Quick Take
Measles is spreading in Texas, writes retired Santa Cruz physician Jeoffry B. Gordon, which should concern us all. We are safe in Santa Cruz County, largely because 95% of school-age children are vaccinated, he writes, but our government’s response to the outbreak is “shockingly inadequate.” He worries about misinformation about vaccines, vaccine skeptics whose views he calls “dangerous to others” and the way President Donald Trump’s health secretary, Robert F. Kennedy Jr., has minimized the seriousness of the outbreak.
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You should be deeply concerned about the recent ongoing, uncontrolled measles outbreak in West Texas now spreading toward Austin, which has so far led to over 155 confirmed cases across Texas and New Mexico, primarily affecting unvaccinated children. So far it has resulted in the tragic death of two unvaccinated people – one an adult and one a child— the first measles-related fatalities in the United States since 2015.
One death from a totally preventable disease is one too many. This measles outbreak demonstrates the avoidable risks and harms of misunderstanding vaccines.
This could happen here, but is unlikely in California.
We are protected because more than 95% of school-age children in Santa Cruz County are vaccinated against measles, owing to strict state laws that were enacted in 2014-15 after 125 people caught measles at Disneyland in winter 2015. These laws were enacted to protect community safety and came amid vociferous opposition advocating for individual freedom of choice.
Many of our neighbors are concerned about harms from vaccination, but that view is risky, very inaccurate and dangerous to others. Meanwhile we, locally, remain protected by herd immunity.
Prior to the first measles vaccine in 1963, approximately 500,000 cases of measles and 500 measles-related deaths were reported annually in the United States. Measles is the most infectious virus there is. It’s spread by contact, droplets and aerosols – on average, one infected person will spread it to 12 to 18 unvaccinated people.
Measles can result in diarrhea (8% of infections), ear infections (7%), pneumonia (6%) and death in less than 1%. Delayed long-term effects from measles infection include permanent deafness, brain inflammation (subacute sclerosing panencephalitis) and erasure of immune memory to other diseases, leading to an increase in all-cause deaths years later. In contrast, adverse events after measles vaccination are estimated to occur at a rate of 30.5 adverse events per million doses distributed (less than 0.001%).
Because of near-universal vaccination, measles was declared eliminated in the United States in 2000, but cases still occur from infections caught in foreign countries by those unvaccinated.
The largest outbreak of measles in the U.S. since 1992 occurred in 2018 in New York City, with one unvaccinated child bringing measles home from abroad. Over the next 10 months, 649 cases of measles were confirmed. The median patient age was 3 years (81.2% of the patients 18 or younger), and 85.8% of the patients who had a traceable vaccination history were unvaccinated. Serious complications included 37 cases of pneumonia and 49 hospitalized patients. Among the patients who were hospitalized, 20 were admitted to an intensive care unit.
There were no deaths, and long-term complications have not been evaluated. To control the outbreak, the New York City Department of Health and Mental Hygiene required an emergency “all hands on deck” effort involving 559 staff members at a cost of $8.4 million. This required a geographically focused, intensive, mandatory vaccination, immune globulin, or home quarantine as indicated, program (backed by legal requirements and sanctions on non-compliant schools and individuals) resulting in nearly 200,000 vaccinations.
The recent federal and state response to the current outbreak has been shockingly inadequate.
During a recent White House cabinet meeting, Health and Human Services Secretary Robert F. Kennedy Jr. minimized the ongoing danger, saying the number of cases was “not unusual.” He reported two deaths associated with this outbreak (later corrected to reflect only a single confirmed death). Kennedy also wrongly suggested the hospitalizations are mainly for quarantine – an assertion challenged by medical professionals who emphasize that hospitalizations were due to the severe health complications caused by measles, not merely for isolation. Further adding to our risks, on March 2, Kennedy in an op-ed wrote, “The decision to vaccinate is a personal one.”
While duly reporting the Texas epidemic (in an area where only 82% of children are vaccinated), the Centers for Disease Control (CDC) has neither recommended nor promoted, nor started, a targeted vaccination program. The Texas and New Mexico state departments of health, while reporting the outbreak, and the death, as of Feb. 28, had not undertaken any steps to mitigate the spread other than to inform people where they can get vaccinated if they choose.
Vaccination is the most important and successful medical science discovery since 1700, saving countless lives. The simple, well-proven, public health response to this geographically focused measles outbreak is contact tracing, isolation and an aggressive localized MMR (measles, mumps, rubella) vaccination campaign. This will create local herd immunity and stop the spread.
Because of Texas culture, political and legal restraints on the CDC and Kennedy’s incompetence, this has not yet happened and remains unlikely.
Everyone must consider your family’s and your neighbors’ safety and seek out and rely on accurate, science-based information. Consult your health care professional regarding vaccination. Vaccination protects not only individuals, but also contributes to community (herd) immunity, safeguarding those too young to be vaccinated and those who cannot be vaccinated due to medical reasons.
Public figures and officials must communicate responsibly and ensure their statements are based on verified data to prevent the spread of misinformation, which can undermine public health efforts and lead to unnecessary harm. While we remain protected here, official public agencies in Texas should immediately undertake a contact tracing and expansive vaccination program in the impacted area. Collective adherence to evidence-based health practices is essential to control the spread of measles and prevent further tragedies.
Otherwise cases will multiply and we may see more deaths.
Jeoffry B. Gordon had a family medicine practice in Santa Cruz for 35 years until his retirement 17 years ago. He spent four years in a federally qualified health center treating the unhoused. He is currently a member of the California Citizens Review Panel for Critical Incidents (fatalities due to child abuse). He served as a medical bioethics consultant at Sharp Memorial Hospital in San Diego for 10 years. He spent eight years on the Medical Board of California, which licenses and disciplines physicians. Gordon lives in Santa Cruz and is a widower with two daughters and four grandchildren.