How has measles, a disease previously eliminated within the U.S., once again become a threat? The recent outbreak in Texas is especially concerning, considering we already have an effective tool against the virus: the Mumps, Measles, and Rubella vaccine (MMR vaccine). The MMR vaccine is 97% effective against measles even with just one shot. At 95% coverage among the community, we have herd immunity, which means enough people are immune to a disease (either through getting it or vaccination) that the infection can not spread amongst a population. Furthermore, research has shown that if you contract measles after receiving your vaccine, you will likely have milder symptoms. The recent Measles outbreak in Texas has mostly affected unvaccinated children or children whose vaccination status is unclear, and in communities with low vaccination rates.
Now, I am not trying to solely lay the blame on the communities that were hit by the measles outbreak. The narrative of disease outbreaks and vaccination should not be a blame game between the binary of the vaccinated and the unvaccinated. Many aspects influence a person’s decision to vaccinate or not (The CDC, in fact, recommends some groups of people not to receive certain vaccines). However, one thing that can help with disease outbreak management is better and more ethically responsible communications from our public health officials.
This failure of public communication did not begin with the Texas measles outbreak but has become endemic to the public health sector. The problem of health officials’ relations with the public was supercharged by another disease outbreak – the COVID–19 pandemic. In an article co-authored by public health professor Michael T. Osterholm in the Washington Post at the start of the pandemic, they wrote that the scientific community was ignorant of the best way forward in the pandemic, including the effects of closing down K-12 schools (in fact, he cited the closure of schools in Hong Kong and the non-closure in Singapore, with no significant differences in transmission rate). Furthermore, he brought up the secondary considerations of lockdowns, especially the effects on parents who could least afford to lose work to care for their children.
However, as the pandemic wore on, public officials seemed to have forgotten the nuances in dealing with a novel pandemic and abandoned any spirit of epistemological humility. One such official was Governor Andrew Cuomo. In his speech on shutting down New York, his single-minded focus on preventing deaths from COVID culminated in this line: “If everything we do saves just one life, I’ll be happy.” While saving lives should, of course, be a priority for public officials like Mr. Cuomo, he didn’t consider the enormous costs of lockdowns properly. Shutting schools down and disrupting the economy have severe consequences. The New York Times found that the more time a school spent fully remote or hybrid, the greater the decline in student performance. The same article states that, in fact, the majority of experts now agree that the shuttering of schools did not stop the spread, but did still incur a major negative cost on children.
Social isolation also has a mental health toll. Researchers have found that social isolation during COVID has caused an uptick in mental health problems, including more attempted as well as completed suicides. In a talk with Dr. Francis Collins – director of the National Institute of Health (and Dr. Anthony Fauci’s boss) during part of the pandemic – he admits (to his credit) that public health officials were less than transparent with the public, and that they often failed to acknowledge their ignorance while issuing recommendations to the public. Furthermore, he also states that public officials often had a narrow goal during the pandemic – stopping the disease – without considering any of the secondary costs, such as the aforementioned school closures. While COVID was an unprecedented national emergency, public officials failed to uphold a spirit of scientific humility and transparency with the American people.
Public health officials have a duty to explain a vaccine’s effects, as well as the risks and dangers of the disease. In Texas, the decision on whether to receive an MMR vaccine shot was left up to the parents, and the decision can be a dangerous one when parents do not receive complete and transparent information on vaccines. However, our top public health officials have done an abysmal job at this necessary communication. The Secretary of Health and Human Services, Mr. Robert Kennedy, has not been honest with the people about the Measles outbreak. In a recent interview with Fox News (filmed during the outbreak), he went on and listed many negative effects of MMR vaccines.
Even while some of these claims have a degree of truth to them, he utterly failed to present the whole picture and the major positive aspects of vaccination. The CDC states that MMR vaccines can cause adverse side effects, but research has also shown that getting the vaccine is much safer than actually contracting measles. And while the MMR vaccine can cause death in rare circumstances, the Infectious Disease Society of America has said that these deaths only occur in people who are immunocompromised, and they are recommended by professionals not to receive the vaccine. Mr. Kennedy says he likes transparency, and yet, he didn’t qualify any of his statements (including the statement on deaths), and he didn’t offer the other side of vaccines – that vaccination is highly effective and causes no adverse effects in most people. On the flip side, however, getting measles actually has a fairly high mortality rate – about 1 to 3 in 1,000 children die as a result of contracting measles. As a result, people who hear such fearmongering are understandably concerned and skeptical of vaccination, but if we are truly transparent with people in the way that Mr. Kennedy seems to want, we must tell them both the great benefits of getting vaccinated and the potential side effects.
Although Mr. Kennedy is entitled to push his own beliefs, he has a responsibility to the people as a public health official to be transparent, especially considering that people trust him. As the pastor of the Texas community said in an interview with AP, “Do I trust all the vaccines? No,’ Klassen said. ‘And I get from (Kennedy) that he doesn’t trust all the vaccines, either. And he is very well educated in that; I’m not.” People’s lives depend on truthful and fully transparent communications from scientists and public health officials, including admitting ignorance when appropriate, and our officials owe it to the communities they serve to offer the best report possible. Doing so will help in restoring the lost trust between the people and public health officials, or at least curb the presence of misinformation in our country.
Image Credit: Dr. Jenner Performing His First Vaccination (1796), Ernest Board — Wikimedia Commons
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