What’s Behind The Measles Outbreak In Florida?

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Back in the year 2000, measles was declared eliminated from the US, but it still pops up every now and then. According to the CDC, this year, as of February 22, a total of 35 measles cases were reported by 15 states. And in early February, a measles outbreak began at an elementary school in Broward County. That’s in Southern Florida. And as of February 27, Broward County has nine cases– that’s out of 10 for the whole state.

You know, measles is one of the most infectious diseases in the world, and it has a tried-and-true vaccine called MMR, for measles, mumps, and rubella, that saves lives. And kids usually get the vaccine early in life. Well, not so much, it appears. Let’s take Florida.

Surgeon General Dr. Joseph Ladapo has been criticized for how he’s handling the outbreak. For example, by not explicitly encouraging parents to get their kids vaccinated. So how did Florida get to this point, and is it a reflection of a broader public health crisis? Joining me to talk about this are my guests Dr. Rana Alissa, pediatrician, Vice President of Florida chapter of the American Academy of Pediatrics, Associate Professor at the University of Florida in Jacksonville. Welcome to Science Friday.

RANA ALISSA: Thank you, Ira. Thank you for having me.

IRA FLATOW: And Dr. Paul Offit, pediatrician and Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia in Pennsylvania. Welcome back to Science Friday, Dr. Offit.

PAUL OFFIT: Thank you, Ira. It’s my pleasure.

IRA FLATOW: Dr. Alissa, let me begin with you. How concerned are pediatricians in Florida about this and how frustrated are they?

RANA ALISSA: We are very, very concerned. We’ve been sounding the alarms for a long time now, having fear of going through exactly this crisis. I’m going to call it crisis because the numbers are not decreasing. Actually, they are going up. So we are very concerned.

And regarding the frustration, we are frustrated because, unfortunately, we’re having conflicted messages from the leadership of our state.

IRA FLATOW: That’s very interesting. Dr. Offit, how dangerous is measles? Fill us in on that.

PAUL OFFIT: Sure. So before there was a measles vaccine in 1963, every year in the United States, 3 to 4 million people would suffer measles– mostly children less than 15 years of age. Every year, 48,000 would be hospitalized, and 500 would die. When they died, typically they die of pneumonia, or encephalitis, or severe dehydration. It was a severe and common infection which, fortunately, as you noted, we eliminated by the year 2000. Unfortunately, because there’s been an erosion in vaccine rates, we’re seeing it come back.

IRA FLATOW: Well, let’s talk about that. Why are outbreaks like this happening? You say there’s an erosion in vaccine rates. Why is that?

PAUL OFFIT: There was a study that was published recently by the CDC showing that there has now been an increase in parents choosing non-medical exemptions, meaning philosophical exemptions or religious exemptions to vaccination, the highest it’s been in a long time. And with that erosion in vaccine rates, as you note, the canary in the coal mine– the first disease to come back is measles because it is, far and away, the most contagious of the vaccine-preventable diseases.

To put that in perspective, it has a contagiousness index– and by that, what I mean is, how many people would you infect in a single day if you’re infected, and everybody you come in contact with is susceptible– the answer is 18. For diseases like COVID, or flu, it’s more like two or three. This is, far and away, the most contagious disease. When you see one case, you should be worried because it can exponentially increase.

IRA FLATOW: You have come on this program many times over the years talking about how people are refusing to get their kids vaccinated because of a supposed connection to autism. Is this one of those cases? Or are there conspiracy theories here?

PAUL OFFIT: I think this is something else. I think what happened during the COVID pandemic is we mandated vaccines, and that rubbed a lot of people the wrong way. It was a matter, for them, of personal freedom, bodily autonomy, and I think we kind of leaned into a libertarian left hook. As a consequence, anti-vaccine groups are far better funded than they ever have been because they’ve gotten funding from that group, meaning people who see this as a matter of individual freedom. I think the Florida state surgeon general, when he is very lax about vaccination, or very lax about isolation and quarantine, it’s that sort of bizarre notion, if you will, of freedom.

RANA ALISSA: To add, this has been ongoing issue before COVID vaccine. And the reason is just– I don’t know if I want to call it conspiracy theory– but somehow, there is very linked– people link the MMR vaccine to autism. But there are several research to talk about the link between MMR and autism, and they have been 0. It’s not like it’s minimal, or it’s just small amount, or small fraction. No, it’s a 0. There is no link between MMR and autism.

IRA FLATOW: Yeah. We had a very famous case, Dr. Offit, when you were on our show last time many years ago talking about this. And we had a listener calling in about why she did not want to get her kids vaccinated. And she said simply, I just don’t trust anything my government tells me.

RANA ALISSA: Isn’t it that unfortunate?

IRA FLATOW: Dr. Alissa, do you think that’s what’s happening here?

