I'm William Brangham and this is "Horizons."

Measles, it's an illness most of us have no memory of, even though infection was once a reality for almost every American child.

Today, this highly contagious virus is making a resurgence with thousands of people infected this year.

The return of measles coming up next.

♪ Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

From the David M. Rubenstein Studio at WETA in Washington, here is William Brangham.

Welcome to "Horizons."

When it comes to measles, the U.S.

is going backwards.

Our country, once a global leader in our ability to contain this virus, is now seeing measles surge back.

Officially, there have been almost 7,500 cases since January of last year, but many believe that number is a vast undercount.

Eight people have died.

Some tight-knit religious communities in Pennsylvania were the epicenter of this current wave, but there have been outbreaks in 46 states this year.

New York declared a state of emergency over its outbreak.

Measles, of course, is prevented with a vaccine, the MMR vaccine, specifically, which protects against measles, mumps, and rubella.

Over years of study, the MMR shot has proven to be a safe, effective, and lifesaving intervention.

And while a majority of Americans still believe in the safety and effectiveness of vaccines, a small but growing number of them are turning away from those tools.

Childhood vaccination rates in the U.S.

are in decline.

The number of families choosing non-medical vaccine exemptions at school is rising.

So to understand how we got here and where we go now, we turn to two experts in public health.

Dr.

William Schaffner is a professor of preventive medicine at Vanderbilt University and also teaches at its medical school in the Department of Infectious Diseases.

Jessica Malaty Rivera is a public health epidemiologist.

She writes the wonderful Substack column, "'Making Science Makes Sense."

Thank you both so much to you two for being here.

I'm going to ask you both this question, starting with you, Dr.

Schaffner, first.

In 2000, we eliminated this virus from the country through a public health and vaccination campaign.

And yet now we have thousands of cases across the country.

Eight people have died.

Help us understand, how did we get to this moment?

Well, William, I think it took some time for us to get here.

And it's been a combination of reasons.

First, perhaps a growing lack of trust in people of authority, including those of us in the medical profession.

Other things that contributed were confusing recommendations coming from professional societies, but also from at least previously respected federal institutions, such as the CDC.

We also have today people who wish to do things in a more natural way.

It's also true that we now have a couple of generations, the parents and the grandparents who've never seen measles.

And if you don't respect measles, you won't value the vaccines.

And so they ask questions, why?

And then lastly, I would say, and this may be a consequence of what happened during COVID, there are some people who just push back against obligations, mandates.

In most states, in fact, in all states, in order to attend daycare and school, unless you have a medical and in some places, religious or personal belief exemption, you have to be vaccinated against measles.

And some people just push back against that compulsion.

Jessica Malaty Rivera, what would you add to that?

Like we have, again, we've just gone through this tidal shift from having this virus at bay to now having it all over the place.

What would you add to that about how we've gotten into this mess?

You know, one of the things that concerns me is this normalization of pediatric disease.

There seems to be a trend that is okay with disease, disability, and even death of children when it comes to childhood diseases like measles.

So much so that there have been people who say that measles infection is good for you, that it could prevent cancer, which it cannot, that it's mild or just a rash, and it is neither mild or just a rash.

And so I do worry that we have become accustomed to preventable suffering among a young and vulnerable population because of a commitment to individual freedom.

We've kind of lost our way when it comes to the reasons why we vaccinate for viruses like measles, where we don't just do it to protect ourselves, we do it to protect those who cannot be vaccinated, which includes infants.

Four of the eight deaths that have been reported this year have been among infants who were too young to be vaccinated.

Those infants rely on their communities to be vaccinated so that measles doesn't spread.

And I think that we've lost our way with that.

I'd like to play a little bit of an interview that my colleague and I did with a doctor from Lancaster, Pennsylvania, she works in an emergency room there, about what they have been seeing in their community.

This is Dr.

Elizabeth Werley.

Let's listen to what she told us.

I'm Elizabeth Werley and I am the medical director of the emergency department at Penn State Health Lancaster Medical Center.

And we are in the heart of the measles outbreak here in Lancaster County in Pennsylvania.

For many of us in practice, we're only familiar with it from a textbook.

So to actually witness and see what our patients are experiencing, they're in respiratory distress, they're having trouble breathing, they have significant GI symptoms.

I do believe that lack of immunization is a factor in the current measles outbreak.

