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.