it is sort of a useful note here, which is so much of this is obviously a response to what happened during COVID right? And under Biden Particularly. But some of this did predate Biden. Right. Like Trump did Operation Warp Speed. But even early on, when vaccines hit the market for Covid, there was already. There was already a partisan breakdown about who was taking. You know, Republicans were much more likely to resist taking those vaccinations. So some of it was signaling, for sure, and some of it might have just been, you know, recoiling at the Biden administration for pushing the vaccine so hard. But it does seem like we're in a place where it's now become kind of internalized among conservatives that any government mandate, regardless of whether it's for, you know, buying insurance or getting a vaccine or anything that's mandating you to do something, cannot be trusted because it's coming from the government. And so we're in a bad place. I guess the only question is, is this cyclical? Right. Like, are we going to get to a place where the politics shift? And you would say, maybe, but Covid would have been the point. Right. It would have been like, oh, my God, we have this, you know, wild epidemic that's killing tens of thousands. Like, we should be supportive of vaccines. But it did the opposite. You know, we ended up in place where we are now. And it's hard to see, like, a measles outbreak in South Carolina sparking a reconsideration, but maybe.
- [19:35]
Jonathan Cohn
Yeah. I mean, I feel like if I were going to channel my JVL here, I would say we ran the experiment and it failed. I mean, you know, lots. And I say this all the time. I'm sort of. A million Americans died from COVID and we. And it's very clear that if you got vaccinated, you were much less likely to die from COVID There's no ambiguity there. And it is just written off, which is very disturbing. But, you know, I guess if I was going to be hopeful, because I always like to be hopeful in these conversations, as, you know.
- [20:07]
Sam Stein
Yes, of course. Despite what your newsletter.
- [20:10]
Jonathan Cohn
I need to write some more. Maybe we'll do something soon, right? We'll see.
- [20:17]
Sam Stein
I don't know if there's much to work with, buddy.
- [20:19]
Jonathan Cohn
Yeah. You know, Covid was such a. There was so much going on with COVID in so many different ways, and it was such a weird experience. And it came at a time when I think we have seen this sort of, you know, predating that even right now, number one, you know, we have this predating this loss of faith in institutions that's been going on for a while. Right. For reasons that have nothing to do. And Then the public health establishment did make some mistakes in Covid, I think, you know, there were some over promises. So all of that built in. I do think as we, you know, you see sort of things like the measles come back. I wonder if we won't see some backlash. I mean one thing, I don't want to steal a future newsletter, but there are these pockets all over the country of this sort of grassroots movements to push vaccines. I mean there are people making that case right now and who are sort of making the argument. You see, you can see bits and pieces of it on Instagram. There are, you know, and there are politicians also running. I mean, we'll see. I mean my story this week, right. I talked about Annie Andrews, who's a senate candidate down in South Carolina, who's a pediatrician and has really been hammering away at this. You know, tough as a Democrat to win in South Carolina, obviously. But you know, we'll see, we'll see that I may be a cyclical. So I mean I, you know, I people measles pretty bad and so are some of these other diseases pretty bad. Yeah, maybe I'll get people's attention.
- [21:39]
Sam Stein
I mean that chart is just mind blowing. It's a mind blowing chart. It's really frightening. I know people think it's not a big deal. Well, some people think it's not a big deal. But as you write in the piece, I mean there are real consequences. Loss of life for sure, but real even if you do survive it, real long term medical consequences for people get measles. And it's painful to watch because it's all self inflicted. Jonathan, thank you so much, man. I do appreciate this. Everyone in all seriousness, should be subscribed into the newsletter. It's instrumental, it's essential. There's some good topics coming up too on it. So we'll be following it. You should subscribe to it. Go. I'll talk to you later.
- [22:13]
Jonathan Cohn
Bye.
- [22:13]
Sam Stein
Okay.