What Measles Outbreaks Tell Us About Public Health In America

Summary

Fresh Air: What Measles Outbreaks Tell Us About Public Health In America

Hosted by NPR's Tanya Moseley, Fresh Air delves into pressing public health issues with expert guests. In the February 18, 2025 episode titled "What Measles Outbreaks Tell Us About Public Health In America," pediatrician and infectious disease expert Dr. Adam Ratner discusses the resurgence of measles, the challenges facing public health infrastructure, vaccine skepticism, and the implications of recent policy changes.

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Introduction: The Return of Measles

The episode opens with Tanya Moseley introducing Dr. Adam Ratner, a respected professor of pediatrics and microbiology at NYU Grossman School of Medicine and the director of the Division of Pediatric Infectious Diseases at Hassenfeld Children's Hospital and Bellevue Hospital Center. Dr. Ratner's new book, Booster: The Urgent Lessons of Measles and the Uncertain Future of Children's Health, serves as the foundation for their discussion.

Tanya Moseley [00:33]:
"Measles isn't just inconvenient. It is highly contagious and can lead to serious complications, including pneumonia, brain inflammation, blindness and even death."

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Measles: An Indicator of Public Health Resilience

Dr. Ratner explains that measles was declared eliminated in the United States 25 years ago, marking a significant victory for pediatricians and public health officials. However, recent outbreaks signal deeper systemic issues.

Dr. Adam Ratner [02:48]:
"Measles thrives on being underestimated... When we start to see measles, it's evidence of faltering of our public health systems and fomenting of distrust of vaccines."

He recounts the 2018-2019 New York City measles outbreak, which saw approximately 650 cases, highlighting the virus's capacity to exploit weaknesses in public health infrastructure.

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The Impact of Robert F. Kennedy Jr.'s HHS Appointment

A significant portion of the conversation addresses the Senate's confirmation of Robert F. Kennedy Jr. as the head of the Department of Health and Human Services (HHS). Known for his vaccine skepticism, Kennedy's appointment raises alarms about the future of vaccine policy and public trust.

Dr. Adam Ratner [07:51]:
"It's very disconcerting... I worry about vaccine confidence, which many of us have worked for years and years and years to build."
[07:51]

Ratner expresses concern that Kennedy's history of undermining vaccine infrastructure could destabilize ongoing public health efforts.

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Vaccine Confidence and Communication Challenges

The discussion shifts to the decline in public trust in vaccines, exacerbated by figures like Kennedy and historical incidents that have eroded confidence in medical institutions.

Dr. Adam Ratner [24:41]:
"Parents who are hesitant about vaccines... these are people who love their kids. These are not people who want harm to come to their children."
[25:46]

Ratner emphasizes the importance of empathetic communication, noting that combating misinformation requires understanding and addressing parents' concerns without judgment.

Navigating Historical Distrust in Medicine

Dr. Ratner delves into past events that have sown seeds of distrust in the medical community, such as the Tuskegee syphilis study and unethical vaccine trials. These incidents contribute to the current climate of vaccine skepticism.

Dr. Adam Ratner [23:09]:
"There were trials of vaccines and trials of other kinds of medication that were carried out in institutions for children, and those were not carried out with the ethical standards that we would expect today."
[23:09]

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NIH Funding Cuts: A Threat to Public Health Research

A critical issue raised is the recent executive order capping National Institutes of Health (NIH) funding, which poses a significant threat to ongoing medical research and public health initiatives.

Dr. Adam Ratner [18:50]:
"The biomedical research enterprise in the United States is incredible... The executive order capping NIH indirect costs... is going to be an enormous budgetary strain on universities and other research institutions."
[18:50]

Ratner warns that these funding cuts could lead to job losses, reduced research capabilities, and hindered progress in combating infectious diseases.

---

Avian Bird Flu: Emerging Public Health Concern

Beyond measles, Dr. Ratner addresses the spread of avian bird flu (H5N1) across all 50 states, affecting humans in nearly a dozen states. He underscores the necessity of robust surveillance systems to monitor and respond to such outbreaks.