We do have a large plain community here in Lancaster County and in Central Pennsylvania, but we also know it's out in the community, the general community as well.

And even when other patients are immunized, we still have to worry about those patients that are at high risk, whether it is neonates who can't be immunized or those patients with other conditions or medications that put their immune system at risk.

We have decades of information, both in our country and from other countries, demonstrating that the vaccinations are safe and they are effective.

What I would tell someone if they're concerned about a measles exposure is to either get immunized if they have not been immunized, or they can have blood work with their primary care doctor to check their titers to see if their immunization still is active.

And if they are experiencing symptoms that they are concerned about, that they should isolate at home and not go out into the community because of the high infectivity rate of the illness.

It's very easy to spread.

It can stay in the environment for a few hours afterwards.

We have to take care of our community in addition to the patients that we're taking care of here in the hospital.

I mean, it does put additional strains on an overworked healthcare system, and especially in emergency medicine, it's just one more thing that we have to be aware of to keep us on our toes.

Dr.

Schaffner, listening to her talk, there's so many factors in there.

One of them that she was stressing is the contagiousness, the infectivity of this virus.

For people who don't appreciate just how powerful this virus is, can you just remind us, how does it compare, say, to how easy it is to catch COVID or a cold?

William, it is the most contagious virus that we know.

One of the things she alluded to was a person who's shedding, breathes out the measles virus, can leave the room, and if a susceptible person comes into that room up to two hours later, they can still inhale the few viral particles that are hovering in the air and become infected and become ill.

This is a virus that is extremely contagious, and obviously, that's why we want to vaccinate everyone.

As Ms.

Rivera said, we're protecting not only ourselves, our own children, our own families, but we're contributing to protection of everyone in the neighborhood and in our communities, because there are little babies who could get measles, and they have high mortality associated with that, who can't be vaccinated yet, and there are people who are immune-compromised.

They can't take the vaccine.

How do we protect them?

All the rest of us are protected.

We create a cocoon of protection around them so that the virus can't get to those most susceptible who live amongst us, our more frail brothers and sisters.

Jessica, I mentioned that the official count, quote-unquote, "is 7,500 cases nationally this year."

Do you think that that's an accurate picture of how widespread measles is in the country right now?

I do not.

I think that is a massive undercount, and I say that with confidence because if we've already seen eight deaths reported this year, which is a tragic milestone that we just hit this week, typically what you would see in a measles outbreak is one to three deaths per 1, 000 confirmed cases, so if you do a little bit of rough math, that would mean we would be well over 8000 cases to see a death rate at eight so far, and there's a few reasons for that.

There is a slow-to-report sentiment in a lot of these closed communities.

It is also just so massive that contact tracing and reporting is very overwhelming for departments of health.

You have to recognize the fact that a measles outbreak is extremely resource-expensive for departments of health, both in the time and the personnel and even the cost of managing that size of an outbreak, and so I think it is much, much bigger than what we see right now.

Dr.

Schaffner, I'm curious, if someone is hearing all of this, worried about perhaps this very big undercount of measles, if they get vaccinated, how much protection does that offer you?

Is this a bulletproof, 100% protection?

How much does it give you?

It's close to bulletproof.

It's among the best vaccines we have.

If you take the two recommended doses, you will get somewhere between 97% and 98% for likelihood of protection for the rest of your life, and even if you do happen to get a breakthrough infection, namely you're vaccinated, you're exposed, and you still get an infection, your illness will be milder, so this is a terrific vaccine in terms of effectiveness and it's also terrifically safe.

There are very few adverse events associated with this vaccine.

It's been used in the literal billions of doses around the world for 50 years now.

Jessica Malaty Rivera, HHS Secretary Robert F. Kennedy Jr.

plays a complicated role here.

At times, when asked about measles outbreaks, he has said, "Yes, go get vaccinated, "it will protect you," but in his previous career and in his current role in the federal government, he has done an enormous amount to sow distrust about vaccines and say that they are dangerous, they are harming people, that the government is not being square with people about this.

How much responsibility do you place at the leadership of the federal government right now?

I think he and the federal government bear a huge amount of responsibility because I think that this movement or this unprecedented outbreak didn't necessarily start at the beginning of it.

