--:-- Halima Shah: Measles was declared eliminated in the United States over 20 years ago. But today, there are cases popping up around the country. This morning, measles cases on the rise in South Florida.
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--:-- Halima Shah: At Manatee Bay Elementary School near Fort Lauderdale, most Americans were vaccinated against it as kids. That's the good news. The bad news is that it's really easy to catch if you weren't.
--:-- Halima Shah: Measles is one of the most, if not the most, contagious infectious disease on Earth. And the number of people opting out of common vaccines is growing. It's concerning to me that, especially in this post-pandemic world, we are allowing our response to infectious diseases to be a choose-your-own-adventure type of approach, rather than using decades of standards of practice.
--:-- Halima Shah: Coming up, a new resurgence of an old disease. And how Florida became the center of another outbreak.
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--:-- Halima Shah: 41 cases of measles were reported so far across the United States. Florida is in the lead with 10 of them. But the case numbers aren't the only reason Florida's measles outbreak is in the spotlight.
--:-- Halima Shah: It's the state's unusual response to it. We reached out to Caroline Katherman to explain what's going on. She's a health reporter at the Orlando Sentinel.
--:-- Halima Shah: Florida's a really wild state to be a health reporter. I asked her how the measles outbreak started in Florida.
--:-- Caroline Katherman: That began a few weeks ago when a kid at an elementary school in South Florida tested positive for measles, despite having no history of travel.
--:-- Halima Shah: Parents say they found out Thursday night by email. It said that a field trip was canceled because of a confirmed case of measles.
--:-- Caroline Katherman: So when I saw confirmed, I was like, wait, what?
--:-- Halima Shah: The outbreak spread pretty quickly among other kids in the school.
--:-- Halima Shah: We are at Manatee Bay Elementary in Weston, where there are now five confirmed cases of measles.
--:-- Caroline Katherman: Eight percent of kindergartners in that county are not vaccinated for measles, according to state data.
--:-- Halima Shah: At this point, a few people, you know, outside the school have contracted it. A tenth case has been reported in the state.
--:-- Caroline Katherman: It is a travel related case in an adult that was reported in Polk County.
--:-- Halima Shah: Now, the other nine cases you probably know are in Broward County.
--:-- Caroline Katherman: Seven of those linked to Manatee Bay Elementary School in Weston.
--:-- Halima Shah: Now, after going through the COVID pandemic, when the numbers, the case numbers were in the thousands, 10 can sound like a small number.
--:-- Caroline Katherman: Can you talk about why that's such a significant number?
--:-- Caroline Katherman: Measles is a serious, highly contagious airborne disease that is characterized by a rash and also often comes with a fever, a dry cough and a runny nose.
--:-- Caroline Katherman: Physicians today know that measles is more than a nuisance. It can bring on bacterial infections, can cause fatal pneumonia, and in some cases, encephalitis, inflammation of the brain.
--:-- Caroline Katherman: Each case needs good medical care. It is almost completely preventable by vaccination. Vaccination prevents 97% of cases.
--:-- Caroline Katherman: Measles is also incredibly infectious, even more infectious than COVID.
--:-- Halima Shah: How did the Florida Department of Health respond to this outbreak?
--:-- Caroline Katherman: The Florida Surgeon General sent a letter to parents at the school, essentially saying that though the typical recommendation is to stay home for three weeks, unvaccinated kids can go to school if their parents are comfortable with it.
--:-- Halima Shah: Due to the high immunity rate in the community, as well as the burden of the families and educational cost of healthy children missing school, DOH is deferring to parents or guardians to make this decision about school attendance.
--:-- Caroline Katherman: He did not urge parents to vaccinate unvaccinated kids.
--:-- Halima Shah: The Florida Department of Health has, however, been offering measles vaccines at Manatee Bay Elementary since the outbreak began.
--:-- Halima Shah: What do we know about this particular Surgeon General?
--:-- Caroline Katherman: He was appointed to the position during the COVID pandemic after being a very outspoken critic against the COVID vaccine.
--:-- Halima Shah: One of the things that we've lost sight of during this pandemic and really far in the rearview mirror is choice.