Dr. Adam Ratner [33:00]:
"Avian flu has the potential to affect humans and has made some humans sick already in the current outbreak. We need ongoing surveillance and we need to understand the extent of the problem."
[33:00]

---

Excerpt from Booster: The Role of Memory in Public Health

Dr. Ratner shares a poignant excerpt from his book, highlighting how societal forgetfulness about diseases like measles undermines public health efforts.

Dr. Adam Ratner [34:39]:
"A fundamental issue in how we think about measles is memory... Measles thrives both within the body of an individual and in a society, making decisions about whether to prioritize vaccination."
[34:39]

This reflection underscores the cyclical nature of disease resurgence when vigilance wanes.

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Strategies to Combat Misinformation

In response to the pervasive spread of misinformation, Dr. Ratner advocates for trusted relationships between pediatricians and families as a cornerstone for rebuilding vaccine confidence.

Dr. Adam Ratner [36:21]:
"I think that pediatricians being trusted sources and about personal family to family type discussions... That's it."
[36:21]

He acknowledges the challenges but remains hopeful that personalized communication can counteract the widespread misinformation landscape.

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Conclusion: The Fragile State of Public Health

The episode concludes with Dr. Ratner emphasizing the precarious achievements in public health, cautioning that current policy changes and rising misinformation could reverse decades of progress in controlling infectious diseases.

Dr. Adam Ratner [17:08]:
"The successes that we have and the point that we are at in children's public health is not guaranteed. I am worried that actions taken in the next year, two years, may have long lasting effects on the health of children."
[17:08]

Tanya Moseley wraps up the conversation by highlighting the urgency of addressing these multifaceted challenges to safeguard the future of children's health.

---

For listeners seeking to understand the complexities of public health in the modern era, Dr. Adam Ratner's insights offer a sobering yet actionable perspective on safeguarding against the resurgence of preventable diseases.

Transcript

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[Tanya Moseley]

I'm Tanya Moseley. Last week, the Senate confirmed Robert F. Kennedy, Jr. Who has historically been a vaccine skeptic, as President Trump's head of the Department of Health and Human Services. Today we're gonna be talking about the importance of vaccines amid the growing avian bird flu and measles spread with pediatrician and infectious disease expert Dr. Adam Ratner. 25 years ago, measles was declared eliminated in the United States. It was a long fought win for pediatricians and researchers and those who work in infectious diseases. Today, however, measles is back. And Dr. Ratner says the resurgence points to a larger, more significant problem for public health. Measles isn't just inconvenient. It is highly contagious and can lead to serious complications, including pneumonia, brain inflammation, blindness and even death. Dr. Ratner's new book, Booster the Urgent Lessons of Measles and the Uncertain Future of Children's Health, warns that as the number of vaccinations in children decreases and the lack of public trust in science increases, the resurgence of illnesses like measles is a foregone conclusion. Measles, like many communicable diseases, Ratner says, is a biological agent that preys on human inequity, thriving on conditions of chaos, colonialism and war. Dr. Adam Ratner is a professor of pediatrics and microbiology at NYU Grossman School of Medicine and the director of the division of Pediatric Infectious Diseases at Hassenfeld Children's Hospital and Bellevue Hospital Center. We recorded this conversation last week. Dr. Ratner, welcome to FRESH AIR.

[Dr. Adam Ratner]

Thanks so much. Delighted to be here.

[Tanya Moseley]

Well, your book is very relevant. President Trump has announced significant funding cuts for the nih, the National Institutes of Health, which will have a direct impact on medical research. The anti vax movement continues to grow. There is still this disbelief in science and research that we are seeing. And you have made it your life's work to study and treat infectious diseases. Why did you want to tell the larger implications of what we're seeing through this story of measles When I first.

