Doctors: The US must concentrate on the unvaccinated to fight measles outbreak

Chicago Tribune

2 days ago

The father of modern vaccines was a microbiologist named Maurice Hilleman, who developed a number of effective vaccines including that for measles. His work probably saved as many lives as that of any scientist in history. When measles resurfaced in the U.S. in the early 2000s, he was asked whether public education about vaccines could avoid the suffering of children with measles again. He answered with brutal honesty, 'No, I think children are once again going to have to suffer this disease in order for us to be aware of how bad it can be.'
So far he has been proven correct. Last month, measles cases in the U.S. for 2025 passed 1,000, the highest figure since 2019. Measles is the most communicable disease known to man and although many consider it a trivial disease, three people have died in the ongoing U.S. outbreak — two children and one adult. More than 10% of U.S. cases have required hospitalization, a quarter of whom were children under 5.
In our lifetime, few medical interventions have been as effective as measles vaccination. Before a measles vaccine was introduced in the mid-1960s, hundreds of thousands, and in some years millions of cases occurred annually, often resulting in hundreds and sometimes thousands of deaths.
As long as U.S. vaccination rates remained above 95%, measles cases remained below 1 per million population: the country had established relative herd immunity (although even a high overall vaccination rate does not guarantee against a limited outbreak in an unvaccinated community.) In the past decade, vaccination rates have dropped to between 92% and 93%, a small decrease, but enough to create pockets of infection. Cases spiked above 2 per million in 2014, 2019, and this year.
The direct and immediate challenge for Secretary of Health and Human Services Robert F. Kennedy Jr. is to concentrate on the unvaccinated fraction of the population — where measles spreads. To do this, he must shelve the idea that the measles vaccine plays a role in autism (that study has been debunked many times over) and further, he cannot leave the decision to vaccinate to individual whim, as he has suggested. He must address the reasons parents withhold measles vaccine from their children.
The vaccine-hesitant are not limited to one ethnic or social class, or income group. Some are quite affluent, as evidenced by a 2014-2015 Disneyland outbreak among wealthier parkgoers. This year's final episode of the popular television medical drama 'The Pitt' concerns the interplay between the emergency room doctors and an upper middle class anti-vax mother of a teenager with life-threatening measles.
Some vaccine-hesitant individuals will eventually accept vaccination for themselves and their children. First and foremost, this demands sensitive face-to-face discussions with parents, along with a nonjudgmental and empathic attitude. Parents of all social strata want the best for their children and many will listen to public health workers with communications expertise or trusted pediatricians and family physicians. Here's what will turn people off: reciting the medical facts in a condescending manner and turning the discussion political.
Another relatively unvaccinated group are religious communities. No major religion forbids vaccination, but some religious communities have seen measles outbreaks in the unvaccinated. The current North American outbreak took hold in Mennonite communities in the U.S., Mexico and Canada. Once again, this means sensitive discussions with religious leaders to encourage vaccination in their communities.
The final group of concern are foreign entries into the country. Migrants from low- to middle-income countries tend to be under-vaccinated, but their numbers are actually small compared to numbers of international tourists, who may be unvaccinated or inadequately vaccinated (and are not counted in vaccination statistics.) Foreign travelers have been the source of past measles outbreaks in Australia, Europe and North America. Mexico's outbreak is believed to have originated with a traveler returning from Texas. Travel medicine specialists play an important — but underutilized — role in preventing the risk of measles when people travel abroad.
Currently, measles is not simply a domestic problem. While the media concentrate on reporting U.S. measles cases, where the current incidence is 3 patients per million population, it is lower than in Europe or Mexico. The situation is most serious in Canada, where the 2025 incidence of measles stands at 50 per million, more than 15 times higher than in the U.S. The vaccination rate in Canada is under 85%, another illustration of the importance of vaccination.
There are definite indications the outbreak is slowing nationally and in Texas, the hardest hit state. If we are lucky, the outbreak may soon burn itself out — the pool of most susceptible will be exhausted and the school year is ending. But school will reopen in the fall and we should never depend on luck if there is a better alternative. In this case, vaccination.
Memo to Robert F. Kennedy Jr.: You are on record as wanting better health for our children. If you are sincere, you must pay attention to Dr. Hilleman's words and put away any personal reservations you have about the measles vaccine. Have the federal and local public health officials in your charge implement vaccine solutions for the unvaccinated — without delay.
Dr. Cory Franklin is a retired intensive care physician. Dr. Robert Weinstein is an infectious disease specialist at Rush University Medical Center.