What will it take to get measles under control?

Summary

Consider This: What Will It Take to Get Measles Under Control?

Podcast: Consider This from NPR
Host: Ari Shapiro
Release Date: April 8, 2025

In the latest episode of NPR’s Consider This, host Ari Shapiro delves into the resurgence of measles in the United States, exploring the factors contributing to the outbreak and the strategies needed to control it. Drawing parallels with historical public health initiatives, the episode underscores the ongoing challenges in maintaining disease eradication and the critical role of effective communication and robust public health infrastructure.

Historical Context: The 1993 Measles Initiative

Ari Shapiro opens the episode with a flashback to February 12, 1993, when President Bill Clinton addressed a group of children at a public health center in Arlington, Virginia. Surrounded by children who had just received vaccinations, Clinton announced a significant federal initiative aimed at increasing childhood immunization rates.

Bill Clinton [00:08]: “We came here today to make this day a landmark and to fight to protect the health of millions of our children.”
Ari Shapiro [00:33]: “One virus was top of mind.”

This initiative led to the passage of the Comprehensive Childhood Immunization Act, which facilitated the purchase and distribution of vaccines, made them free for many children, and improved tracking of immunizations. By the end of Clinton’s presidency, the World Health Organization had declared the elimination of measles in the United States, a public health milestone that stood for 25 years.

The Current Outbreak: West Texas and New Mexico

Fast forward to 2025, and measles has made an unsettling comeback. The outbreak is centered in West Texas, particularly in Lubbock, and has spread to neighboring states like New Mexico. To date, there have been approximately 500 cases, including two child fatalities.

Ari Shapiro [01:34]: “Katherine Wells is the director of public health in Lubbock, a city near the heart of the current measles outbreak in West Texas.”
Katherine Wells [01:42]: “The uptake for vaccines definitely been a struggle. I mean, I want to be honest with that.”

Adding to the crisis, the federal Department of Government Efficiency (DOGE) announced the termination of hundreds of millions of dollars in grants to the Texas Department of State Health Services, directly impacting cities like Lubbock that rely on these funds to combat the outbreak.

Ari Shapiro [02:54]: “Consider this. 25 years after measles was officially eliminated in the US, the disease is once again spreading in West Texas and New Mexico.”

Challenges in Controlling Measles: Vaccine Uptake and Funding Cuts

The episode highlights two primary challenges in controlling the current measles outbreak: low vaccination rates and significant funding cuts to public health programs.

Katherine Wells [01:48]: “The uptake for vaccines definitely been a struggle. I mean, I want to be honest with that.”

The reduction in federal support has forced local health departments to operate with diminished resources, making it increasingly difficult to contain the spread of the virus.

Expert Insights: Dr. Caitlin Rivers on Communication and Infrastructure

Dr. Caitlin Rivers of the Johns Hopkins Bloomberg School of Public Health provides a comprehensive analysis of what is needed to control the measles outbreak.

Dr. Caitlin Rivers [04:55]: “There are two things we need to see in order to get this crisis under control. One is clear and frequent communication. I think we could be doing better on that front.”

Rivers emphasizes the importance of consistent and clear messaging from the federal government about the importance of vaccination. She also points out the dire state of public health funding:

Dr. Caitlin Rivers [05:35]: “The majority of Americans live in counties that spend less than $150 per year per person on public health. A single outbreak can really blow that budget for the year.”

Rivers draws inspiration from historical public health victories, such as the eradication of smallpox, to illustrate what sustained effort and support can achieve.

Dr. Caitlin Rivers [06:34]: “Smallpox was an absolute horror. It killed up to a third of people it infected... And through years of dedicated boots on the ground, community by community, efforts to vaccinate, we drove that virus off the face of the earth.”

The Role of Federal Leadership and Messaging

A critical part of the conversation focuses on the role of federal leadership in public health crises. Despite past vaccine skepticism, recent statements by HHS Secretary Robert F. Kennedy, Jr. have been pivotal.

Dr. Caitlin Rivers [06:52]: “I think we need to keep it coming... reaching people is really about communicating frequently and clearly.”

Rivers advocates for a sustained and repetitive messaging strategy to counteract the fragmented information landscape and ensure that accurate information about vaccinations reaches all communities.