[Dr. Adam Ratner]

Started writing the book, the question that I got most often was, why measles? Because I think a lot of people I talked to thought of measles as a solved problem. And really, so did I. And that's kind of the encapsulation of the measles story, put very simply in the sense that measles thrives on being underestimated. So all throughout my training, I learned to take care of children with all sorts of diseases. And then as I focused on infectious diseases, I learned to take care of kids with complicated infections and sometimes with unusual infections. And measles was something that in my mind had been filed under solved problems. It was a thing that we had had a vaccine for since the mid-1960s and that we very, very rarely saw. I saw a handful of cases in my training, and then in 2018 and 2019, we had a huge measles outbreak in New York city with about 650 cases and some kids who were very, very sick. I took care of children in intensive care units due to complications of measles. And that was the point at which I dug deeper into the meas. And I realized that there was so much here that people don't think about, and that when we start to see measles, it's evidence of faltering of our public health systems and fomenting of distrust of vaccines. And that measles outbreaks and measles cases are so much more than just the. The rash that you see.

[Tanya Moseley]

Right. You know, I mean, I talked about how confidence in medicine and public health may actually be at an all time low, which is very interesting because the pandemic showed us how infectious disease spreads. We watched a vaccine be developed, and we also saw all of the inequities that a crisis like that revealed about who has access to medical care and vaccinations. I assume this is also what keeps you up at night as you think about measles being an indic.

[Dr. Adam Ratner]

Absolutely. I mean, I think the pandemic we all experienced together, but we each experienced in kind of a different way. The way that I experienced it was in the hospital taking care of children with COVID and some children who were very sick from it. And also, of course, in my home life, worried about my wife, worried about my daughter, worried about my parents. And I think we all got to see the evolution of a pandemic, which is something I had never seen before. We also got to see an incredible scientific triumph, which was the development of the MRNA COVID 19 vaccines. And I think Back to how I felt when those first trials of the MRNA vaccines came out. And they were enormously effective against hospitalization and disease, and they still are. And they were highly effective against catching COVID 19, although that effect is limited in time, which we didn't know then, and we didn't know then that boosters would be necessary. But there was such a feeling of relief when I saw those data. And I remember the moment I got my first dose of the MRNA vaccine. I remember the day my wife got hers. I cried, I cried when my daughter got hers because I felt like we had won. Like I felt like science had saved us, vaccine science had saved us. And in the back of my mind I thought, this is the end of the anti vaccine movement. Like, how do they possibly recover from everyone in the world seeing what we can do? And of course, looking back now, five years after the start of the pandemic, I was naive and I was wrong at that time about how the anti vaccine movement would respond to the COVID 19 vaccines and where we would be just a few years later.

[Tanya Moseley]

Now that we're several years past that. What do you make of the growth in the movement? We now have Robert F. Kennedy Jr. Who is now a voice that many American people listen to and feel. They feel hopeful that someone like this actually will be in a high office.

[Dr. Adam Ratner]

To start, I want to be clear that my comments about RFK and about everything that we talk about today are my personal opinion and aren't meant to represent the institutions I work for or anyone else I'm affiliated with. The. It's very disconcerting, it's very disturbing that someone who has spent so much of his career trying to undermine confidence in vaccines, trying to tear down the infrastructure that approves and recommends vaccines, has the potential to be in a position of power over the infrastructure that has those goals. I worry about vaccine availability in the United States, but more than that, I worry about vaccine confidence, which many of us have worked for years and years and years to build. And as mentors of mine have said many times over the years, it is much easier to scare people than to unscare them. And I think, I think that just by elevating anti vaccine views in the guise of rfk, I think that we risk a crisis in vaccine confidence in.

[Tanya Moseley]

The U.S. you're also saying it's why it's an important thing to look at children's health as we think about the health of larger society. And something really interesting as you describe all of those past communicable diseases whooping cough, polio, all of those things that have been eradic. You actually describe measles as this quintessential human pathogen because it teaches us about ourselves and namely, our capacity to learn, but also to forget. So anybody who was born before the 1970s, you will have a very different discussion about the value of immunizations, because they saw many of those diseases in real life. But today, some of the skepticism does come from not being able to see it. I'm just wondering for you, as a doctor, how do you manage that with your patients who have real concerns about side effects when it comes to vaccinations, in part because they've never even seen many of these diseases when they were in society?