There were seeds that were planted years and years ago by RFK Jr.

himself and by people from his organization, his former organization, Children's Health Defense, and many like both of those actors who were sowing seeds of doubt about the MMR vaccine safety, the MMR vaccine's effectiveness, even the MMR vaccine's utility.

And I think he would even say today that the only way to prevent the virus, the infection, is through the MMR vaccine.

But what he's also saying is that it's okay to get it and it's okay to suffer for it because it's just a mild disease.

And this is where I think that the normalization of disease has become so ubiquitous among people who are anti-MMR vaccine because they've been sold a lie.

They've been sold a lie that it is something that can be treated with vitamin A and it cannot, that it's something that is typical for childhood when, you know, I'm grateful that I live in a time where my children don't have to experience a disease that was so prevalent back in the 80s.

Even varicella is an example of that, that we have the tools to prevent them.

Suffering can be avoided.

It should not be the expectation simply because there are ways in which you could care for somebody.

Now, it's also important to note there is no known, like, specific treatment for measles.

It's all supportive care.

And some kids will get pneumonia, and pneumonia is the number one cause of measles-related death.

Some kids may get encephalitis.

That is a very dangerous swelling of the brain that can cause a lot of permanent damage, including hearing loss and blindness and other impairments.

It can cause complications years after recovery.

And a rare encephalitis called SSPE can cause immune amnesia.

These are not benign complications of a disease that is almost nearly entirely preventable through two doses of that vaccine.

And RFK Jr.

absolutely knows this, and it is the responsibility of the administration and our HHS secretary to make it extremely clear that kids do not have to be getting a very preventable disease.

Dr.

Schaffner, RFK Jr.

has also suggested that vaccines, including MMR, cause a great deal of injury to individuals and that the government has not really done a good job of studying this.

He's actually, under his leadership, set up a panel at the NIH to study vaccine injury in people.

Is there any evidence of that?

I mean, you mentioned before the safety record of this vaccine, but is there any evidence that the government knows that this is doing more damage to people and not telling us, or that these vaccines are complicated in any way?

Well, William, before a vaccine is licensed, it is studied very, very carefully in large populations, not only how well it works, but whether it's safe.

And then, more importantly, on an ongoing basis, after the vaccine is used, its safety continues to be monitored very carefully, not just by us, but by health departments, ministries of health around the world.

And there is a uniformity of agreement that these vaccines are exceedingly safe.

Adverse events associated with them, no vaccine, no pharmaceutical is perfect.

They do occur rarely.

And we have a compensation program that has been established in the United States to recognize those rare adverse events and provide at least some financial compensation to the families involved.

So this has been thought about and studied with enormous care.

If you look at the standard vaccine textbooks under measles vaccine, they have a whole large section under safety describing all of these studies that have been done.

Brangham: Jessica Malaty Rivera, again, I can't help but know that we've got this ocean of misinformation out there.

I just saw a study in JAMA this week that a survey of over 30,000 people and one in four Americans think that vaccines or taking Tylenol when you're pregnant is a major risk factor for autism.

How do we...?

As you write, making science makes sense.

You are a science communicator.

You're trying to help people understand the efficacy and safety of these.

How do we go about combating this?

It is so challenging.

I can't deny the fact that this is incredibly difficult work, especially because even if the data are on our side, even if it was debunked, even if the paper that originally made the claim that connecting vaccines and specifically the MMR vaccine to autism was retracted, even if that person who wrote the paper had their medical license retracted as well or rescinded, it doesn't change the fact that something like that is incredibly sticky.

And there's a lot of literature about the psychology and the dynamics of misinformation and why they stick, why they continue to spread and grow legs and continue to kind of morph into people's worldviews about public health.

This is one of those things that has unfortunately remained very, very strong in people's minds when it comes to vaccine safety.

And I think it is partially because it evokes a lot of fear.

A lot of the misinformation that we see based on vaccines is intended to cause a very intense emotional reaction.

And it dysregulates people.

And dysregulated people consuming more misinformation just causes an information ecosystem that becomes even more difficult for trained and untrained eyes to decipher what is true and what is not true.

We're dealing with people who are outside of their expertise opining on issues about vaccinology, about immunology, about infectious diseases, but said with conviction, said with identifying features that seem connected to the audience, whether that be a person who's a parent, whether that be a person who's an advocate, those types of things kind of suspend the facts, unfortunately.