--:-- Caroline Katherman: And this has actually been a cornerstone of public health I would say that he is one of the most influential and honestly probably the most credentialed voices in the movement against the COVID vaccine
--:-- Halima Shah: He Harvard educated was at UCLA until Governor Ron DeSantis appointed him our state surgeon general.
--:-- Caroline Katherman: And he's a big proponent of natural immunity, of just letting the virus, you know, wash over the population.
--:-- Halima Shah: And he has just been incredibly skeptical of the COVID vaccine, despite overwhelming evidence that it is safe and it is effective.
--:-- Caroline Katherman: In his role as the Surgeon General has gone on the campaign trail when our governor was running for president.
--:-- Halima Shah: He's attracted a lot of criticism. I know after this measles incident, U.S. Rep. Debbie Wasserman Schultz called for his resignation.
--:-- Halima Shah: Our state leaders are failing us on this front. Surgeon General Lodapo needs to go.
--:-- Caroline Katherman: He's gotten a lot of negative feedback from the health community and others.
--:-- Halima Shah: So this highly credentialed, Harvard-educated medical professional is questioning the COVID vaccine.
--:-- Halima Shah: And it's obviously not sitting well with other members of the public health community.
--:-- Halima Shah: But I wonder how parents and schools are reacting to him.
--:-- Caroline Katherman: I feel like it is a mixed bag.
--:-- Halima Shah: I mean, I think there's definitely parents who believe that vaccines fall under parental rights.
--:-- Halima Shah: And that is something that should be left up for them to decide for their children.
--:-- Caroline Katherman: But I also have talked with parents who are concerned for their children's health.
--:-- Halima Shah: It makes me a little concerned.
--:-- Halima Shah: So my daughter's fully vaccinated, but my son can't get his second one until he is four.
--:-- Caroline Katherman: And he's high risk for a lot of other issues.
--:-- Halima Shah: There are some kids who can't get vaccinated because they are allergic to the ingredients in vaccines or kids who are immunocompromised and vaccines don't work as well for them.
--:-- Halima Shah: And a lot of parents are very afraid for their kids and afraid of the implications of not encouraging vaccines.
--:-- Halima Shah: It also occurs to me, Caroline, that parents have had to deal a lot with schools being in lockdown, with their kids being at home, with struggling to find childcare.
--:-- Caroline Katherman: Is any of that, is any of the struggle of COVID-19 influencing how parents are seeing this particular situation?
--:-- Halima Shah: The state surgeon general has made concerns about kids staying home from school a big part of his vaccine hesitancy.
--:-- Halima Shah: In his letter where he said parents could decide whether to keep their kids home from school, he referenced the impacts on social and educational development that keeping kids home from school for three weeks would potentially cause.
--:-- Halima Shah: So, you know, obviously kids staying home from school really set a lot of kids back.
--:-- Halima Shah: I think the education value is still there with him returning to school.
--:-- Halima Shah: You know, we already had a massive time away from school with COVID.
--:-- Halima Shah: We didn't want to repeat that.
--:-- Halima Shah: Caroline, the Surgeon General is now facing calls for his resignation.
--:-- Halima Shah: There is now nationwide attention on Florida's measles outbreak.
--:-- Halima Shah: Do you think that any of that is going to have an impact on how Florida addresses this going forward?
--:-- Caroline Katherman: Honestly, I don't think so.
--:-- Halima Shah: He's faced a lot of calls for his resignation before from powerful people.
--:-- Halima Shah: The FDA and the CDC have sent him multiple letters throughout the COVID outbreak telling him that by discouraging vaccination, he is endangering public health and abandoning his duty to the public as a public health official.
--:-- Halima Shah: I don't think that this scandal is going to change Florida's public health policy.
--:-- Halima Shah: Caroline Katherman is a health reporter for the Orlando Sentinel.
--:-- Halima Shah: We reached out to the Florida Department of Health to get their take.
--:-- Halima Shah: And they told us media outlets are politicizing this outbreak and that, quote, 97% of students at Manatee Bay Elementary received at least one dose of the MMR immunization.
--:-- Halima Shah: End quote. MMR stands for the measles, mumps, and rubella immunization.
--:-- Halima Shah: One dose is highly effective, but the CDC recommends kids get two for more immunity.