[Dr. Adam Ratner]

That is the crux of what I was trying to get at in the book. I trained in pediatrics and then in infectious diseases at this incredible inflection point, where the generation before mine had seen diseases that I was not seeing as a resident. There were things that vaccines just made disappear between that generation and my generation. So there was a horrible disease called Hib, which is a bacterium that can cause sepsis and pneumonia and meningitis and death in children. There were a couple hundred thousand cases of this in the United States every year. And pediatricians worried about Hib all the time. When my mother trained. So my mother, also a pediatrician a generation before me, she had tons of patients with Hib, and she lost patients with this disease. And then in the late 1980s, a Hib vaccine came out. It was widely adopted, and I did not see a single case over the course of my training. And so there was this. It was like a switch. There was this incredible power of vaccines that was visible right in front of me in real time. But if you look at people who are parents today and people who may have questions about vaccines and are weighing risks and benefits, which is a fully reasonable thing for parents to do, they may say, I've never seen someone with polio. I've never seen someone with whooping cough. One person says that there are side effects of the vaccine. The other person says that there aren't. Why would I take a chance by giving the vaccine for something I've never. I've barely heard of? And the answer to that, of course, is that you've never seen these things. You've never heard of these things because of vaccines. But that's a hard thing to communicate. And it's sort of the difference between. I found this during the measles outbreak in 2018, 2019, talking to the parents of the Children with measles. And talking to the grandparents of those children was entirely different. The grandparents had seen tons of children with measles. They had probably had measles themselves. Their kids had had measles, and they knew that even though most kids do fine with measles and are better after about a week, there are rare cases where children have to go to the hospital, they have pneumonia, and occasionally, unfortunately, they die.

[Tanya Moseley]

You know, I'm just thinking about what we see in media, in television shows and movies. Measles is always portrayed as, like, this nuisance, almost like chickenpox. Why is it so hard to control once it's spread?

[Dr. Adam Ratner]

So measles is the most contagious disease that we know of. It is more contagious than flu. It is more contagious than polio. It's more contagious than Ebola. It's more contagious than Covid. But in a susceptible population, measles can infect 90% of the population easily. If someone with measles walks into a room of people who have not been vaccinated and haven't had measles before, 90% of those people will get infected with measles from that one person. And that is much more infectious than most things that we generally deal with. And so it's a. And so measles is a. An indicator for whether there is vaccination going on, whether people are protected, because it is so very infectious. The. The thing about measles is that most kids with measles do fine, but there are these rare effects. There are kids who get pneumonia. There are kids who die of measles. You know, one or two in a thousand children who get measles will die. One or two in a thousand children who get measles will have encephalitis, which is swelling of the brain, and that can lead to deafness or seizures or other bad outcomes. And it's, you know, if you're one family, you may not ever have known someone who had one of those bad outcomes. And so usually when kids get sick, they feel sick for a week, and then they get better. And so that was most people's experience with it. If you listen to RFK talk about his experience with the measles, what he says is that, oh, it was. You know, my 10 siblings and I all had measles at the same time. It was a week off from school, and we got to watch television and eat soup. Yeah, so that's fine. But he also comes from the most privileged background imaginable. And that is not everyone's experience of measles.

[Tanya Moseley]

You know, actually in 2019, there was this measles epidemic, as you know, that killed 80 children in Samoa. And Robert F. Kennedy, Jr. Actually wrote to the country's prime minister and made this false claim that the measles vaccine was probably causing the people there to die. What are your biggest concerns about Kennedy being tasked with leading the nation's biggest health agency?

[Dr. Adam Ratner]

I have many concerns about that. My greatest concern is that he will harm or disable the vaccine infrastructure, that he will make vaccines unavailable to people who want to get them, and that he will make people who are unsure of whether they should vaccinate their children feel like they should not vaccinate their children. I think he has spent a lot of his adult life fighting against vaccines, and I see no reason that that is going to stop.

[Tanya Moseley]

What are you thinking about as you think about a path forward and what this agency might mean for children's health and vaccinations?

