What will it take to get measles under control?
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On February 12, 1993, President Bill Clinton took the lectern at a public health center in Arlington, Virginia. Thank you. He was surrounded by kids sitting on the stage in front of him. Some had just received vaccinations. Clinton was just a few weeks into his presidency, and he was announcing what would become a major initiative of his first term, a massive push by the federal government to vaccinate children. We came here today to make this day a landmark in the fight to protect

the health of millions of our children. One virus was top of mind. The recent resurgence of measles in our country afflicted over 55,000 people, most of whom were children. Remember, this was 1993. A prolonged measles outbreak between 1989 and '91 killed more than 100 people and sickened tens of thousands.

A federal advisory committee found that pricey vaccines, cuts to federal support for vaccination, and low vaccination rates among young children had caused the outbreak to be so severe. This is what Clinton wanted to fix. So did lawmakers. Six months after that event at the Public Health Center, Congress passed Clinton's Comprehensive Childhood Immunization Act.

The law helped the government purchase vaccines and negotiate prices with drug manufacturers. It made vaccines free for many children and helped the Department of Health and Human Services track childhood immunizations. By the end of Clinton's second term in office, the World Health Organization had declared the elimination of measles in the United States.

Fast forward 25 years. This is going to be a large outbreak, and we are still on the side where we are increasing the number of cases.

Katherine Wells is the director of public health in Lubbock, a city near the heart of the current measles outbreak in West Texas. The uptake for vaccines has been definitely been a struggle. I mean, I want to be honest with that. So far, there have been around 500 cases in West Texas since late January. Two kids there have died. The outbreak has spread to neighboring states, including New Mexico.

On top of that, the Federal Department of Government Efficiency, or DOGE, announced it would terminate hundreds of millions of dollars in grants to the Texas Department of State Health Services. Lubbock is one of the cities which will lose that money.

Consider this. 25 years after measles was officially eliminated in the U.S., the disease is once again spreading in West Texas and New Mexico. What can be done to get the virus under control? From NPR, I'm Ari Shapiro. ♪

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It's Consider This from NPR. The last major measles outbreak in the U.S. was 2019. More than 1,200 people got sick.

At the time, NPR spoke with Anthony Fauci, who was then head of the National Institute of Allergy and Infectious Diseases. People sometimes incorrectly and inappropriately think that to get infected with measles is a trivial disease. It is not. It can be very dangerous because if you look at the history of measles prior to vaccinations that were available throughout the world, there were a couple of million deaths per year.

Now, you might wonder how the U.S. could still be said to have eliminated measles when there are hundreds of cases. Well, in public health, elimination is a technical term. Specifically, it means the disease has not had a steady 12-month spread. We're only about four months into 2025, so it's a long way off before we're in that kind of scenario. But certainly, the longer the virus circulates, the more chance that we'll run up against that

outcome. That's Dr. Caitlin Rivers of the Johns Hopkins Bloomberg School of Public Health. She just wrote a book called Crisis Averted about the history of public health victories, and I asked her what the U.S. needs to do to avert this crisis.

There are two things we need to see in order to get this crisis under control. One is clear and frequent communication. I think we could be doing better on that front. State and local communities are doing what they can to communicate, but I don't think that the messaging coming out of the federal government has been as clear as it needs to be about the importance of vaccination.

The other thing that concerns me is funding and support for our public health infrastructure. The majority of Americans live in counties that spend less than $150 per year per person on public health. A single outbreak can really blow that budget for the year. And so if we are asking states and locals to take on more responsibility for outbreak control, we need to resource them to do that. From your research on the book, is there a specific example of a public health victory that you think is especially useful here today? Yeah.

My favorite is the example of the eradication of smallpox, which I think is one of history's and humanity's greatest achievements. Smallpox was an absolute horror. It killed up to a third of people it infected. Survivors were left often with lifelong disabilities.

And through years of dedicated boots on the ground, community by community efforts to vaccinate, we drove that virus, the smallpox virus, off the face of the earth. And it has not circulated for 50 years. And what I love about that story is it really shows what we as a global community, as a public health community can accomplish when we set our mind to these big goals and have

the funding and the political support to go after them. And measles too, we successfully eliminated it. And I would hate to see that take a step backward. You said messaging from the federal government isn't as clear as it needs to be. Of course, HHS Secretary Robert F. Kennedy Jr. has a long history of vaccine skepticism.

Earlier this week, he said the MMR vaccine is the most effective way to prevent the spread of measles. Do you think that message did what it needed to do? I think we need to keep it coming. The information landscape is very fractured. People get their news from all sorts of places. They tune in, they tune out. And so reaching people is really about...

communicating frequently and clearly. And so I'm really heartened to hear that message from Secretary Kennedy. But I do think it needs to become a pattern or a cadence of that kind of messaging. And on funding, we have seen widespread cuts across the government, including in the public health establishment. Do you think that is going to trickle down to states that need resources to fight measles outbreaks? Absolutely. And I wouldn't be surprised if it already has.

There were cuts to public health programs that directly affected states and local public health governments. They have had to lay off personnel as a direct result of those cuts. And I think we'll continue to see more. And I think as funding declines, we'll see more and more of these preventable outbreaks resurging. Just to return to the question of whether a country is declared to have measles eliminated,

Yeah.

Well, we care most about what's happening on the ground. So as you know, the fact that there are children who are dying of this preventable infection and there are dozens of people who have been hospitalized, that's really the thing that matters. But elimination status is a reflection or a testament to our ability to control these preventable viruses. And so losing elimination status would be a blow because it signals that something's gone wrong with our public health system.

That was Dr. Caitlin Rivers of the Johns Hopkins Bloomberg School of Public Health. We had additional reporting from Olivia Aldridge of member station KUT in Austin. This episode was produced by Noah Caldwell and edited by Courtney Dorning. Our executive producer is Sammy Yenigan. It's Consider This from NPR. I'm Ari Shapiro. Support for NPR and the following message come from Washington Wise.

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