The Importance of Public Health Infrastructure

The episode underscores the vulnerability of the current public health infrastructure, which has been weakened by years of underfunding and personnel cuts.

Dr. Caitlin Rivers [07:25]: “They have had to lay off personnel as a direct result of those cuts... we'll see more of these preventable outbreaks resurging.”

Rivers warns that without adequate funding and support, the ability to respond effectively to outbreaks will continue to deteriorate, leading to more frequent and severe public health crises.

Elimination Status and Its Significance

Ari Shapiro poses a poignant question about the significance of measles’ elimination status, given the ongoing outbreak and fatalities.

Ari Shapiro [07:47]: “Why does it matter whether it is officially, formally declared to have been eliminated or not?”

Dr. Rivers responds by emphasizing that while elimination status is a technical term, the real concern lies in the tangible impacts on public health.

Dr. Caitlin Rivers [08:07]: “Elimination status is a reflection... it signals that something's gone wrong with our public health system.”

Maintaining elimination status is not just a bureaucratic achievement but a testament to the effectiveness of public health measures and the need to uphold them to prevent disease resurgence.

Conclusion: Path Forward for Measles Control

The episode wraps up with a call to action emphasizing the need for increased funding, better communication, and unwavering commitment to vaccination efforts. By learning from past successes and addressing current shortcomings, public health officials aim to steer the nation back towards measles elimination and prevent future outbreaks.

Ari Shapiro [08:32]: “That was Dr. Caitlin Rivers of the Johns Hopkins Bloomberg School of Public Health.”

Consider This effectively highlights the complexity of managing infectious diseases in the modern era, balancing historical lessons with current challenges to outline a path forward in public health.

Transcript

[Ari Shapiro]

On February 12, 1993, President Bill Clinton took the lectern at a public health center in Arlington, Virginia.

[Bill Clinton]

Thank you.

[Ari Shapiro]

He was surrounded by kids sitting on the stage in front of him. Some had just received vaccinations. Clinton was just a few weeks into his presidency and he was announcing what would become a major initiative of his first term, a massive push by the federal government to vaccinate children.

[Bill Clinton]

We came here today to make this day a landmark and to fight to protect the health of millions of our children.

[Ari Shapiro]

One virus was top of mind.

[Bill Clinton]

The recent resurgence of measles in our country afflicted over 55,000 people, most of whom were children.

[Ari Shapiro]

Remember, this was 1993. A prolonged measles outbreak between 1989 and 91 killed more than 100 people and sickened tens of thousands. A federal advisory committee found that pricey vaccines, cuts to federal support for vaccination, and low vaccination rates among young children had caused the outbreak to be so severe. This is what Clinton wanted to fix. So did lawmakers. Six months after that event at the public health center, Congress passed Clinton's Comprehensive Childhood Immunization Act. The law helped the government purchase vaccines and negotiate prices with drug manufacturers. It made vaccines free for many children and helped the Department of Health and Human Services track childhood immunizations. By the end of Clinton's second term in office, the World Health Organization had declared the elimination of measles in the United states. Fast forward 25 years.

[Katherine Wells]

This is going to be a large outbreak and we are still on the side where we are increasing the number of cases.

[Ari Shapiro]

Katherine Wells is the director of public health in Lubbock, a city near the heart of the current measles outbreak in West Texas.

[Katherine Wells]

The uptake for vaccines definitely been a struggle. I mean, I want to be honest with that.

[Ari Shapiro]

So far, there have been around 500 cases in West Texas. Since late late January, two kids there have died. The outbreak has spread to neighboring states, including New Mexico. On top of that, the federal Department of Government Efficiency, or doge, announced it would terminate hundreds of millions of dollars in grants to the Texas Department of State Health Services. Lubbock is one of the cities which will lose that Money. Consider this. 25 years after measles was officially eliminated in the US the disease is once again spreading in West Texas and New Mexico. What can be done to get the virus under control? From npr, I'm Ari Shapiro.

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[Ari Shapiro]

It's Consider this from NPR the last major measles outbreak in the US was 2019. More than 1200 people got sick at the time. NPR spoke with Anthony Fauci, who was then head of the National Institute of Allergy and Infectious Diseases.

