Measles: An Expert’s Perspective

MEASLES, A DISEASE that was once considered eradicated in the U.S., has once again been making headlines. Due to declining measles vaccine coverage, the U.S. and other countries are experiencing increased widespread outbreaks. In a report published in the New England Journal of Medicine, experts noted how quickly the disease can spread, citing one casein which a single child with measles infected 23 other children at a pediatric oncology clinic, which had a fatality rate of 21 percent.¹

As professor and chair of family science at the University of Maryland School of Public Health, Sandra C. Quinn, PhD, recently weighed in on this rising public health concern. Dr. Quinn is also a researcher funded by the National Institutes of Health and the U.S. Centers for Disease Control and Prevention to examine public attitudes toward vaccines.²

BSTQ: Is something changing in the national conversation about vaccination and resistance to vaccination?

Dr. Quinn: The proliferation of social media has enabled a spread of misinformation in ways that are frankly hard for us not only to keep up with, but hard for us to understand who’s doing the talking, who’s doing the communicating and what their motives are. We also see bad actors like bots and trolls that are not just promoting misinformation, but also seeking to sow discord or to sell you something.

BSTQ: How does social media help incite resistance to vaccines?

Dr. Quinn: People questioning vaccines has been around a long time, but social media has amplified voices that may not represent the larger public. When you look at the Pew survey data, we still see very high support for vaccination. If you look at social media data, you might not see that. With social media and the Internet, many people don’t know how to identify credible, legitimate information. That’s not a criticism of individuals; it’s more a criticism of organizations and providers that don’t necessarily help foster the kind of health literacy that’s needed.

BSTQ: What about the move to push companies or websites like Amazon and YouTube to make anti-vaccine content less available?

Dr. Quinn: That’s the $64,000 question. There’s a part of me that’s relieved in some ways it is happening. There’s another part of me that says, just because people can’t get it here doesn’t mean they won’t get it somewhere else. It’s also a little bit of a challenge for me because of the concept of freedom of speech, and I feel torn between that and reducing disinformation and fostering high vaccination rates as a collective good for our society. But I also know from our research how many of those anti-vaccine messages are paid ads. This isn’t all about private citizens expressing themselves.

BSTQ: What action is needed (to address philosophical exemptions to vaccines)?

Dr. Quinn: There still are 17 states that allow for philosophical exemptions to vaccination requirements. That can just be, “I don’t believe in vaccination.” That is increasingly becoming a focus of policymakers. After the Disneyland outbreak in 2014 and 2015, California changed its state laws and did away with exceptions except for medical exemptions. Policymakers in Washington state are literally battling that out as we speak. I think policymakers and the public are beginning to recognize we have tipped so far that we are at a danger point for these diseases. I would argue it is time to look at our policies and reconsider the implications for the health of our children and communities that result from lax laws that allow many possible exemptions for nonmedical reasons.

BSTQ: Is anything changing for the better? Dr.Quinn:With the number of outbreaks and cases that just keep increasing — it’s measles now, but we’ve had pertussis outbreaks, we’ve had mumps outbreaks — I think there’s beginning to be a renewed appreciation that these diseases are dangerous, but they also are preventable. I think it is also being understood that the decision to vaccinate one’s own children is not just about one’s own children, it’s about the broader community, and particularly about protecting people who are vulnerable because they cannot be vaccinated for real health reasons. As we’ve seen in places where there are outbreaks, when you go below a certain percentage vaccinated, you lose herd immunity that protects everyone. With the U.S. this year already surpassing the 2018 case number,I am hopeful more legislators will take action and more parents will step forward to protect their own and others’ children from unnecessary suffering.

Editor’s note: Portions of this article are reprinted with permission from an article written by Chris Carroll and published in Maryland Today, a publication of the University of Maryland: today.umd.edu/articles/faltering-shieldagainst-disease-5f19f347-f16d-4986-8 bed-95ebde0fd1cb.