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Vox
04-04-2025
- Health
- Vox
RFK Jr. is cutting HHS and challenging vaccine science amid a measles outbreak. Here's what it all means.
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. When Robert F. Kennedy Jr. sought to be confirmed as Donald Trump's secretary of Health and Human Services (HHS), he had to overcome a long record of fringe anti-science beliefs. He had indulged in conspiracies about chem trails, questioned whether HIV was the actual cause of AIDS, and, most notably, spread the repeatedly debunked theory that childhood vaccinations could lead to autism. In private meetings with senators and public confirmation hearings, he downplayed that record and claimed he wasn't anti-vaccine: 'I am pro-safety,' Kennedy said in his opening statement at one hearing. 'I believe vaccines have a critical role in health care.' He gave assurances to Sen. Bill Cassidy of Louisiana, an MD and one of the last Republican holdouts on his nomination, that he would not change federal vaccine guidance But less than two months into his term, Kennedy is blocking the release of pro-vaccine data amid a widening measles outbreak even as he puts into motion long-term projects that seem set to further erode Americans' wobbly trust in childhood vaccination. Coupled with the massive staff cuts at HHS, a weakened federal health department is being remade in Kennedy's anti-vax, anti-science image — an overhaul that could have dangerous consequences for Americans' health for years to come. On Tuesday, the Trump administration began to lay off 10,000 workers across HHS, which includes the Food and Drug Administration, the Centers for Disease and Control and Prevention, and the National Institutes of Health. Combined with workers who had already departed or were laid off earlier, the department's overall headcount is expected to shrink from 82,000 to 62,000 people. Many rank-and-file staff were simply let go; some senior leaders were offered reassignment in different roles, sometimes in a different part of the country, according to the New York Times. Subagencies focused on substance abuse and environmental health that were previously allowed some independence are being brought under HHS's direct supervision. Top deputies who might have clashed with Kennedy — such as the FDA's senior vaccine official, Peter Marks, one of the architects of the highly successful Operation Warp Speed in Trump's first term — are being forced out. HHS touches the lives of Americans from birth to death: It oversees Medicaid and Medicare, which cover one in three Americans, it sets the standards for medical care across the health system, including vaccine schedules; and it is the biggest funder of the kind of vital medical research in the country that leads to new medical treatments. Trump promised during the 2024 campaign to let Kennedy 'go wild'; now he and his subordinates have the means to execute his vision. Some of the effects are being seen immediately as a massive measles outbreak spreads. Other reverberations in public health and medical research may not be fully felt for years. Former federal officials say the overhaul represents a fundamental reimagining of what HHS should be, a withdrawal from an active government role in the safeguarding of America's health. We could be living with the consequences of these changes for a long time. 'This is not a so-called restructuring. These are reckless, thoughtless cuts that will only make American communities less healthy and less safe,' Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation and a former acting CDC director, said in a statement. 'They represent an abdication of the department's essential responsibility to promote and protect health.' More than an abdication, Kennedy's new regime is steering the department in a radically new direction — one that seems poised to send American health backward. The immediate dangers of RFK Jr.'s health care overhaul Kennedy's leadership is already making the biggest US measles outbreak since 2019 worse. The number of cases across five states is nearing 500, twice as many as the United States saw in all of 2024, and two people, including an unvaccinated child, have died. Some experts believe it may take up to a year for the disease's spread to be brought under control. Epidemiologist Michael Mina wrote this week in the New York Times that the US could see tens of thousands of cases. More people would die, and many of the ones who survived could be more vulnerable to other viruses in the future after the measles virus wipes out many of their preexisting antibodies. The response to the current measles outbreak is a good measurement of just how much Kennedy has changed things. During Trump's first term, the president himself urged people to get vaccinated to stop a measles outbreak. Now, Kennedy, as the nation's top health official, is instead using his enormous platform to undermine the importance of the measles vaccine while the virus rapidly spreads. (Measles vaccination is the best way to protect yourself against the virus, and health officials even encourage unvaccinated people who have already been exposed to get a shot because it could reduce their symptoms.) Kennedy has extolled vitamin A and cod liver oil as treatment options, but doctors caution that, while vitamin A could benefit someone who is vitamin-deficient when they contract the measles, almost no one in the US has a vitamin A deficiency.. A Texas doctor hawking those remedies to patients skeptical of vaccines said he has been in direct contact with the HHS secretary during the outbreak. Kennedy isn't just using the bully pulpit to pitch pseudoscience. His department is now actively suppressing information about the value of the measles vaccine during the outbreak, according to ProPublica. A CDC forecast that would have shown the risk of catching measles is