[Dr. Adam Ratner]

I think about how hard it has been to get to the point that we're at right now. And I think the most important message that I want to come across from my book is that we live in a time when children, for the most part, grow up happy and healthy and where infectious diseases that used to kill large numbers of children have been brought under control through vaccines. And that has been through a tremendous amount of work. And some of that has been scientific work, but some of that has also been policy work in building an infrastructure that can withstand fluctuations in funding and can provide support for getting vaccines to children whose families may not be able to afford them, and all sorts of other things that have been built over time. The successes that we have and the point that we are at in children's public health is not guaranteed. And I am worried that actions taken in the next year, two years, may have long lasting effects on the health of children, not just in the United States. I think it will be in the United States first, but I think worldwide.

[Tanya Moseley]

Can you talk a little bit more about the latest action from the National Institutes of Health, which is now capping funding for medical research at medical schools and universities? How does this impact the fight to keep infectious diseases at bay, as we.

[Dr. Adam Ratner]

Were talking about with the infrastructure for vaccine delivery? The biomedical research enterprise in the United States is incredible. And there have been advances that have helped all Americans. And we would never have had the COVID 19 vaccines without NIH research. We would never have the chemotherapies that we have or the gene therapies that are emerging to cure diseases. That is, all of those advances are built on the back of NIH funded basic research. It is absolutely critical to people's health in both the short and the long term. I think that the executive order capping NIH indirect costs at 15% and making it effective immediately and apply to existing grants is going to be an enormous budgetary strain on universities and other research institutions. And it has the potential to have people lose their jobs, to drive scientists out of the field, to have universities shut down labs that they can't afford to run because they haven't budgeted for this abrupt change. And I think that the effects of this may be long lasting.

[Tanya Moseley]

Our guest today is Dr. Adam Ratner. We recorded this conversation you're hearing last week about his new book, booster the Urgent Lessons of Measles and the Uncertain Future of Children's Health. We'll be right back after this break. I'm Tanya Mosley and this is FRESH.

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[Dr. Adam Ratner]

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[Tanya Moseley]

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[Dr. Adam Ratner]

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[Tanya Moseley]

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[Dr. Adam Ratner]

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[Tanya Moseley]

Hi, this is Molly Sivi Nesper, digital producer at FRESH air.

[Dr. Adam Ratner]

And this is Terry Gross, host of the show.

[Tanya Moseley]

One of the things I do is.

[Dr. Adam Ratner]

Write the weekly newsletter and I'm a newsletter fan. I read it every Saturday after breakfast. The newsletter includes all the week shows, staff recommendations and Molly picks, timely highlights from the archive. It's a fun read.

[Tanya Moseley]

It's also the only place where we tell you what's coming up next week.

[Dr. Adam Ratner]

An exclusive, so [e-mail] Fresh Air and look for an email from Molly every Saturday morning.

[Tanya Moseley]

One of the things that we also don't talk about a lot is faith. And what I mean by that is faith that the system will actually work for our benefit. So you actually tell a story of how the vaccine trial for polio in 55 was really a high watermark for public enthusiasm. Then President Carter came into office and relied on that accumulated goodwill as they tried to eradicate some of these childhood diseases like measles. But as we move through time, I'd also love to just slow down a little bit and talk about some of those moments in the 80s and 90s that really shook our trust in government decision making as it relates to our health and well being.

[Dr. Adam Ratner]

There were a few things. There was the unmasking of the Tuskegee syphilis study, in which government scientists had observed as black men with syphilis had gone through the stages of disease and not provided them with medication that was available and was known to work. And when that came to light, that generated, and still does, very reasonably, a tremendous amount of mistrust in the government and in scientists. And there were other smaller scale incidents that also shook people's trust. There were trials of vaccines and trials of other kinds of medication that were carried out in institutions for children, and those were not carried out with the ethical standards that we would expect today and in some cases with no informed consent at all. And some of these trials were horrific and should never have been allowed to happen. And I think when those came to light, there was a growth of distrust in medicine as a whole. And I think that that hindered people's trust in vaccines at the time as well.

