In February, we marked a sad and unnecessary milestone when an unvaccinated 6-year-old girl in Seminole, Texas, became the first person in a decade to die of measles in the United States. A second measles death, an unvaccinated adult in New Mexico, followed shortly after.
Alarmingly the Centers for Disease Control and Prevention (CDC) is reporting that this measles outbreak, which began in January and has been responsible for more than 300 cases at the time of writing, continues to expand rapidly (most recently into Oklahoma and the Mexican state of Chihuahua), due to suboptimal vaccine coverage levels across communities.
Given this context, it was bewildering to learn that the CDC is poised to launch a large and likely expensive study on the link between vaccines and autism, despite a robust body of research that has very clearly demonstrated that vaccines, including the measles, mumps, rubella, and varicella vaccines (MMR and MMRV) are not responsible for autism. This is not only a waste of resources that should instead be used for legitimate autism research, but it also serves to sow public doubt in vaccines, the main tool for fighting many deadly and disabling diseases.
And then, amid this unfolding crisis, Robert F. Kennedy Jr., secretary of President Donald Trump’s Department of Health and Human Services, falsely discredited the measles vaccine while promoting fabricated theories about measles prevention and treatment.
Why are these developments such a dangerous detour from progress on controlling measles nationally as well as here in our Minnesotan communities? Persistent and deliberate spread of unfounded rumors regarding the measles vaccine’s safety have already led to precariously low vaccination rates.
Here in Minnesota, 15 years ago Somali communities were aggressively targeted by misinformation on the measles vaccine. In the decade that followed, vaccine confidence fell. Previously high measles vaccination rates among Somali children plummeted.
A remarkable aspect of getting a vaccine is that it not only protects the individual, but it also helps protect communities. When enough people in a community are vaccinated, the community gains “community (or herd) immunity” and becomes essentially measles-proof (with measles, 95% of the population needs to be vaccinated for community immunity).
However today, the overall Minnesota measles vaccination level is at its lowest in over a decade. Some schools in the Twin Cities have exceedingly low measles vaccination rates with multiple schools having fewer than 65% of kindergarteners fully vaccinated against measles. Given these vulnerabilities it is not surprising that Minnesota has seen multiple measles outbreaks in recent years.
People’s concerns, even if they are mistakenly based on inaccurate information, are real in the sense that they are a part of what determines their decisions about getting vaccinated. It is critically important to the goal of vaccination promotion to understand why people and communities who would benefit greatly from vaccination develop “vaccine hesitancy.”
To address this we conducted a study (led by Dr. Inari Mohammed, an Oromo-American epidemiologist) on vaccine behaviors, attitudes, and concerns among Black women in Minnesota. We learned that current and even past misinformation campaigns have left persistent doubts, even among those who are aware that vaccine autism links have been disproven. Repeatedly in the interviews we heard that doubt, which measles vaccine misinformation had initiated, spilled over and jostled people’s comfort level with other vaccines as well.
It is a great injustice in the U.S. that people do not have equal access to health across racial, ethnic, cultural and socioeconomic lines. It is especially tragic when a simple, inexpensive, safe intervention, like the measles vaccine, could have saved someone from disease, disability and/or death.
We believe it is imperative to address this by doing research, like our study, where people across communities engage on issues related to their vaccine hesitancy and access. This enables the possible implementation of programs that effectively deliver disease prevention to all communities. Yet, earlier this month there was yet another setback, a part of the Trump administration’s coordinated attack against advancing vaccine and health equity, when the National Institutes of Health (NIH) reported it would abruptly halt research around vaccine hesitancy.
We do not believe that this suspension of vaccine hesitancy research is what people in the U.S. want. Participants in our study told us repeatedly they would like to see outreach to their communities. They wanted people who delivered messages about vaccines to come from their communities, to listen, and understand their concerns and their community’s history interacting with health care and public health.
In our study we documented how concerns and decision-making might differ across Black Minnesotan cultural groups, a reality that had been mostly ignored previously. For instance we learned that there were certain social media posts from influencers that were popular within specific immigrant communities that were very influential in their thinking.
Similarly media from women’s countries of origin had reached into these Minnesotan communities and had been highly persuasive. We also heard how untrue rumors related to vaccines and reproductive health could shatter confidence, suggesting that confidence could be bolstered by effectively communicating how being vaccinated with MMR/MMRV prior to pregnancy actually reduces the risk of babies having congenital issues. The research produced valuable insight that can inform future outreach, messaging, and policy approaches.
This present situation is not the future we would have expected 25 years ago. Measles control in the United States was one of the greatest public health victories of the 20th century. It had been achieved through widespread measles vaccination.
Prior to the introduction of measles vaccination programs in the U.S., an estimated 3 to 4 million people contracted this highly contagious disease annually, resulting in nearly 50,000 hospitalizations and 500 deaths each year. In 2000 there was optimism that measles had been conquered in the U.S., at the time it was declared to be “eliminated.” We have been backsliding.
We will not make progress on preventing measles outbreaks and the harms that follow when doubt is being aggressively seeded by research initiated in bad faith, premised upon debunked theories. And blocking avenues for understanding and tackling vaccine hesitancy across cultures will set us back even further. To regain vaccine confidence, which is critical to measles control, we need to provide truthful information and communicate about vaccines honestly.
