(April 19, 2019) – Measles. In 1980, 2.6 million people died of it. In 1990, 545,000 died; by 2014, global vaccination programs had reduced the number of deaths from measles to 73,000. The disease still affects millions of people across the globe, primarily in the developing areas of Africa and Asia. However, for the last couple of years, rates of disease and deaths have increased due to a decrease in immunization.
In the United States, 2019 is shaping up to be one of the worst years for measles in a long time. The U.S. is up to 555 total cases and counting. That's nearly 200 more than occurred in all of 2018, making this the second-worst year for measles since the U.S. declared it eradicated in 2000. What is the primary way a measles outbreak begins? Someone unvaccinated travels and brings the virus back to the States. And when you have pockets of low vaccination rates, those singular events can spread rapidly.
Given the fact the measles vaccine can be 97 percent effective against the disease, making measles one of the leading vaccine-preventable causes of death, you might logically assume policy makers are doing everything they can to ensure as many people as possible are vaccinated. But if efforts in several state legislatures are any evidence, increasing the numbers of measles vaccinations may be difficult.
Legislation in six states has been introduced to make it harder to avoid vaccinating school-age children. But that legislation is facing opposition; and in other states, legislation has been introduced to broaden vaccine exemptions. The question boils down to this: Are there legitimate non-medical reasons for refusing measles vaccinations? Stated another way: How broad should vaccine exemptions for personal or philosophical reasons be?
The issue has gained the attention of U.S. Food and Drug Administration Commissioner Scott Gottlieb, who suggested if states don't tighten vaccine exemption laws, the federal government may step in. "Some states are engaging in such wide exemptions that they're creating the opportunity for outbreaks on a scale that is going to have national implications," the FDA head said in a recent interview.
Any time the desires of an individual conflict with the health of the public, there should be a thoughtful sensitivity to all points of view. However, if this really is a public health issue, as most in the healthcare world believe, we might be well-advised to heed the warnings of Commissioner Gottlieb.