higher in less vaccinated areas was shelved, after the agency originally planned to release it as encouragement for people to get the measles shot. The CDC justified its scrapping of the report by claiming the data 'does not say anything that the public doesn't already know.' Even as the emergency grows more serious, Kennedy is reducing his own infectious disease staff: One workgroup focused on vaccinating underserved communities was eliminated as part of the layoffs. HHS has also pulled back grants that support the state and local health workers who are frontline responders. According to Reuters, health officials in Lubbock County, Texas, near the epicenter of the crisis, had their funding halted for several grants that were being used to support work on the outbreak. At the same time, Kennedy is launching a systemic analysis of any supposed links between childhood vaccines and autism — a link that has already been refuted by previous scientific analyses. He has placed a long-discredited anti-vaccine researcher in charge of it. Americans' trust in vaccines had been slipping before the pandemic, and then widespread conspiracies about the Covid shots helped make those views even more mainstream. A federal probe that seems designed to sow distrust could drive vaccination rates lower. The national measles vaccination rate has already slipped just below the 95 percent target that experts say is necessary to maintain population-level immunity. The speed of that decline has been alarming: In the 2019–2020 school year, 20 states were above the 95 percent vaccination rate threshold, and just three had dropped below 90 percent. But by the 2023–2024 school year, only 11 states had more than 95 percent of schoolchildren vaccinated against the disease, and 14 states had fallen under 90 percent. In individual communities, rates have slipped even lower, which creates the right conditions for an outbreak to explode; measles, after all, is one of the most contagious diseases known to humanity. In the Texas school district most affected by the current measles outbreak, the vaccination rate is under 50 percent. What this means is that measles outbreaks could again become a recurring public health nuisance, 25 years after the US declared the virus was no longer spreading within the country. At the same time measles is spreading, a potential H5N1 bird flu pandemic is brewing: The virus has been found in nearly 170 million birds and 1,000 livestock herds; 70 humans have been infected. On that disease, too, Kennedy is signaling a more hands-off approach: He has suggested allowing the virus to spread unchecked through factory farms, and the department is threatening to end a recent contract to develop a universal pandemic flu vaccine. One of the groups laid off this week were scientists testing pet foods for any trace of the virus. The long-term implications of RFK's MAHA agenda Other long-running health campaigns will be jeopardized by the combination of HHS cuts and Kennedy's fringe beliefs. In a 2021 book, Kennedy favorably presented the discredited theory that drug use, not HIV, was responsible for the development of AIDS. Now, despite Trump's previous pledge to eradicate HIV completely, Kennedy's department is pulling back on one of the defining health crises of the modern era. Staff at the CDC Division of HIV Prevention office was cut in half as part of the mass layoffs. They had made great strides thanks to a muscular government approach: New HIV infections declined by 12 percent since 2010, aided by public health campaigns and direct subsidization of HIV treatment. Deaths have steadily fallen as better disease management allowed doctors to turn HIV into a chronic condition patients could live with, rather than a death sentence. Now the programs and medical research grants on the HIV crisis that made that progress possible are being cut. One analysis projected there would be 143,000 more HIV cases and 14,000 more deaths in the US by 2030 as a result, according to Anna Person, an HIV physician at the Vanderbilt University Medical Center. 'Many people who have been living with HIV for decades are afraid we are returning to the 1980s era of HIV, when many buried countless friends and loved ones,' Person said in a media briefing this week. 'They ask how it makes sense to cut prevention funds or endanger access to HIV medications? My answer: It doesn't. These actions are inefficient and will lead to increases in health care costs.' The prospects for future drug development could also grow dimmer given the massive funding cuts at NIH. The federal government does not manufacture drugs itself, but the basic research supported by NIH is critical for identifying possible targets for pharmaceutical interventions that private companies then work to develop. The vast majority of prescription drugs approved in the US benefited from the kind of federal medical research funding that will be reduced by billions of dollars in the second Trump term. Other changes could further slow down drug approvals: Some of the FDA staff who were laid off had been dedicated to approving new medications. He could even reorient substance abuse treatment, just as the US is finally making progress in reducing the long-running scourge of fentanyl deaths. Kennedy, who is in recovery himself, has endorsed some unusual ideas for addiction care, such as sending people to so-called wellness farms where they would attempt to break their habit while participating in. It's a concept that has failed in the past, and experts remain skeptical of its value today versus other more mainstream harm reduction strategies. Public health is often slow and steady work, except when there is an emergency. We saw the consequences of an ill-equipped federal government during Covid, and the measles outbreak will test what happens when federal authorities are disinterested in an ongoing public health threat.
