U.S. Measles Outbreak Highlights Growing Vaccine Hesitancy: Q&A With Jeanne Marrazzo

In a conversation with Pharmaceutical Executive, Jeanne Marrazzo, MD, FIDSA, MPH, IDSA chief executive officer, discusses how the United States is experiencing a significant measles outbreak, with over 730 cases reported this year. Dr. Marrazzo mentions how the resurgence is driven by vaccine hesitancy and the highly contagious nature of the virus, along with noting how the outbreak is the largest in decades, leading to the loss of measles elimination status and severe complications, including deaths.

A transcript of Dr. Marrazzo’s conversation with Pharmaceutical Executive can be found below.

Pharmaceutical Executive: What factors are driving the resurgence of Measles, and how does the current situation compare with previous cycles of measles transmission?

Jeanne Marrazzo: The current outbreak is really being driven by two factors. One is an increasing pool of people who are susceptible because they haven't been vaccinated. Measles vaccine is very effective, but the second factor is that Measles is probably one of the most contagious viruses you will ever encounter, so all it takes is a relatively small number of people who haven't been vaccinated and don't have protective immunity to really set off a chain of events that spreads like wildfire, and that's exactly what we're seeing happening.

In terms of your second question, how does this compare? It's the biggest outbreak of measles we've seen in decades in the United States. In fact, we have lost our measles elimination status because of this outbreak as a country, as have neighboring countries, and it's so big right now, particularly in South Carolina, that we're hearing about complications in kids, which are really devastating.

We already know there have been a number of deaths. Mexico alone has had 28 people die of the measles, and we're hearing about kids who are being hospitalized for some of the worst complications of measles, things like paralysis and brain inflammation. So, it's a pretty big deal compared to anything we've experienced before.

PE: From your perspective, what strategies are most effective today for rebuilding public trust and improving vaccination uptake?

Marrazzo: I think it's a really challenging time for parents, because they are hearing so many different messages. You're hearing from what was once a very trusted source, namely our government, HHS and particularly the CDC, that maybe these vaccines aren't so important. Maybe they actually are tied to conditions like autism, which has never been proven and clearly is not true and not accepted by the scientific establishment.

Right now, the atmosphere of mistrust and confusion is even worse than it was before. Its feeding into what we're seeing now. What it's going to take to fix this, I think, is a coming together of a number of widely respected, well recognized, professional organizations who have no stake in the game other than to keep kids and people safe.

I'm talking about, the American Academy of Pediatrics, the American Academy of Family practitioners, the Infectious Disease Society of America, the Pediatric Infectious Disease Society, the American Medical Association. All these groups are coming together as a consortium to try to make sure that we can say with one voice, look, we are in it to give you the information you need, and we are in it to make sure you and your family stay healthy. I think that's going to be the best start that we can have right now,

Pharmaceutical Executive: Beyond short-term containment, what longer-term policy or infrastructure changes are needed to prevent measles from reestablishing itself as a persistent public health threat in the United States?

Marrazzo: Public health departments, at the local level, have been decimated by some of the funding cuts we've seen, and whenever there's an outbreak of any kind, you need to have a robust local public health system that can investigate cases and also can get the word out to people about how they can protect themselves and can maybe set up rapid vaccination sites, because again, people may want to get vaccinated, but they may not have access.

The people may also not have insurance or doctors, so the first thing is making sure you have, at the local level, good public health capacity and that's just been undermined over decades, unfortunately in the United States.

You also have to be transparent about the messaging because you need trusted people getting out there and talking on the news, talking to reporters, trying to give the facts really not colored by any judgment or by any wishful thinking, but just saying, look, this is the situation, the disease is spreading like wildfire right now, we're seeing bad things happening to kids, and talk about what those things are.

Know that the vaccines are safe, they've been proven safe and they have a good track record. The best thing you can do if you want to protect your kids or yourself from measles is to get vaccinated.

It's also important to let people know we don't have a medicine to treat measles once it gets established. Nine out of ten cases will recover, but it's that one in ten that can go down the tubes, and we don't have anything to do to reverse that or to treat it. So again, when you're looking at the risk benefit ratio of vaccine versus not vaccine, those are the kinds of facts people need.

PE: As outbreaks expand across multiple states, what operational gaps, whether in funding, public health workforce, or policy execution are becoming most apparent?

Marrazzo: I believe funding is a large factor for public health departments. They are not generally very well-funded and are often operating on a shoestring. Remember, they're dealing with a lot of other things besides infectious diseases, such as dealing with water quality or homelessness. They may be dealing with all kinds of things, particularly in large urban centers, so funding to public health departments is going to be really important.

The other thing we are seeing less of an emphasis from the current administration on is emerging and reemerging infectious diseases.

There has been downplaying of the whole idea of preparing for an epidemic or even a pandemic, and that's probably going to hurt us. This is where professional societies can step up and say, okay, we think this is still a concern and we want to be prepared for these reemerging infectious diseases.

Measles is just one, there’s also whooping cough that we're seeing now, and we've had several reported deaths in children, again, a vaccine preventable disease.

So, I think continuing to be transparent about what's happening without being alarmist, and again, trying to make sure that we have resources to get evidence base reviews so we can give people the information they need.