By Alan Shapiro

With measles once again sickening large numbers of American children, I can't help recalling 1990, the year I began my career as a pediatrician -- and the year a measles epidemic swept across the U.S.

There was a nationwide dearth of primary care for children and families at the time, and I began working in a community health center , bringing services to New York City's homeless family shelters aboard mobile medical clinics. The overcrowded shelters were to measles what dry tinder is to wildfires, and the spread of infection ravaged them.

Children were hit especially hard. My days were spent racing from room to room, evaluating families suspected of having measles, immunizing the unvaccinated and sending the very sick to the emergency room, many requiring hospitalization.

I'll never forget those children: burning with fever, covered in rashes, their eyes red and their lungs struggling with pneumonia. That epidemic saw over 5,000 cases and 21 deaths in NYC alone. Nationwide, there were 55,000 cases and 132 deaths.

Those deaths were preventable. The epidemic should never have happened.

A dozen years earlier, in 1978, the U.S. Centers for Disease Control and Prevention set the goal of eradicating measles nationwide by 1982. By 1981, cases had declined by 80% thanks to the measles vaccine. But the insidious lack of access to adequate healthcare gradually erased those gains, leading to a resurgence.

What went wrong? New York City's shelter system was an extreme example of a much broader problem for U.S. families. In 1990, 15% of U.S. children were uninsured; many more lacked access to comprehensive primary care. Not enough children were being vaccinated: less than half were adequately inoculated for measles in the U.S., with the rates among Black and Latino children even lower. Infants, too young for vaccination, were especially vulnerable when exposed to unimmunized siblings and others.

Measles is not just another childhood viral illness, like a cold; it has implications beyond missed school for children and work for parents. Complications occur in almost a third of those infected. Pneumonia develops in one in 20 children, which can be fatal. Encephalitis, or brain inflammation, is less common but can progress to neurological deterioration and lifelong disabilities or death. Another complication is "immune amnesia," which leaves patients more susceptible to infections as the immune system "forgets" the pathogens it previously protected the body against.

Overall, measles is fatal for one to three of every 1,000 infected children. It's so contagious that 95% of the population must have immunity to halt its spread, compared with 75-85% for Covid.

The 1990 epidemic was a wake-up call. Advocates including the American Academy of Pediatrics, the American Public Health Association and elected officials pushed for expanded Medicaid coverage. In the next several years, Congress established the Vaccines for Children $(VFC)$ program, providing free vaccines to poor, under- or uninsured children, and the new State Children's Health Insurance Program was created to cover families who were ineligible for Medicaid.

As access to preventive care increased, vaccination rates improved, and measles cases plummeted again. In 2000, the CDC declared measles eliminated from the U.S. But this was not to last either.

This year, as of May 1, there have been 925 confirmed cases in 29 states, 30% of the patients under 5 years of age, with 121 hospitalizations and three deaths, including two school-age children. It was all preventable, even more so than three decades ago.

When I began my practice in 1990, not enough families could get vaccines. Now the problem is that too many parents are afraid to vaccinate their children.

This trend of vaccine hesitancy has been growing for years, as parents get misinformation about the dangers of vaccines, such as a debunked study linking the MMR vaccine (for measles, mumps and rubella) to autism. A public health paradox also plays a role: When a disease disappears from a community, the perception of vaccine danger overrides the fear of the illness itself, which leads to a decline in immunizations and the risk of re-emergence.

The federal government has the critical function of educating Americans about public health risks. But messaging about the importance of the measles vaccine has been largely absent as the measles threat has emerged again. This is not surprising, as the Secretary of Health and Human Services, Robert F. Kennedy Jr., has a record of opposing vaccines and has supported discredited measles treatments, fired vaccine experts and dismantled surveillance and communications functions at the Centers for Disease Control and Prevention. In early April, he appeared to endorse the MMR vaccine within a social-media post, but has since continued to raise questions undermining it.

Once again, we are learning that our hard-won public health success is fragile.

I still work in the same South Bronx community health center where I started decades ago. Now the children in our practice have vaccination rates approaching 95%. Improved access to preventive care and trusting relationships with medical providers is the key to this success. But that is only part of the equation. Millions of children and families rely on the support of the federal government, through expanded Medicaid eligibility and the VFC program.

As a pediatrician, I am deeply concerned by the fraying of safety net programs for children. The recent defunding of USAID's international vaccination program is not just a threat to children abroad but to our own children, as infectious diseases spread globally, without respect to borders. And Medicaid cuts of more than $800 billion over the next 10 years, currently proposed in Congress, would be devastating.

With a new wave of measles spreading across the nation, we need urgent, scientifically sound information, reminding the public of the importance of vaccinating our children. Health officials should be working to counter misinformation about vaccine safety and to implore parents to vaccinate their children. But inexplicably we are getting a whisper, not a roar.

In 35 years of practice, I have seen many gains for the health and well-being of children in this country. I cannot imagine going back to 1990, and pray to never see the preventable death of another child.

Alan Shapiro is a pediatrician practicing in the Bronx, N.Y.

(END) Dow Jones Newswires

May 08, 2025 12:03 ET (16:03 GMT)

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