Vox
19-03-2025
- Health
- Vox
More than 1 million people die of tuberculosis every year. They don't have to.
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. Tuberculosis is no longer the threat it once was in the US and Europe, but the disease is still killing more than 1 million people worldwide every year. Gamma-Rapho via Getty Images Humanity's battle against tuberculosis has been one of slow and imperfect progress. The disease no longer kills one in seven people in the US, as it did in the 19th century. But look elsewhere and its burden is still terrible: TB killed more than 1.2 million people in 2023, likely making it once again the deadliest infection on Earth, after it was briefly supplanted by Covid-19 during the pandemic. And as John Green, the YA author, YouTuber, and author of the new book Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection, told me in an interview: 'That number is about to go up.' As part of its evisceration of US international aid, the Trump administration is ending funding for its global TB programs. The US is the world's largest single funder of tuberculosis treatment, and the spending cuts quickly interrupted medical care for TB victims. And any delay in treatment can lead to worse outcomes for patients and makes it more likely the bacteria will evolve to resist antibiotics. 'All of this is a direct result of the decisions made by the US government,' Green told me. 'Allowing tuberculosis to spread unchecked throughout the world is bad news for all humans.' There may be as many as 10 million additional TB cases by 2030 because of the cuts, depending on how deep they ultimately are, according to one initial estimate. An additional 2.2 million people could die in that worst-case scenario. It's difficult to know what's happening on the ground, as ongoing lawsuits try force aid funding to resume and the Trump administration itself has given conflicting information at times. One TB program director told The Guardian last week their funding had still not resumed despite receiving a reassurance from the administration that it would. The funding freeze is not only a threat to people in the developing world who live with tuberculosis as an ever-present threat, Green told me — it also poses a risk to the US itself. Right now, Kansas has 68 active TB cases, one of the largest US outbreaks in recent history. One estimate from the Center for Global Development finds that US TB cases will rise in parallel with cases in the rest of the world. That won't just increase health care costs — it will increase the risk that TB will become more drug-resistant and therefore deadlier to people around the world, including in the US. I spoke with Green about the history of one of humanity's oldest infectious diseases, the threat posed by the Trump administration's cuts, and what concerned people can do in response. Our conversation is below, edited for clarity and length. What is the state of tuberculosis right now? Why do people in the US and other wealthy countries often think of it as a disease of the past, a problem that has been solved? I used to think of it as a disease of the past as well. I thought of TB primarily as the disease that killed John Keats, and then we figured out a solution to it, so now it's not a threat anymore. But in fact, tuberculosis is still the world's deadliest infectious disease. It kills over 1.2 million people per year. That number is about to go up. It sickens about 10 million people per year. Around a quarter of all living humans have experienced a TB infection. Now, the vast majority of those people will never become sick. They'll have what we call latent TB, where these clumps of white blood cells form what are called tubercles to surround the bacteria and keep it in check. But in about 10 percent of people who experience a TB infection, they will become sick. We understand some of the risk factors for developing active TB disease. They include malnutrition, other health problems like diabetes, or HIV infection. But we don't fully understand why some people develop active TB and others don't. You call the disease 'weird' in your book. What is weird about TB? The weirdest thing about TB is the cell wall that the bacteria builds. It builds this really thick, fatty cell wall. That takes a long time to build, so TB has an extremely slow growth rate compared to other bacteria; in some cases, hundreds of times slower. That means that it sickens us slower because it takes a long time to overwhelm the body's defenses. This is one of the reasons why tuberculosis used to be a narratively convenient disease, a disease that was the subject of so many books. It was a narratively compelling disease because it tends to take a life slowly over the course of months or years, rather than all at once like a disease like cholera or the black plague. Classically, we understood death as something that occurred very early on in life because about half of people died before the age of 5, or something that occurred late in adulthood, in your 50s or after. Tuberculosis killed so many people in their 20s and 30s that it was