[Tanya Moseley]

I'm really curious how you manage the distrust as you interface with parents and legislators and all types of people. Because you said something earlier that I thought was really interesting. You said, like, once you scare the public, you can't unscare them. Like, it's really hard to dial that back. And that had me thinking about discredited academic Andrew Wakefield, who, as folks may know, the medical journal Lancet in 1998 published a paper from Wakefield that promoted this fraudulent hypothesis that the MMR vaccine, measles, mumps, rubella, could cause previously healthy children to develop a form of autism. And while that has widely been discredited, it also seemed like a flashpoint as well. I learned about it as a mother in 2007. This had been discredited years before, but there was still such a debate about it, a strong debate in belief. How do you deal with that growth of mistrust in the conversations that you have with parents and others.

[Dr. Adam Ratner]

It's not easy. I think that pediatricians still, even today, I think, are in a place of trust for most families. I think that very reasonably, most families think that those of us who have devoted our lives, our careers to taking care of kids and trying to keep them safe, even if they don't implicitly trust us, they realize that we bring something valuable to the conversation. And so I think it's really important to use that trust wisely. And I think the other thing that sometimes gets lost is that, and this is a conversation I have with my colleagues a lot, parents who are hesitant about vaccines and parents who are frankly anti vaccine. These are people who love their kids. These are not people who want harm to come to their children. It's the opposite. There is nobody who is on Team Disease. There's nobody who wants a child to get sick. And I think that for me, that's the grounding point. You know, that's the place where I think that I or any other pediatrician can come together with a family and then we can talk about the details and we can talk about balancing risks and benefits, which is something that we all do all the time. And often with not enough information for people to feel entirely comfortable. Some of it is talking about the diseases that we're trying to prevent, which can get minimized in anti vaccine rhetoric, but can be really serious. I'm old enough that I'm able to use my personal experience often in those conversations. I've seen a lot of the diseases, although not all of them, that we vaccinate against. And I think building that trust and building on the fact that we're all pulling for the same thing is the most important piece of the conversation. But it's hard and it's usually not one conversation.

[Tanya Moseley]

Not one conversation. And do you feel that you've been successful?

[Dr. Adam Ratner]

Variably so. I'm not a primary pediatrician. I am an infectious disease specialist and I see kids in the hospital. So I see families at kind of a different time than their primary pediatricians do. And the primary pediatricians are really the heroes in this piece of things. Like, I think they're the ones who have repeated conversations with families who develop trust over time and who can help families take in good science based messaging and help bring them around to vaccination. I see parents at a different time. There is no family who wants to be where I work, which is a joke.

[Tanya Moseley]

You're at a critical time. Yes.

[Dr. Adam Ratner]

And so I sometimes have families I sometimes have conversations with families who are in the hospital because their child has a vaccine preventable disease. And that's a different conversation. And it's one that can very easily go south in the sense that people can often feel like they're being blamed, which is never my intention. And people can feel like it's not an appropriate conversation to have at the time. And I think it's a conversation that needs to be had, but it needs to be done carefully, like you need to choose your words carefully. It needs to be done with empathy, because when I'm seeing children, it's usually because they have a child who's sick enough to be in the hospital. But it needs to be done clearly, because the story that this family is going to tell themselves and tell their relatives and their friends about what happened may hinge on how you talk about vaccines in that moment.

[Tanya Moseley]

Let's take a short break. If you're just joining us, my guest is pediatrician and infectious disease expert Dr. Adam Ratner. He's written a new book called Booster the Urgent Lessons of Measles and the Uncertain Future of Children's Health. We'll continue our conversation after a short break. This is FRESH air.

[Dr. Adam Ratner]

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[Tanya Moseley]

That after the success of the COVID vaccine that there is this rising skepticism? We got to see all of the advancements come to fruition just in those few years, and yet there's more skepticism than ever.

[Dr. Adam Ratner]

That came as a surprise to me, and it is unbelievable to me now, five years after the start of the pandemic that we are in the situation that we're in. I thought that we would be in a place where vaccine skepticism was rare and where people had gotten to see firsthand the incredible beneficial effects of vaccination on the population. And, you know, the COVID vaccines saved millions and millions of lives. And they are an incredible success story. And amazingly, that's not the story that is generally being told, and it's not the story that most people believe.