RANA ALISSA: Yes, definitely. There is an increase. Anti-vaxxer movement is what actually is making everything worse when it comes to vaccines. I want to mention that you go Google, ask questions about vaccine, and Google it. You’re going to see all these videos, and they are compelling. They’re really convincing that you should not be vaccinating your child. And unfortunately, they are allowed to be there. It’s because of freedom of speech and all of that.

But people choose to listen to those instead of listening to their pediatricians, and to their CDC, and to the American Academy of Pediatrics, and all these researchers who know more than these sporadic videos that spreading false information, completely false information.

IRA FLATOW: Do you think if the surgeon general in Florida were to take a more active, proactive, pro-vaccine stand, that things might change?

RANA ALISSA: Absolutely, absolutely, 100%. And like people who are questioning, let’s say they’re not 100% sure if they want to vaccinate or not, they would look and see, OK, if the physicians among themselves are not on the same page, why would we believe this one, not that one? We should be on the same page. We have tons of evidence. We have tons of research, tons of data talking about how safe is the vaccine, how effective is the vaccine. And instead of being all together, we have our surgeon general, unfortunately– it’s very unfortunate– that is giving the very opposite message.

IRA FLATOW: So the surgeon general is saying, don’t get the vaccine?

RANA ALISSA: The surgeon general is giving parents a choice. And there is nothing wrong with that. But when the choice is if you’re going to send your unvaccinated child to school, where they are some sick kids in the school that cannot, for medical reason, get vaccinated– they probably have cancer, they probably have other immunodeficiency diseases– they’re going to risk their lives. You’re risking the unvaccinated children’s life, and you’re risking other sick people’s lives– adult people who could not get vaccine as children for medical reason.

Our surgeon general is giving the ultimate choice to parents.

IRA FLATOW: Dr. Offit, what’s your take on this?

PAUL OFFIT: Well, I do think that anti-vaccine activity, in many ways, is at an all-time high. And really there never was a politics of the anti-vaccine movement. On the left, it was always, all things natural. I don’t want to be inoculated with anything that has a manufacturing residual, or a preservative, or an adjuvant. And so the California outbreak, for example, of measles in 2014-2015 that started in the area around Disneyland, which was a very much left-leaning area, that was an example of that.

But that is not what’s going on now. This is a right-leaning phenomenon. And the right has– when they reject it about vaccines, it’s been for this reason. This sort of libertarian, government off my back, don’t tell me what to do. I mean, if you look what happened during the COVID pandemic, you were much more likely to be hospitalized and die if you lived in a county that was heavily red, as compared to one that was heavily blue. It was called, at one point, red COVID. That’s what’s going on now. And that’s where all the funding is coming from.

If you look, for example, Eric Trump, in the last few years, stood up and said, if you choose not to get a vaccine, know that the Republican Party is behind you. What is that about? It’s just been hard to watch this dramatic shift to the right.

IRA FLATOW: How is the vaccine supposed to work, Dr. Offit?

PAUL OFFIT: Now, so measles is a long incubation period disease, incubation period meaning from the time when you’re exposed to the time that you develop symptoms. You can eliminate those kinds of diseases from the face of the earth. Smallpox is a long incubation period disease, which we’ve eliminated. Polio is a long incubation period disease. You’ll never eliminate short incubation period diseases, like influenza, respiratory syncytial virus, COVID.

So the way the measles vaccine works is that you induce memory cells, which are long-term and can protect you against even mild disease. For short incubation period diseases, memory is not enough. You need to have high titers or high levels of antibodies at the time of exposure. And that doesn’t last very long. And so that’s what you see with COVID. You’re protected against mild and severe disease for three to six months after vaccination or natural infection. But you’re protected against severe disease for a much longer period of time.

So the way a measles vaccine works is that, because all you need is memory, and memory is long-lived, you can eliminate measles. So here’s the most contagious of the vaccine-preventable diseases that we eliminated with vaccination by the year 2000.

IRA FLATOW: And what is it about herd immunity? We hear that thrown around a lot. How does that work here?

PAUL OFFIT: Right. So herd immunity means a critical percentage of the population has been vaccinated, which then does not allow the virus to spread from one person to the next. For a disease like measles, if you can get 95% to 96% of the population vaccinated, you can really eliminate the disease. That really doesn’t work well for short incubation period disease.

So look at rotavirus, for example. Rotavirus– another short incubation period disease– probably 95% of children are vaccinated in this country. That is not a virus that creates variants. And so we virtually eliminated hospitalizations. But the virus still spreads in the community. It still causes mild disease. That’s what you would hope to get from this vaccine.

IRA FLATOW: Dr. Alissa, where do you think we should go from here? I mean, if people are making a choice not to get vaccinated, I’ve always found it’s very hard to change people’s minds if they don’t want to do it.