called the robber of youth. But it also killed people early in childhood and late in adulthood. It killed indiscriminately. To some extent, it still does. I mean, 218,000 kids are going to die of tuberculosis this year. What's so frustrating to me is that all of those deaths are unnecessary because we've had a cure since the 1950s. This disease has been with us forever. It was even glamorized to an extent in earlier generations. But then there was a transition when it became more stigmatized — it became associated with being dirty and poor. How did that happen? Until 1882, at least in Northern Europe and the United States, it was generally believed that tuberculosis was an inherited genetic condition. But in 1882, the German doctor Robert Koch proved that tuberculosis was in fact caused by bacteria. The moment it became an infectious disease is really the moment that our imagining of the disease changed radically. Instead of being a disease of wealth and civilization, it became a disease of poverty. The implications of this were huge because it meant that we could control tuberculosis by trying to control the bacteria that caused TB. But it also meant that we wanted much more control over the lives of people living with tuberculosis. We started to understand them very differently. We started to see people with tuberculosis as a threat to the social order. At the same time, by the middle of the 20th century, we developed vaccines and cures. How did our perception of TB continued to change — and how did race increasingly factor into it? TB had long been understood by Europeans as a racialized disease. It was widely believed in Europe and in the US among white doctors that only white people could get consumption because it was a disease of civilization. To acknowledge that consumption was common among people of color and colonized people would have been to undermine the entire project of colonialism itself. After we understood the disease as infectious, it became racialized in a different way, where it came to be argued that people of color were uncommonly susceptible to tuberculosis. Instead of believing that it was impossible for them to get tuberculosis, people started to argue that their susceptibility to tuberculosis was owing to some factor inherent to race. Now, we knew this was hogwash from the beginning. There were lots of doctors, including African American doctors and researchers, pushing back against this notion. They argued, correctly, that the actual cause of tuberculosis was crowded living and working conditions, poor pay, malnutrition — all the stuff that today we know does cause tuberculosis. But the racialization of the disease was so profound that it's still shaping who lives and dies of tuberculosis. Today, how does tuberculosis look in the United States versus a place like Sierra Leone, which you cover extensively in your book? Starting in the 1940s, we began to develop treatments for tuberculosis that were very powerful. We created combinations of multiple antibiotics that, given over the course of several months or even years, could cure tuberculosis. This disease that had always been one of the leading human killers suddenly became curable. Unfortunately, we did a really poor job of distributing this cure to the places where it was most needed. As a result, we've seen the development of extensive drug resistance for tuberculosis, and we've seen a huge amount of ongoing suffering from the disease. The Ugandan HIV researcher Dr. Peter Mugyenyi said of HIV drugs in the year 2000: 'Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not.' And that's very much the case with tuberculosis as well. If you or I got tuberculosis tomorrow, even if we had a complex drug-resistant case, we would get access to the best personalized, tailored treatments of antibiotic cocktails we would need in order to cure our TB. But for someone like my friend Henry living in Sierra Leone, when he got really sick in 2019 and 2020, those drugs weren't available to him. So even though his TB was very curable, his life was at risk — not ultimately because of a lack of technology, but because of failure to get the technology to the places where it's most needed. In the book you called TB both a form and an expression of injustice. It seems to me that TB is one very striking example of a pattern of injustice that applies across a lot of diseases. Yeah. I think it's really important to acknowledge that tuberculosis is not the only disease of injustice. Hepatitis is a disease of injustice. Malaria, HIV, cancer are diseases of injustice. When my brother got cancer, one of the first things he said to me was that there was a 94 percent cure rate if you have access to treatment, and about a 5 percent cure rate if you don't. It's very hard to grapple with the fact that the real cause of a huge percentage of human death is injustice — the failures of human-built systems. There are many deaths that we simply don't have the technology or the tools to prevent. But there are many, many, many, many deaths that we do have the technologies and tools to prevent. It's important