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The Grim Prognosis For Measles Elimination
We are headed toward a completely avoidable disaster
One summer in the late 80s when I was working at a summer camp we had an outbreak of chickenpox. We collected volunteers who had already had the disease to help care for the kids in the infirmary. That was probably the last time I saw a case of chickenpox until about 15 years ago when an unlucky patient of mine caught it. She was too old to have been vaccinated and somehow escaped the disease as a child. It was miserable. Because of vaccination, since finishing medical school in the late 90s, I’ve seen that one case of chickenpox and one case of mumps. I’ve never seen a case of measles—yet.
A new study published in the Journal of the American Medical Association looked at a ton of data and used sophisticated mathematical modeling to give us a big piece of bad news—if we don’t make changes in our vaccination practices, we're in for a return to the bad old days.
Measles, one of the diseases they modeled, was declared “eliminated” in the US in 2000. This means it was no longer spreading regularly. To keep measles from spreading, we need a vaccination rate of about 95%. Right now in, for example, Oakland County, MI, about 83% of toddlers are up to date on their measles, mumps, rubella (MMR) vaccine.

Infant mortality has been declining, and a large part of that decline is due to vaccination
The study simulated different starting points of vaccination rates and simulated different changes in vaccine rates over time. One scenario was the ending of mandatory childhood vaccination, for example. But when they ran their simulation using current vaccination rates, they predicted over 850,000 cases of measles over the next 25 years. That’s if we do nothing different. This would lead to about 2200 deaths, mostly in children. They also calculated rates of other severe complications of measles and the numbers were grim.
But there was good news, of a sort. If our vaccination rates were to go up only 5%, we would expect only 5800 cases rather than 850,000 (and at least 2000 fewer dead kids). Five percent isn’t that much. It’s totally doable.
But if we were to see our vaccination rates drop 10%, we would see over 11 million cases of measles over the next 25 years. That could mean around 10,000 dead children.
This isn’t surprising but having real data helps us plan. Childhood vaccination programs have been a huge success, and have decreased childhood mortality tremendously. We know how to do this. If we choose to.
Our current Secretary of Health and Human Services, Robert Kennedy, has approached this year’s measles outbreaks in ways that are completely opposed to what we know of the disease. He has occasionally given lip service to vaccination, but more often has made completely false claims such as vaccination doesn’t protect for very long, or it is dangerous, or there are known treatments for measles. All of these are false. Only vaccination prevents measles, and there are no known treatments for the infection other than supportive care.
This study was very well done. We are clearly headed for disaster, and we have a clear way to avert it. If we choose to.
Stay well.
-pal