Amid a growing measles outbreak in west Texas and New Mexico, many doctors and nurses are fielding questions from patients about an infectious disease they have never seen and assumed they never would.
Measles was considered eliminated in 2000 thanks to a highly effective vaccine and high vaccination rates.
Public health officials are warning that declining immunization rates, driven in large part by misinformation, and the lack of clear guidance and messaging from Washington, D.C., are hindering efforts to combat the measles outbreak, along with rising cases of other preventable diseases.
"The measles outbreak that we are currently witnessing is the result of misinformation," Dial Hewlett Jr., M.D., medical director of tuberculosis services at the Westchester County Department of Health, said during a media briefing hosted by the Infectious Diseases Society of America (IDSA).
"When I was completing my fellowship in the New York area back in the 1980s, the attending physicians said to me, 'You will never see a case of measles.' And so I thought at that time that we were never going to see measles, but we ended up seeing it."
To date, more than 300 cases of measles have been reported across multiple states, with 95% of those individuals either unvaccinated or their vaccination status is unknown, and 17% of them have been hospitalized, according to data from the Centers for Disease Control and Prevention. There have ben 259 measles cases in Texas alone. There has been one confirmed death, an unvaccinated child in west Texas. In New Mexico, health authorities are investigating a possible second fatality as an unvaccinated adult who recently died tested positive for measles.
Local health departments already face tight budgets, public health officials say, and moves by the Trump administration to slash the workforce at the Centers for Disease Control and Prevention (CDC) and cut federal grant funding will make it harder to stop the spread of infectious diseases like measles, avian flu and tuberculosis.
"I actually spoke to 120 nurses who had a lot of questions and concerns, especially on the heels of the news in just the last 24 hours, and again these are school nurses that, while they had been well trained and read in all aspects of preventative medicine, most had never, ever seen a case of measles. It's very important to understand that we have a workforce that has largely not experienced this. We need an all-hands-on-deck. Now is not the time to be depleting an already depleted public health workforce," said Matifadza Hlatshwayo Davis, M.D., director of health at the City of St. Louis Department of Public Health, during the IDSA media briefing.
Health officials reiterate that the measles vaccine, given as part of the MMR (measles, mumps and rubella) vaccine, is extremely effective, giving those vaccinated with just one dose 93% protection against measles infection. Both doses of the vaccine provide individuals with a 97% protection rate throughout their lifetime.
Dr. Davis said there have been declining immunization rates in Missouri. Statewide, the MMR vaccination rate among kindergarteners has dropped steadily from 95.4% in the 2016-17 school year to 90.5% at the start of the 2023-24 school year, according to preliminary data reported by Missouri school districts.
"Local health departments are being impacted negatively because messaging from the top down has given, in some cases, credence to people pushing vaccine misinformation and disinformation," Davis said.
In the past three months, St. Louis health officials have investigated three measles cases with one confirmed positive, compared to none in the last three years, she noted.
The lack of clear guidance and messaging from both state and federal officials can create a vacuum where misinformation and panic can thrive, public health officials said.
"We are seeing trusted places that the community leans into already making adjustments, and now is the time for us to have more information that is standardized and clear," Davis said.
Robert F. Kennedy Jr., who heads the nation's top health agency, is a longtime critic of well-established vaccines. In a recent interview, RFK Jr. offered conflicting public health messages as he tried to reconcile the government’s long-standing endorsement of vaccines with his own decades-long skepticism, The New York Times reported. He also linked the measles outbreak to poor diet and health, citing fringe theories.
“It’s very, very difficult for measles to kill a healthy person,” RFK Jr. said, as the NYT reported, adding later that “we see a correlation between people who get hurt by measles and people who don’t have good nutrition or who don’t have a good exercise regimen.”
RFK Jr., in a recent op-ed, also noted that the CDC updated its guidance on measles management to include "physician-administered outpatient vitamin A."
Doctors and public health experts stress that vitamin A isn’t effective for preventing measles, and some are concerned people will see vitamin A as an alternative.
"Vitamin A is not a replacement for vaccination. The measles, mumps and rubella vaccine is the only reliable way to prevent measles," Davis said. "It's important to note that vitamin A supplementation has been shown to reduce measles mortality in malnourished populations, in resource-limited countries where deficiencies are common. However, in well-nourished populations, the benefits are unclear."
She added that high-dose vitamin A therapy carries safety risks including toxicity, liver damage and increased intracranial pressure.
The Trump administration is slashing about 1,300 employees, or 10% of the workforce, at the CDC, multiple media outlets reported in February. These workforce cuts will impede the work of local health departments, public health leaders say.
Timely and transparent public health data are critical to enable health departments to effectively use resources and respond to outbreaks.
"The prevention measures we implement operate on the bedrock of data. Data needs to be shared at the earliest stages, and the sources need to be transparent and holistic in its collection. The recent firings of CDC and [National Institutes of Health (NIH)] scientists and personnel will have a cascading effect of how we make decisions. We have already seen delays in being able to get and report data, and we fear that that will only increase if we continue down this route," Davis said.
At the same time, the NIH is continuing its grant-canceling spree, allegedly targeting dozens of research projects related to studying vaccine hesitancy and improving vaccine rates, according to several news reports.
The St. Louis health department is largely grant-funded, Davis noted, and any potential funding cuts would be detrimental to its ability to provide core services.
Impending federal cuts will not just impact organizations at the federal level, she noted. "There is always a trickle-down effect to local health departments that I believe are the front line for preventative healthcare within the community, and have been for decades. Local health departments are currently lacking clear, timely guidance and messaging from both our state and federal officials. This silence is causing confusion and fear in the public. When we don't know how big of a problem something is, we are hamstrung in providing important information to our jurisdictions," she said.
A lack of funding for personnel means less health workers in the community, leaving a gap for lower income families and for seniors who are at risk, she added.
The Trump administration and its advisory body, the Department of Government Efficiency, have touted massive cuts as part of an effort to make the federal government more efficient and to reduce costs.
Davis noted that delaying vaccine research, responding slowly to outbreaks and firing workers and then rehiring them have the opposite effect by creating more inefficiencies and potentially wasting resources.
"Being in an environment where misinformation and disinformation is ripe, we actually see here at our level, increases of inefficiencies and that can certainly waste taxpayer dollars," she said.