[Tanya Moseley]

I also want to ask you, while I have you, about the bird flu, also known as the avian flu and H5N1. It is now present in all 50 states, impacting humans in about almost a dozen states. What should we be worried about?

[Dr. Adam Ratner]

So I think that there are a couple of things to be concerned about here, and I think that first and foremost, what we know about the avian flu and how it has spread and the situation that we're in right now is because there is a robust surveillance system. And it points to the importance of funding for CDC and for state and local health departments to do that crucial work. That is the only reason that we know what's going on. I think that avian flu has the potential to affect humans and has made some humans sick already in the current outbreak. I think that we need ongoing surveillance and we need to understand the extent of the problem and to be able to do things like rapidly type the flu strains that people have when they go to their hospitals or go to doctors. It is something that is done sometimes now, but a lot of our diagnostics don't tell us exactly what sort of flu someone has, and that's important to understanding the scope of the problem. But really what needs to happen is strengthening and keeping them strong of public health systems in order to keep this under control.

[Tanya Moseley]

Dr. I think I'd like to end our conversation by having you read an excerpt from your book.

[Dr. Adam Ratner]

A fundamental issue in how we think about measles is memory. In the same way that the measles virus kills the cells that are the keepers of immune memories, our temporary successes and competing priorities distract us from the toll that it continues to exact of every year. When we forget. Measles thrives both within the body of an individual and in a society, making decisions about whether to prioritize vaccination. Both kinds of amnesia leave us vulnerable to a host of conditions beyond measles. Measles is a master at infiltrating and revealing the cracks in our human systems. When we forget to use the tools that we have, when we allow anti scientific voices to influence policy, when we ignore the places that it is difficult to deliver care, there it is. For all these reasons, you can think of measles cases as a probe for whether we are paying attention. As outbreaks pop up, we should ask ourselves what we could have done better and what other warning signs we are ignoring. While measles is often first, it is a harbinger of problems to come.

[Tanya Moseley]

You close this book by taking a moment to think about the two battles that we are facing, the war against the pathogen and the fight over information, like fighting fake news and wrong information. What should be our strategy to fight that second fight? And does it feel insurmountable or all of this history that you have compiled for this book, does it show us a way?

[Dr. Adam Ratner]

This is the prime problem of modern public health communication. It is a different world than it was in the stories that I told about the measles vaccine development and vaccines for children and things like that. Where there were limited news sources, there was often collaboration between public health entities and news outlets. And now we're in a very different situation where there is unlimited information. Much of it is bad, some of it is malicious. And I don't have a simple answer to this question. I will go back to what I said about pediatricians being trusted sources and about personal family to family type discussions that are difficult to scale but that are effective. And I think that's it. I mean, I think there certainly does need to be direct countering of misinformation and disinformation that are put out there by anti vaccine groups. And that is something that CDC and public health departments should be doing. But there's also the direct outreach to individual families and to communities and bringing good information and being willing to sit and listen to what people have heard and try to help them disentangle the bad information that they may have gotten and to explain the science based information that hopefully your pediatricians and your trusted community members are bringing.

[Tanya Moseley]

Dr. Adam Ratner, thank you so much for this book and for this conversation.

[Dr. Adam Ratner]

My pleasure. It was wonderful to speak to you. Thank you.

[Tanya Moseley]

Dr. Adam Ratner is the author of the new book Booster the Urgent Lessons of Measles and the Uncertain Future of Children's Health. Coming up, our book critic Maureen Corrigan reviews Memorial Days, the new memoir from Pulitzer Prize winning novelist Geraldine Brooks about the sudden loss of her husband. This is FRESH air. Geraldine Brooks is the Pulitzer Prize winning novelist of March as well as her most recent novel, Horse. Brooks is also the widow of Toni Horowitz, perhaps best known for his book Confederates in the Attic. Brooks's new memoir, memorial Days, recalls their long marriage and the aftermath of its sudden end. Our book critic Maureen Corrigan has a review.