RANA ALISSA: It is. It’s extremely hard. It’s extremely difficult, exactly like what Dr. Offit said. Unfortunately, it’s becoming political, and I have to agree with this 100%. I wanted to repeat what Dr. Resneck, the former president of the American Medical Association, said about a couple of years ago. He said it’s becoming very crowded in the physician exam room. What happened to patient listening to their physicians? What happened to parents listening to their pediatricians? We used to be like pediatrician was part of the family. Now we don’t anymore.

So we have, in addition to insurance issues, and addition to people not listening, now we have politics involved. So I think changing mind is very, very difficult. I just hope we can have more open discussion. Because anti-vaxxers feel offended very quickly, and they don’t want to listen because they already set up their mind. I just would like them to have open conversation, be open-minded.

Let’s talk. Let’s talk. Hear the pediatrician who’s been doing this for a very long time. Please follow the experts in the CDC, follow the American Academy of Pediatrics. If the CDC recommended unvaccinated child to stay at home for 21 days because there’s an outbreak, please stay at home.

IRA FLATOW: I want to expand this picture, Dr. Offit. It’s no secret that the state of public health, the health care system in the United States, is in trouble itself. I would say it needs some medication. Does this measles outbreak tell us about that or mirror the state of public health in the US?

PAUL OFFIT: I think it’s more what Rana just said, which is this loss of trust in public health agencies– not just the CDC and the FDA, but also locally with your physician. I think that’s what’s happened here. I mean, the fact of the matter is, we had the same public health system that eliminated measles from this country in the year 2000. I just think that what’s happened is science is losing its place as a source of truth. People just declare their own truths. Science has become just another voice in the room to a level I’ve never imagined before, where you’ll see people– including people in the world of science– who will stand up in front of Congress and say something that’s just blatantly wrong.

So I’ve never seen anything like this. We’re entering this post-truth era. And I think that’s where we’re sunk.

IRA FLATOW: Are we going to see any other diseases making a resurgence, do you think?

RANA ALISSA: So you have anti-vaxxers movement. So we have all the vaccines. You think about any vaccine you have. So you might have pneumonia from strep pneumo not being vaccinated, H flu because they’re not getting H flu as children. That’s two, and four, and six months of life. Maybe Hepatitis B, God knows.

IRA FLATOW: Dr. Offit, do you agree? That’s a triple dose– mumps, rubella are included in the measles. Might we see those come back?

PAUL OFFIT: Right. So we eliminated rubella from this country by 2005. Mumps still circulates. I think you’ll probably see more mumps cases. The one that worries me is the one that you saw occur a couple of years ago in Rockland County, New York, which is polio. That was a 27-year-old man who never left this country. Because the polio virus– at least this so-called revertant polio virus– still circulates. It was in the wastewater in the area he lived. It was in the waste water in surrounding counties. If you look in the wastewater of many cities in this country, you’ll see this so-called revertant strain of polio virus that itself can cause polio.

Drop polio immunization rates far enough, and that’s what happened in Rockland County. Immunization rates were 30% in that county, and you saw polio come back. These are not diseases you want to relive.

IRA FLATOW: So if I hear you correctly, you’re saying that basically health care has been politicized. And unless we un-politicize it, we’re going to be staying in this state of doubt.

PAUL OFFIT: Right. I think that, over the last few years associated with the COVID pandemic, we have lost the public’s trust– or at least we’ve lost a critical percentage of the public’s trust. And we just have to figure out why and how we can get it back. Because there’s a lot at stake.

IRA FLATOW: Last word, Dr. Alissa, from you.

RANA ALISSA: We lost the trust, and I hope to gain it back. We need– we can’t do it alone. Because we lost it tremendously during COVID, and it doesn’t seem that it’s coming back. We need the leadership. We need to start– since it’s political, it has to start from the president’s office down.

IRA FLATOW: And it’s not just Florida. There are, what? Outbreaks in 15 states.

RANA ALISSA: Yep, exactly. And it’s going to be more. It’s going to spread. Like I said, from the beginning, we’ve been sounding the alarm. And it’s getting worse, and it’s going to continue to get worse unless we fix this.

IRA FLATOW: I want to thank both of you for taking time to be with us today and having a great conversation.

RANA ALISSA: Thank you so much, Ira. Nice to meet you, Dr. Offit.

PAUL OFFIT: Thank you, Ira. Nice to meet you, Rana.

IRA FLATOW: Dr. Rana Alissa, pediatrician, Vice President of Florida’s chapter of the American Academy of Pediatrics and Associate Professor at the University of Florida in Jacksonville. Dr. Paul Offit, pediatrician and Director of the Vaccine Education Center at Children’s Hospital in Philadelphia, Pennsylvania.

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