to understand that as a justice problem, as an equity problem, as a failure to appropriately apportion the resources that we as a human species have developed. It breaks my heart. It's devastating. I'm often asked whether I think people are good. Like, at the end of this book, do I think people are good? And I can't answer that question. What I can say is I think people are capable of extraordinary generosity and compassion and sacrifice. When people are proximal to suffering, they show an extraordinary capacity for giving. And when people are not proximal to suffering, when people don't let themselves become close to the suffering of others, they can act monstrously. There has been imperfect progress on global health, but progress nonetheless. But now the US government is pulling back from the global health commitments that have helped make that progress possible. What does this mean for TB specifically? The United States has long been the most generous donor when it comes to fighting TB, and now essentially all tuberculosis-related funding has been cut. That's catastrophic on a number of levels. To my Republican friends and congressional representatives, I try to compare it to the 2008 financial crisis when the capital markets just froze, and it was very hard to get them to start working again. In many communities, that's what's happening as a result of this sudden, chaotic, very unpredictable, haphazardly rolled out funding freeze. Hundreds of thousands of people have seen their treatment interrupted, and we know that's a catastrophe, not only for those individuals, many of whom will die, perhaps most of whom tragically will die, but also because it means that they will develop drug resistance. Even a couple of weeks without getting access to your medication means a skyrocketing chance of drug resistance. Even if they're able to get back on treatment, the relatively inexpensive treatment that worked before may no longer work. That means more cases of extensively drug-resistant tuberculosis circulating in communities. It's also a threat to the United States. We have 10,000 cases of active tuberculosis in the US every year. We have a tuberculosis outbreak right now in Kansas. Tuberculosis anywhere is a threat to people everywhere and allowing tuberculosis to spread unchecked throughout the world is bad news for all humans. It's bad news for human health. We've made so much progress in human health during my lifetime. The year I graduated from high school, 12 million children died under the age of 5. Last year, fewer than 5 million did. It's easy to feel like that progress is inevitable or natural or somehow it was always going to happen. But it wasn't always going to happen. It happened because millions of people worked together to make it happen, because we decided collectively to value children's lives more and to work hard to protect them. Now what we're seeing is the first regression of my lifetime when it comes to overall human health. We're seeing it in the United States where life expectancy has been going down. We're about to see it globally where tuberculosis cases, by one estimate, will increase by 30 percent over the next couple of years, leading to 13 million people getting sick every year instead of 10 million and leading to hundreds of thousands more people dying. All of this is a direct result of the decisions made by the US government. I feel like it's hard for people to understand the feedback loop that's potentially in play here that can put our health at risk because diseases are spreading elsewhere. I think it's also hard for us to take the long view. I'm curious where you think that failure comes from? And have you seen anything that's sort of effective in overcoming that? I think we have to bridge the empathy gap. There's always an empathy gap between every person, right? I don't know what it's like to be you. I don't know about your joys and sorrows. And even when I do, I can only kind of situate them in my own experience. I can only relate to it through my own eyes because those are the only eyes I get to see through for the whole time that I'm here. And so there's always an empathy gap, but that empathy gap grows or shrinks based on how close you allow yourself to be to the suffering and joy of others. And so you know when my uncle gets sick, I'm going to respond to that very differently than if I hear through the grapevine that someone else's uncle is sick. And for me, the empathy gap is also a social justice gap. The further the rich world feels from someone's life, the less likely the rich world is to intervene. So for me, it's about shrinking that empathy gap everywhere we can so that we understand that the lives of other people, even other people whose lives may feel distant from ours are just as real and just as important as ours, that their joy and grief and longing and loss is as real and profound as ours is. I try to do that in the book by telling Henry's story because you can talk all day about what a great investment tuberculosis response is, and it is a great long-term financial investment. You can talk all day about