The United States has now surpassed 4,000 measles cases and appears to have doubled last year's measles-related deaths, a milestone that would ordinarily prompt a loud, unified federal response. Instead, money is flowing to state and local health departments while clear communication from top health leaders remains notably scarce - and some of what has been said publicly may have done more harm than good.
Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials (NACCHO), says local departments are simply overwhelmed. "There's so much measles out there that the chances of it popping up in different communities is really high. And so, the attention certainly at the local level is very much there," she said.
The Centers for Disease Control and Prevention (CDC) has issued roughly $100 million in additional funds to state, local and tribal health departments for vaccinations, prevention and disease detection, and this week said it would deploy additional support to Pennsylvania - the state reporting the highest number of cases and the only one with confirmed measles-related deaths.
What hasn't flowed as readily is guidance or vocal endorsement of measles vaccination and mitigation. CDC Director Erica Schwartz, now two months into a job that sat unfilled for a long stretch, has had little to say about the outbreak. She touched on it in September during an interview with Atlanta News First (ANF), calling measles "the most contagious disease" and reiterating that the measles, mumps and rubella (MMR) vaccine is "safe and effective."
Infectious disease specialists argue a strong federal messaging campaign would go a long way. Jeanne Marrazzo, CEO of the Infectious Diseases Society of America and former director of the National Institute of Allergy and Infectious Diseases (NIAID), suggested an overarching message explaining what the MMR vaccine does would be a good start - especially with 42 outbreaks counted this year. "I don't think that pronouncements from the federal government are necessarily going to fill that much more complex space where decisionmaking is impacted by a lot of things we often don't understand or aren't articulated," said Marrazzo. "I do think that a national message can be crafted to encompass a more broad kind of acceptance of people's vaccine hesitancy. We just haven't really seen that because, again, I don't think we've seen a full-throated endorsement or explanation of why the vaccine right now is so critical."
Others argue that what has been said publicly may have actively hurt the response. "With an ongoing increase in cases, the standard response is to provide support to jurisdictions, including vaccine, financial resources, and offer staff. These things are currently still happening," said Demetre Daskalakis, former director of CDC's National Center for Immunization and Respiratory Diseases and chief medical officer at Callen-Lorde. "What is atypical is the friction created by CDC second-guessing Pennsylvania on their adjudication of deaths attributed or related to measles. It is also atypical to have a secretary that is a disinformation agent that distorts data to support his personal agenda."
Daskalakis, who resigned from the CDC last year in protest of what he claimed was overt political interference, was referring to federal health leaders - including Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services - questioning whether Pennsylvania's measles deaths had really occurred. The CDC's total tally does not currently reflect Pennsylvania's six deaths, because the agency switched to a different database for verifying measles deaths and no longer uses one in which local jurisdictions can provide real-time case information.
Asked by ANF why the CDC isn't recording those deaths, Schwartz invoked the COVID-19 pandemic, when the virus was linked to deaths that may not have been directly caused by it because the individual had tested positive at the time. "A lot of Americans thought, you know, people are just adding deaths to make this thing look worse than it is. It was a terrible, terrible thing that we had to go through. But definitions matter," she said.
Casalotti echoed Daskalakis's concerns that federal messaging has hindered anti-measles efforts. "When there are mixed messages coming at any of the levels of governmental public health, it makes it a lot harder for the local health departments to do their job," she said. "But it also makes it harder for people to figure out 'What should I be doing?' when you're hearing different things."
Kennedy has a well-known history of questioning the MMR vaccine's safety and efficacy, famously refusing to discount a possible autism link despite no evidence establishing one. Last year he called the MMR vaccine the "most effective" way of stopping measles spread and in August said parents should get their children vaccinated. Yet he has continued to cast doubt on vaccine safety. "In our country we care about rare illnesses and deaths. We care about every child who dies from measles. They get headlines," he said at a September conference hosted by Children's Health Defense, the anti-vaccine group he previously chaired. "I'd ask you to care about children who are dying or suffering or being injured by vaccine injuries." He claimed "vaccine-injured children" were "damaged" by conditions like asthma and autism and said sudden infant death syndrome and anorexia were common side effects.
HHS senior press secretary Emily Hilliard pushed back in a statement: "CDC is also working directly with state and local health departments to provide epidemiological, laboratory, and technical support. Texas, South Carolina, Virginia, Kansas, New Mexico, and Wisconsin have requested CDC Epi-Aid assistance and worked alongside federal teams to help bring their outbreaks rapidly and successfully under control." Hilliard added that "CDC continues to provide guidance and resources to communities responding to outbreaks, and Secretary Kennedy and CDC Director Dr. Erica Schwartz continue to make clear that the MMR vaccine is the most effective way to prevent measles."