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.
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."
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.
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.
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]
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.
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.
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.