how many people are dying of TB every year. All that just boils down to statistics. And the statistics don't decrease the empathy gap, at least for me. And so I wanted to tell a human story at a human scale because I feel like that's what really changes our perspective. What options are available to people like Vox readers, who want to contribute in some small way to making these problems better? It sounds meaningless and everybody says it, but it's true. When you reach out to your congressional representatives insofar as you're lucky enough to have some say in your governance, it really matters. What funding we've been able to claw back for USAID is a result of people reaching out to their senators and representatives and those senators and representatives in turn reaching out to Secretary [of State Marco] Rubio and saying, 'This is ridiculous. This can't happen.' It's really, really important that people in power hear that it is unacceptable for the United States to walk away from its long-term commitments to global health and human health, and that it's unacceptable for the United States to break its promises. They need to hear it's also bad for America. It's bad for farmers who provide food aid. It's bad for overall human health in the United States. We're seeing our own numbers of tuberculosis cases go up every year, and that will accelerate now.
Vox
18-03-2025
- Health
- Vox
Measles is back — and more dangerous than you think. Here's what you can do to protect yourself.
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. One of America's worst measles outbreaks in recent years continues to spread, with 292 reported cases in western Texas and eastern New Mexico as of March 17. A nearby Oklahoma county has confirmed its first case, which officials believed to be linked to the outbreak's epicenter in Gaines County, Texas. Two people have so far died from measles infections since the outbreak began in late January. The actual number of cases is likely higher than the official count, based on reports from doctors who are treating patients as well as statistical analysis (two deaths would suggest thousands of cases, based on the measles' mortality rate of roughly 1 in 1,000 infections). Officials fear the virus's spread could persist into the spring and summer travel seasons, allowing the virus to reach other parts of the country; more cases and deaths could follow. The outbreak has now exceeded the total number of reported measles cases in the US last year, which itself had already represented an increase from 2023. Measles vaccination rates in most US states have fallen below the 95 percent threshold scientists consider necessary to control the disease, and those rates have continued to drop. The Texas emergency appears to have begun in an insular religious community with high vaccination exemption rates; 14 percent of all children in Gaines County have exemptions. The nation's health leadership, meanwhile, is undermining the best defense against measles. While US health secretary Robert F. Kennedy Jr. has paid lip service to the value of vaccines, he has also pitched alternative treatments unsupported by medical science. He's also launching new government investigations into the long-debunked theory linking autism and vaccines — investigations seem designed to erode public trust in the measles shot's safety at the very moment it is most needed. What's happening right now could only be the beginning. The more the US strays from the public health playbook that helped the country to reach official measles elimination in 2000, the more outbreaks will likely occur — and the bigger they'll be. We may be entering a new era when this once-dormant virus is again an active threat to people's health. Here's what you can do to protect yourself and your family. You really, really don't want to get measles Most Americans have been lucky enough to live in a world without measles, a disease that globally still kills over 100,000 people, most of them young children. Its risks, therefore, have become largely hypothetical. But for the unvaccinated, those risks are real. Measles is a formidable and extremely contagious virus. It is dangerous during the initial infection, which can lead to high fever and the signature measles rash, while some patients will go on to develop pneumonia or encephalitis, an inflammation of the brain, both of which can be deadly. Measles has a fatality rate of 0.1 percent, but an estimated 20 percent of cases require hospitalization. The disease is particularly threatening to kids, especially young infants, as well as pregnant women and people who are immunocompromised. Some vaccine skeptics, including RFK Jr., downplay the risk of measles. 