--:-- Halima Shah: The department also said that the Surgeon General's current guidance, quote, ensures that parents or guardians are able to make the best decisions for their families regarding school attendance.
--:-- Halima Shah: End quote.
--:-- Halima Shah: Coming up, the number of parents opting out of vaccines for their kids is hitting a record high.
--:-- Halima Shah: An epidemiologist explains what's behind that.
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--:-- Halima Shah: Support for the show today comes from LifeKit, the podcast from NPR.
--:-- Halima Shah: What's in your life kit? I'm asking.
--:-- Halima Shah: They didn't ask that.
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--:-- Halima Shah: R. We're back. I'm Halima Shah filling in on Today Explained.
--:-- Halima Shah: The invention of the measles vaccine was a hallmark of human progress.
--:-- Halima Shah: That's because the disease was nearly unavoidable for most of history.
--:-- Halima Shah: Measles is one of the most, if not the most, contagious infectious disease on Earth.
--:-- Caitlin Jetelina: I'm an epidemiologist and publisher of the newsletter, Your Local Epidemiologist.
--:-- Halima Shah: What has a measles diagnosis meant for a person for most of history?
--:-- Caitlin Jetelina: I mean, for most of history, it is detrimental.
--:-- Caitlin Jetelina: I will say most cases is a rash. It's usually mild, but cases can move and to be very severe, leading to hospitalization and death.
--:-- Caitlin Jetelina: One thing that people don't realize what measles can do is the secondary impact.
--:-- Caitlin Jetelina: So even if you survive a measles infection, it can wipe the immunity you have to other viruses.
--:-- Caitlin Jetelina: So for example, influenza or COVID-19.
--:-- Caitlin Jetelina: And so what happens is, yeah, you may survive from measles, but unfortunately, your defenses are down to other common viruses circulating, which can then also lead to severe disease.
--:-- Caitlin Jetelina: So bottom line, it's nothing to mess with.
--:-- Halima Shah: And vaccines have been a game changer with this disease in the United States and across the world.
--:-- Halima Shah: Caitlin, measles was declared eliminated in the U.S. in 2000.
--:-- Halima Shah: It wasn't supposed to be a problem for us in the new millennium.
--:-- Caitlin Jetelina: So why are we seeing outbreaks today?
--:-- Caitlin Jetelina: So in the United States, you're right, we have this elimination status.
--:-- Caitlin Jetelina: And what this means is that we just don't have sustained community spread, that it's not randomly spreading at a grocery store, for example.
--:-- Caitlin Jetelina: But it's not abnormal to have a measles case here and there.
--:-- Caitlin Jetelina: We actually see them every year.
--:-- Caitlin Jetelina: And cases typically come from international traveling and people bringing them to the states and then spreading in little pockets of unvaccinated people.
--:-- Caitlin Jetelina: And so it's not abnormal, again, to see a measles case here or there, but we are starting to see measles come in hot in the year 2024.
--:-- Halima Shah: Back here at home, the CDC is warning about the rise in measles infections in the U.S.
--:-- Halima Shah: Hundreds of thousands of children are at risk of getting deathly ill.
--:-- Caitlin Jetelina: The reason why us epidemiologists are a bit concerned about 2024 is, one, measles flares up every five years.
--:-- Caitlin Jetelina: It has these cyclical flare-ups.
--:-- Caitlin Jetelina: The last big quote-unquote measles year was in 2019, where we had about 1,200 cases.
--:-- Caitlin Jetelina: And in fact, in 2019, we almost lost our elimination status because we did have community spread for a couple months.
--:-- Caitlin Jetelina: And that was mainly due to a huge outbreak among Jewish Orthodox community in New York City.
--:-- Halima Shah: An outbreak in New York City led the mayor to declare a public health emergency in part of Brooklyn today.
--:-- Halima Shah: This Orthodox Jewish section of Williamsburg, Brooklyn, is ground zero, where some 250 measles cases have been confirmed within the last nine months.
--:-- Caitlin Jetelina: We're also starting to see more sparks or more embers across this nation at a higher rate than we did see last year.
--:-- Caitlin Jetelina: And the concern is if these sparks hit a pocket of unvaccinated people, it could lead to a wildfire.
--:-- Halima Shah: What is ultimately driving the lower vaccination rates that we're seeing?