[Maureen Corrigan]

To us readers who admired Tony Horowitz's writing, infused with his animated and wry first person voice, his sudden death in 2019 was hard to take in. Horowitz, who was a fit 60 year old, died of cardiac arrest a few days after his book Spying on was published. Like his 1998 bestseller Confederates in the Attic, spying on the south presciently explored the great divide in America between red states and blue. Curiously for a writer so attuned to boundary lines, Horowitz, who was traveling on book tour, collapsed and died on a street that divides Washington, D.C. and Maryland. Horowitz's wife, novelist Geraldine Brooks, was far away, at their home in Martha's Vineyard. The opening of her memoir, Memorial Days, describes in present tense, fragmented phrases what it was like to be on the receiving end of a call from an ER doc whose voice is flat, exhausted, impatient, and who refers to her husband's body as it. That call, Brooks reflects, was the first brutality in what I would learn is a brutal, broken system. Memorial Days is a beautifully modulated cry in the wilderness, an unsentimental contribution to the ever growing pile of secular literature about grief, in which the end of life is punctuated by a period not an ellipsis. Brooks converted to Judaism when she married Horowitz some three decades earlier, and though Judaism doesn't offer her the assurance of an afterlife, it endows her with a spiritual language and vision. Memorial Days alternates between the immediate time after Horwitz's death and 2023, when Brooks flies to an isolated cabin on Flinders island, off the coast of her N. Australia. The trip, Brooks tells us, represents an effort to escape what Hebrew scriptures call the mezar, the narrow place. Tending to her two sons in the wake of their father's death and meeting her own writerly deadlines meant that Brooks couldn't surrender to grief. Here's how she explains the need to withdraw. I am taking something that our culture has stopped freely giving the right to grieve, to shut out the world and its demands. I've come to realize that my life since Tony's death has been one endless, exhausting performance. I have cast myself in a role woman being normal. I have not allowed myself the wild wideness of an elaborate, florid, demonstrative grief. Instead, it has been this long feeling of constriction, of holding it in and tamping it down and not letting it show. Brooks is far from clueless about the privilege that enables such a retreat. She grew up, as she tells us, in a blue collar neighborhood of Sydney, in a house where all the furniture was secondhand. She arrived as a scholarship student at Columbia Journalism School, where she met Horowitz and her life took a turn. The luxury of spending weeks alone in a cabin by the sea gives Brooks not only the time to grieve her husband, but also to grieve the life she might have lived had she never met him. Given Brook's own distinguished career as a novelist and journalist, it's no surprise Memorial Days is such a powerful testament of grief. But what is more of a surprise is the emergence of another subject, namely, the tough reality of the writing life. Brook says at one point that she thinks of Spying on the south as the book that killed Tony. She recalls that to finish it on deadline, her husband chewed boxes of Nicorette gum, nibbled Provigil, the pill developed to keep fighter pilots alert, and drank pints of coffee at night. He countered all the stimulants with wine. Wondering how she can practically sustain her life without Horowitz, Brooks is told by a financial advisor that she'll be okay as long as she just keeps writing. There's the rub. Fortunately, Brooks was able to finish her stalled novel in progress, Horse, which was published in 2022. And fortunately, she was able to go on to write Memorial Day. So a book that not only pays tribute to a loving marriage between two successful writers, but also manages to be a clear eyed assessment of the costs of that success.

[Tanya Moseley]

Maureen Corrigan is professor of literature at Georgetown University. She reviewed Memorial Days by Geraldine Brooks on the next FRESH air. Germany's federal elections are on Sunday and Elon Musk is supporting the far right candidate for chancellor. As the Trump administration moves America's foreign policy to the right, European leaders are concerned about the future of their alliance with the U.S. we'll talk with Anne Applebaum, who writes about the new authoritarianism. Join us to keep up with what's on the show and get highlights of our interviews. Follow us on Instagram at prfreshair. FRESH Air's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham. Our managing producer is Sam Brigger. Our interviews and reviews are produced and edited by Phyllis Meyer, Ann Marie Boldonado, Lauren Krenzel, Teresa Madden, Monique Nazareth, Thea Chaloner, Susan Nakundi, Anna Bauman and Joel Wolfram. Our digital media producer is Molly CV Nesper. Roberta Shorrock directs the show with Terry Gross. I'm Tonya Mosley.

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