'It used to be, when I was a kid, that everybody got measles. And the measles gave you lifetime protection against measles infection,' he said recently on Fox News. But measles was and is not some harmless disease: Between 400 to 500 children died annually from measles in the US in the decade before a vaccine was introduced in 1963. From 1968 to 2016, there were about 550 measles deaths total in the US, based on data from the Centers for Disease Control and Prevention. Until the recent deaths in the Texas outbreak, it had been 10 years since a single measles death had been recorded in the US. Even those who do survive a measles infection can face long-term health consequences, particularly for those in high-risk groups. Some of those infected in the current outbreak may be dealing with the fallout for years. Measles can cause what's known as immunity amnesia. The virus can wipe out more than half a person's preexisting antibodies that protect them against other pathogens, which can leave them more vulnerable to other diseases for years after their infection. In rare cases, measles can lead to fatal brain swelling years after the initial infection. Patients can also suffer hearing loss from ear infections experienced during their illness, while those who develop acute encephalitis can suffer permanent neurological damage. What you can do to protect yourself from measles Vaccination remains the best defense against measles: Two doses of the MMR vaccine — given to protect against measles, mumps, and rubella — is 97 percent effective at preventing a measles infection (and therefore spread). It is perhaps the most effective vaccine we have for any disease, and any risks from the vaccine are astonishingly low compared to the dangers of measles itself. In this new world where you're more likely to see a measles outbreak in your community, people should consider taking steps to protect their health or that of their loved ones. Here's what you can do. Parents, if you have young children—the group most at risk from measles — talk to your pediatrician about vaccination. The usual schedule is one shot around age 1 and another shot around age 5, but there is some flexibility. The CDC already advises that infants as young as 6 months can receive one dose if they are traveling internationally, and the recommended age for the second dose ranges from 4 to 6 years old. Several leading public health experts, including former CDC director Rochelle Walensky, wrote in a recent JAMA op-ed that the recommendations should be updated to advise one shot for infants traveling in the US to areas with higher risk of exposure. Reports of vaccinated people getting sick in Texas have at the same time raised questions about how protected vaccinated people actually are. As good as it is, 97 percent effectiveness isn't 100 percent, and it is possible to be vaccinated and still get sick. For a small percentage of people, the vaccine simply doesn't produce immunity. It is also possible that immunity could wane over time, but that was previously not an issue because high vaccination rates had snuffed out the virus's spread. In part because there may not be a lot of excess vaccine supply, the priority should be vaccinating those people who do not have any protection at all: those very young children and the people who weren't vaccinated as kids. Pregnant women should not receive the vaccine, but women planning to become pregnant could talk to their doctor about a booster shot; likewise, people with immune conditions should talk with their doctor before getting an additional dose, as the vaccine's live virus could present a risk depending on their level of immunodeficiency. Those in high-risk groups may want to take additional precautions, such as wearing masks, if there are reports of measles infections in their immediate area. (That doesn't just mean the areas of the current outbreak — isolated infections have also been found in California and Maryland in people who recently traveled internationally.) For other people who have already been vaccinated but are worried about transmission, it may be reasonable to consider a booster shot. But there are some important steps you should take first. First, check your vaccination records if you can find them. If you received two doses as a child, you very likely had a successful immune response; only three in 100 people don't. If you received one dose — as was generally the case before 1989 — you're probably still good, but it is a little more likely that you never developed immunity, according to Aaron Milstone, an infectious disease pediatrician at the Johns Hopkins University School of Medicine. Either way, the next step would be to talk to your doctor. (As always, with anything regarding your health.) They can administer a 'titer test' that measures the measles antibodies in your body. If they're still present — great, you should be good. If they're not, you may want to ask your doctor about getting an additional measles shot. The risks should be kept in context: If you're not near a confirmed measles case, your personal risk remains negligible. If you're vaccinated and have antibodies, you are very likely protected from the virus regardless. But they can not be ignored either. Milstone said he and his fellow infectious disease doctors could not believe it when they heard the news in February of a child's death from measles in the United States of America. 'You hope people don't have to die for others to take this seriously,' Milstone said.