So even if the data on our side, and I'll kind of reiterate too, that there are... I can't think of a vaccine that is more scrutinized than the MMR vaccine, other than the COVID-19 vaccine, in which we've specifically looked into it to see if it has any credibility, this claim about MMR and autism.

They've done massive studies comparing siblings, comparing twins, comparing people from across populations in different vaccine schedules, simply to say, "Can we confidently prove "that there is an association or even a link?"

And we have not been able to do that.

And so unfortunately, emotions and anecdotes outweigh data in situations like this, which is why storytelling and empathy in your science communication have to be part of your strategy, because at this point, you're not dealing with facts against facts.

I'm going to do a couple of all of that.

Just to expand on that, if I may just quickly, we tend to give our patients facts that goes to your brain, but the behavioral psychologists have told us, just as Jessica has mentioned, that how we feel, our attitude, it goes to our hearts.

That determines our behavior more than getting more information.

And how we feel is often determined socially.

What does our social group, the people with whom we interact, think and feel about this?

And changing people's attitudes, how they feel, is much more difficult than just giving them some objective information.

Especially when there's these social media algorithms that feed all of this misinformation and see that it generates a response and pumps more of that into the societal bloodstream.

I mean, that's a whole other series of immunizations we need to deal with in this country.

I do, Will, staying with you for a second, I want to ask you this one question.

President Trump suggested and signed an executive order to this end to break up the MMR shot into three separate shots, saying that that would somehow be safer.

One, we know that there are not three separate shots for measles, mumps, and rubella, but is there any sense that that would be a useful positive tool, to split them up?

Well, as you say, MMR is available.

There are not three separate shots available in the United States.

And there are no scientific data to suggest that it would be more safe.

Indeed, it would require more doctor's visits and more inoculations of the child.

That's exactly what we've been trying to avoid.

It's the benefit of putting all three of them together, and they work wonderfully, as Jessica and I've been saying.

Jessica, the question that I often hear from people when we do stories like this is, "If you don't want to get vaccinated, that's fine, "but if I'm vaccinated, what do I have to worry?

"I vaccinate me and my children.

"Let those other people be those other people "and do what they want.

"They're making choices.

I've made my choice."

What's the argument about that?

Yeah, I think it's a fundamental misunderstanding of public health.

At the end of the day, public health is about community.

The well-being of an individual affects the well-being of people around them.

Now, I do understand that people are not necessarily compelled by that framing.

However, to put it in context with measles, we require a 95% vaccination rate in communities, that's what we call a herd immunity threshold to make sure that that disease does not spread in community.

Once we start dipping below that, that's when you start to see measles outbreak.

So one person's decision is not one person's decision.

That one person contributes to the total percentage of a community.

And once that percentage rate drops, that creates a vulnerability.

And it's a vulnerability for even those who are vaccinated.

Immunity can wane from the vaccine.

Breakthrough infections can happen.

And so everybody relies on this collective contribution to that threshold to make sure that we can stop the disease from transmitting at all.

Unfortunately, as we mentioned at the beginning of this, vaccination rates are plummeting nationwide.

And that herd immunity threshold is dropping in many, many jurisdictions.

We usually base that off of kindergartners because typically the second dose is given before kindergarten.

And that is exactly how an individual or a child even can become at risk if those around them are only thinking about themselves, vaccinated or not.

Bill, in the last minute, last minute.

Yes, please go right ahead.

Well, I just wanted to say those children who are too frail or too young to be vaccinated are put at risk when the rest of us are not vaccinated.

They can become sick.

And when they do, they're likely to become very seriously ill.

So we protect not only ourselves, but others in the community who are too frail or too young to be vaccinated.

And so, Bill, just the last 30 seconds that we have, what would you say to a parent that comes to you and says, "I've heard the president say this, "I've read these sketchy things, I'm not sure.

"What should I do for my family?"

What you should do, please talk to that physician, your pediatrician, your family doctor, who is taking care of your family.

You trust that physician to take care of your children when they are ill.

Please have this discussion to talk to that doctor about how to prevent illness on the front end.

Dr.

William Schaffner and Jessica Malaty Rivera, thank you both so much for being here.

Really important conversation.

Thank you.

Rivera: Thank you for having us.

And that is it for this episode of "Horizons."

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We'll see you next week.

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Additional support is provided by Friends of the News Hour.

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