[Anthony Fauci]

People sometimes incorrectly and inappropriately think that to get infected with measles is a trivial disease. It is not. It can be very dangerous because if you look at the history of measles prior to vaccinations that were available throughout the world, there were a couple of million deaths per year.

[Ari Shapiro]

Now you might wonder how the US could still be said to have eliminated measles when there are hundreds of cases. Well, in public health, elimination is a technical term. Specifically, it means the disease has not had a steady 12 month spread.

[Dr. Caitlin Rivers]

We're only about four months into 2025, so it's a long way off before we're in that kind of scenario. But certainly the longer the virus circulates, the more chance that we'll run up against that outcome.

[Ari Shapiro]

That's Dr. Caitlin Rivers of the Johns Hopkins Bloomberg School of Public Health. She just wrote a book called Crisis Averted about the history of public health victories, and I asked her what the US Needs to do to avert this crisis.

[Dr. Caitlin Rivers]

There are two things we need to see in order to get this crisis under control. One is clear and frequent communication. I think we could be doing better on that front. State and local communities are doing what they can to communicate, but I don't think that the messaging coming out of the federal government has been as clear as it needs to be about the importance of vaccination. The other thing that concerns me is funding and support for our public health infrastructure. The majority of Americans live in counties that spend less than $150 per year per person on public health. A single outbreak can really blow that budget for the year. And so if we are asking states and locals to take on more responsibility for outbreak Control. We need to resource them to do that.

[Ari Shapiro]

From your research on the book, is there a specific example of a public health victory that you think is especially useful here today?

[Dr. Caitlin Rivers]

My favorite is the example of the eradication of smallpox, which I think is one of history's and humanity's greatest achievements. Smallpox was an absolute horror. It killed up to a third of people it infected. Survivors were left often with lifelong disabilities. And through years of dedicated boots on the ground, community by community, efforts to vaccinate, we drove that virus, the smallpox virus, off the face of the earth. And it has not circulated for 50 years. And what I love about that story is it really shows what we as a global community, as a public health community, can accomplish when we set our mind to these big goals and have the funding and the political support to go after them. And, you know, measles, too, we. We successfully eliminated it, and I would hate to see that take a step backward.

[Ari Shapiro]

You said messaging from the federal government isn't as clear as it needs to be. Of course. HHS Secretary Robert F. Kennedy, Jr. Has a long history of vaccine skepticism. Earlier this week, he said the MMR vaccine is the most effective way to prevent the spread of measles. Do you think that message did what it needed to do?

[Dr. Caitlin Rivers]

I think we need to keep it coming. The information landscape is very fractured. People get their news from all sorts of places. They tune in, they tune out. And so reaching people is really about communicating frequently and clearly. And so I'm really heartened to hear that message from Secretary Kennedy. But I do think it needs to become a pattern or a cadence of that kind of messaging.

[Ari Shapiro]

And on funding, we have seen widespread cuts across the government, including in the public health establishment. Do you think that is going to trickle down to states that need resources to fight measles outbreaks?

[Dr. Caitlin Rivers]

Absolutely, and I wouldn't be surprised if it already has. There were cuts to public health programs that directly affected states and local public health governments. They have had to lay off personnel as a direct result of those cuts. And I think we'll continue to see more, and I think as funding declines, we'll see more and more of these preventable outbreaks resurging.

[Ari Shapiro]

Just to return to the question of whether a country is declared to have measles eliminated, if you've got children dying of the disease, if you have regular outbreaks, if you are not doing everything that could be done to fight this disease, why does it matter whether it is officially, formally declared to have been eliminated or not?

[Dr. Caitlin Rivers]

Well, we care most about what's happening on the ground. So as you know, the fact that there are children who are dying of this preventable infection, and there are dozens of people who have been hospitalized, that's really the thing that matters. But elimination status is a reflection or a testament to our ability to control these preventable viruses. And so losing elimination status would be a blow because it signals that something's gone wrong with our public health system.

[Ari Shapiro]

That was Dr. Caitlin Rivers of the Johns Hopkins Bloomberg School of Public Health. We had additional reporting from Olivia Aldridge of member station KUT in Austin. This episode was produced by Noah Caldwell and edited by Courtney Dorning. Our executive producer is Sami Yenigun. It's Consider this from npr. I'm Ari Shapiro.

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