Measles Drop in Pandemic May Generate False Sense of Security

The plunge in reported cases of measles during the pandemic may lead lawmakers and other government officials to underestimate the threat of this and other infectious diseases, setting the stage for a potential rebound in the viral illness, a vaccine expert said.

Speaking at the 12th World Congress of the virtual World Society for Pediatric Infectious Diseases (WSPID), Walter Orenstein, MD, of Emory University, Atlanta, Georgia, urged physicians and public health officials to work on efforts to help children catch up on vaccinations missed during the pandemic.

There may be a false sense of security in the medical profession due to the drop in measles cases during the pandemic, Orenstein warned during a Feb. 22 presentation. He cautioned about a pre-pandemic rise in measles, as well as vaccine hesitancy during the pandemic, as indicators that greater efforts are needed to understand concerns and misinformation about vaccination.

For 2019, 1282 cases of measles were confirmed in 31 states, according to the Centers for Disease Control and Prevention (CDC). That was the highest number since 1992, marking a continuation of a worrying rebound of the highly contagious infection. This number dropped to 13 individual cases of measles in 2020 and then inched up to 49 measles cases in 2021, the CDC said.

“We need to make a case, particularly with the political community, that low incidence of measles today should not be assumed to be security” against measles in the future, Orenstein said at the conference.

“As we go back to our normal lifestyles, unless we do something to catch up, we could be in big trouble,” Orenstein said. “We need to take action before we see a resurgence.”

‘Implementation Science’ Needs a Boost

Orenstein describes measles as the “disease I love to hate, since I spent much of my career trying to get rid of it.” He earlier worked in the CDC’s immunization program, serving as director of the US Immunization Program from 1988 to 2004. From 2008 through 2011, he was deputy director for immunization programs at the Bill & Melinda Gates Foundation.

During his career, he saw a major public health win, the 2000 declaration that measles had been eliminated from the US, meaning that the infection was not considered constantly present in the country.

The US victories against measles were the results of scores of decisions made over decades by federal and state officials, Orenstein detailed in a 2006 article in The Pediatric Infectious Disease Journal. In this article, titled The Role of Measles Elimination in Development of a National Immunization Program, Orenstein noted the importance of creating steady and stable funding for vaccination and “No Shots, No School” laws mandating vaccination for kindergartners.

In recent years, though, the US saw cases of measles creep back up, due in part to misinformation campaigns about the vaccine.

In 2019, two outbreaks lasting most of the year placed the country at risk for losing its measles elimination status. In some ways, the spread of misinformation about measles vaccine risk through social media in the years ahead of the pandemic presaged COVID-19 vaccine hesitancy.

Primary care physicians need information and strategies to counter misinformation about vaccines, Orenstein told Medscape Medical News in an interview. There’s a strong need to prevent the spread of COVID-19 vaccine hesitancy to other vaccines, such as the measles shot.

“I think we need to make investments in what’s called implementation science research, to try and understand what messages, what issues need to be addressed, so that we can overcome hesitancy,” Orenstein said.

Orenstein is not alone in this view. Former National Institutes of Health (NIH) Director Francis Collins raised concerns about the need to help the public better understand vaccines in a December interview about his retirement.

“Maybe we underinvested in research on human behavior,” Collins told PBS Newshour.

“I never imagined a year ago, when those vaccines were just proving to be fantastically safe and effective, that we would still have 60 million people who had not taken advantage of them because of misinformation and disinformation that somehow dominated all of the ways in which people were getting their answers,” Collins added during the PBS interview.

Turning to Humility and “Elmo” in the Fight Against Vaccine Hesitancy

In one search for a solution, US Surgeon General Vivek Murthy, MD, MBA, made a public appeal on March 4 for suggestions on how to fight vaccine hesitancy.

His office is seeking comments through a formal process, known as a request for information, to address health misinformation. In this announcement, Murthy noted that there have been concerns for a while about how misinformation has made it harder to combat threats such as Ebola and HIV.

“But the speed, scale, and sophistication with which misinformation has been spread during the COVID-19 pandemic has been unprecedented,” said the surgeon general’s office in the request for information.

“Recent research shows that most Americans believe or are unsure of at least one COVID-19 vaccine falsehood,” Murthy’s office added. “The digital information environment is a phenomenon that requires further research and study to better prepare for future public health emergencies.”

As surgeon general in both the Obama and Biden administrations, Murthy grappled with the misinformation about the measles vaccine that contributed to cases of children missing these shots in the US and sparked concerns about a resurgence of this illness.

In the wake of a 2015 measles outbreak tied to Disney parks in California, Murthy appeared in a video with the popular Sesame Street character Elmo to discuss the need for vaccinations. The video doesn’t mention any specific vaccine. It explains how these shots prepare the immune system to fight off pathogens. (This approach was revived with the Sesame Workshop producing a series of videos to address specific concerns about COVID-19, including vaccines.)

During his 2021 Senate hearing for his confirmation to again serve as surgeon general, Murthy stressed the importance of working with clinicians in developing the federal response to vaccine hesitancy.

“One has to approach the task of communication with humility, recognizing there's a lot we do not understand,” Murthy told the Senate Health, Education, Labor and Pensions Committee in a February 2021 hearing.

“People on the ground — faith leaders and educators and doctors and nurses — often know far more about what their communities need and what their concerns are, so we've got to listen to them and work with them,” he added.

New Skills for Handling Hesitancy?

The challenges physicians faced in handling vaccine hesitancy during COVID-19 may leave them better equipped to help address future questions about shots in general, said Erica Johnson, MD, chair of the infectious disease board within the American Board of Internal Medicine.

In an interview with Medscape, Johnson noted that clinicians, especially those in primary care, have been working during the pandemic to understand the origins of their patients’ concerns. These physicians have been figuring out what works best to help their patients disentangle fact and fiction and to identify trusted and credible sources of information.

“I hope that all of us working on building those skills will translate to more success in helping people move forward in making decisions around other routine immunizations,” said Johnson, who is also the program director for the internal medicine residency program at Johns Hopkins Bayview Medical Center.

Kerry Dooley Young is a freelance journalist based in Miami Beach, Florida. She is the core topic leader on patient safety issues for the Association of Health Care Journalists. Young earlier covered health policy and the federal budget for Congressional Quarterly/CQ Roll Call and the pharmaceutical industry and the Food and Drug Administration for Bloomberg. Follow her on Twitter at @kdooleyyoung

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