--:-- Caitlin Jetelina: I will say vaccine skepticism.
--:-- Caitlin Jetelina: If you're like 21 years old and you say to me, should I get vaccinated? I go, no.
--:-- Caitlin Jetelina: If you're a healthy person and you're exercising all the time and you're young and you're eating well, like, I don't think you need to worry about this.
--:-- Caitlin Jetelina: All you hear is take this vaccine that doesn't even prevent you from getting the disease or you can't go to the Broadway show.
--:-- Caitlin Jetelina: It's madness.
--:-- Halima Shah: This isn't new, although it seems to be worse than this post-COVID vaccine error because misinformation is starting to hit the mainstream.
--:-- Caitlin Jetelina: I'm sure you've seen the pictures all over the Internet of people who've had these shots and now they're magnetized and put a key on their forehead.
--:-- Caitlin Jetelina: It sticks. They can put spoons and forks all over them and they can stick.
--:-- Halima Shah: Due to loss of trust, due to this changing information landscape, due to bad actors making a huge profit, due to the pandemic, putting vaccines in our microscope.
--:-- Halima Shah: The lies we were told about the COVID vax were so grotesque and so overwhelming, a lot of people were killed or permanently disabled by it.
--:-- Caitlin Jetelina: Now, how many people were hurt by the vax? How many people were killed by the vax? It was mandatory.
--:-- Halima Shah: And then there's also other reasons.
--:-- Caitlin Jetelina: For example, a lot of children missed routine doctor's appointments during the pandemic, and we're still trying to catch up from that in 2020 and 2021.
--:-- Halima Shah: How are people going about bypassing the measles vaccine?
--:-- Caitlin Jetelina: Because that's one of those vaccines that you get as a little kid before you enroll in school.
--:-- Halima Shah: As a parent you can get an exemption at schools and there two types of exemptions
--:-- Caitlin Jetelina: There a medical exemption
--:-- Caitlin Jetelina: So for example the kid medically cannot get this vaccine because it puts them at risk for other more severe outcomes
--:-- Caitlin Jetelina: But then there also non exemptions because of religious reasons or philosophical reasons
--:-- Halima Shah: And these non-medical exemptions have been increasing very quickly in the United States.
--:-- Caitlin Jetelina: And it's concerning because it shows that there's this uptick in parents believing vaccine misinformation or certainly being hesitant to it.
--:-- Halima Shah: People have a lot of reasons for vaccine skepticism.
--:-- Caitlin Jetelina: And, you know, it can range from maybe mistrust in the medical establishment because of a history of medical abuse in your community or go all the way to, you know, a discredited conspiracy theory.
--:-- Halima Shah: How is a provider and a health department supposed to overcome that?
--:-- Caitlin Jetelina: Because these are really emotional issues.
--:-- Caitlin Jetelina: It is emotional.
--:-- Caitlin Jetelina: And it's not only emotional.
--:-- Caitlin Jetelina: I think it's really important to recognize, kind of like what you're saying, is that vaccine hesitancy isn't dichotomous.
--:-- Caitlin Jetelina: It's not, you're not pro-vaccine or anti-vaccine.
--:-- Caitlin Jetelina: Really, hesitancy lays on this spectrum.
--:-- Halima Shah: And so how you help that person, one, you have to realize where they are in that spectrum.
--:-- Caitlin Jetelina: But regardless, empathy really helps.
--:-- Caitlin Jetelina: How you frame a conversation with skeptics matters because our goal is to set new foundations of trust.
--:-- Caitlin Jetelina: And if we use words like absurd or insane, all they're going to do is double down because that is the tribe they're a part of and they'll become defensive.
--:-- Halima Shah: So I think we really need to think about empathy.
--:-- Caitlin Jetelina: And the second reason or thing we need to do is we need to equip trusted messengers, for example, physicians, pastors, education boards, people in our community that people trust and that they'll listen to.
--:-- Caitlin Jetelina: And we need to figure out how to best equip physicians, for example, with this evidence-based education to help diffuse the bad information.
--:-- Halima Shah: But it seems like part of the problem here is that the trusted messenger, at least in Florida, the Surgeon General, is breaking with public health norms.
--:-- Caitlin Jetelina: You're right.
--:-- Caitlin Jetelina: You know, a lot of vaccine disinformation spreaders are physicians, people with white coats, people that have an MD that we're supposed to trust.
--:-- Halima Shah: And so I think that this is where our systems come into place.
--:-- Caitlin Jetelina: For example, our medical review boards, the credentialing process for public health departments, because really that lever is what's going to help stop those top down vaccine disinformation spreaders.
--:-- Halima Shah: I mean, one thing that occurs to me is that the mechanism that parents are using to basically not get their kids vaccinated is filing for an exemption on the basis of philosophical grounds.
--:-- Caitlin Jetelina: Should parents be able to do it as easily as they're doing it?
--:-- Halima Shah: You know, this has been a really strong state level conversation that we've seen.
--:-- Caitlin Jetelina: And there's actually states that do not allow non-medical exemptions anymore.
--:-- Caitlin Jetelina: One, for example, is California.
--:-- Caitlin Jetelina: And they changed that law after a huge measles outbreak at Disneyland in 2014, 2015.
--:-- Caitlin Jetelina: But starting in 2021, it's going to get a lot harder to get a vaccination exemption.
--:-- Caitlin Jetelina: And kids without them have to either get vaccinated or they can't attend school.
--:-- Halima Shah: And the impact that that state-level legislation had was enormous.
--:-- Halima Shah: So I do think it's really important.
--:-- Caitlin Jetelina: And I do think that's where governments help step up.
--:-- Halima Shah: I think the ultimate challenge, though, is that it comes down to we are moving in a more individualized society.
--:-- Caitlin Jetelina: But the problem is with infectious diseases that it violates the assumption of independence, that what you do immediately impacts those around you.
--:-- Halima Shah: And so the biggest question to me is if our society, if the United States is moving towards individualism, how do we then combat things that require community action?
--:-- Caitlin Jetelina: It requires us to be on the same team against these viruses.
--:-- Halima Shah: And I think that it's a cultural question that we're just going to have to see unfold and see how we collectively answer that in the years coming.
--:-- Halima Shah: How does this make you feel as an epidemiologist, Caitlin?
--:-- Caitlin Jetelina: We're talking about a highly contagious disease that is highly preventable, that is spreading in the 21st century.
--:-- Caitlin Jetelina: I'm exhausted.
--:-- Caitlin Jetelina: I feel, and I know a lot of my public health colleagues feel like we're moving backwards.
--:-- Caitlin Jetelina: And maybe that's what it takes, right?
--:-- Caitlin Jetelina: That people may just have to see how badly measles is before there's change.
--:-- Halima Shah: You know, we live in a very reactive society, and eventually the pendulum has to swing between panic and neglect.
--:-- Caitlin Jetelina: It's tiring, but we have this collective amnesia towards these really old diseases.
--:-- Caitlin Jetelina: And I think people are privileged to not know what they do, but it does, it certainly concerns me and makes me a bit nervous going into 2024.
--:-- Halima Shah: Caitlin Jetelina, your local epidemiologist.
--:-- Halima Shah: You can find her newsletter on Substack.
--:-- Halima Shah: Our show today was produced by Jesse Alejandro Cottrell and Victoria Chamberlain.
--:-- Halima Shah: It was edited by Amina El-Sadi.
--:-- Halima Shah: Engineered by David Herman.
--:-- Halima Shah: And fact-checked by Laura Bullard.
--:-- Halima Shah: The rest of the team includes Avishai Artsy, Miles Bryan, Hadi Mawagdi, Amanda Llewellyn, and Rob Byers.
--:-- Halima Shah: Our supervising editors are Amina El-Sadi and Matt Collette.
--:-- Halima Shah: Our executive producer is Miranda Kennedy.
--:-- Halima Shah: We use music by Breakmaster Cylinder.
--:-- Halima Shah: I'm Halima Shah, filling in for our regular hosts, Noelle King and Sean Ramosfirm.
--:-- Halima Shah: Today Explained is distributed by WNYC.
--:-- Halima Shah: This show is a part of Vox, which is totally free, thanks in part to contributions from our listeners.
--:-- Halima Shah: If you're feeling generous, you can contribute too at vox.com slash give.
--:-- Halima Shah: Thank you.
