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Measles is back
Nearly 35 US states have shared news about outbreaks of vaccine-preventable diseases like measles and whooping cough as new protocols emerge around the development and distribution of COVID-19 and other vaccines. Medical experts are sounding the alarm for American and global healthcare in the wake of changes to the President’s Emergency Plan for AIDS (PEPFAR) and funding cuts to GAVI (a global vaccine alliance affecting half the world’s children).
At a May 30 American Community Media press briefing, physicians and scientists voiced concerns about the healthcare challenges that are starting to impact American families and global communities, as these changes take hold.
A sudden rise in measles among educated, middle class communities may be rooted in lack of awareness and vaccine skepticism said Dr. William Schaffner, Professor of Preventive Medicine in the Department of Health Policy as well as Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, Nashville, Tennessee. He said the public’s lack of knowledge and fear about once common diseases stemmed from “not wanting anyone to tell them what to do, a lack of trust in public health, conventional medicine, and the pediatricians who care for them.”
“Measles is a fierce disease,” said Dr. Schaffner. “Before we had the vaccine, back in the 1960s, each year in the United States, 400 to 500 children died of measles and its complications. We had reduced that number to zero. Until this year,” shared Dr. Schaffner. So far, 3 people have succumbed to measles this year.
US vaccination programs eliminated polio, chicken pox, diphtheria, whooping cough, and neonatal tetanus, but knowledge of these once-feared diseases by new parents has also decreased. “If the disease was not respected or even feared, the vaccines were not as valued. This led to more questions, hesitancy, skepticism, and even an anti-vaccine,” said Dr. Schaffner. “This is a large problem that won’t be solved immediately.”
As outbreaks of older diseases recur, cuts to funding for Medicaid and children’s programs will lead to lower healthcare access for economically disadvantaged people. The U.S vaccination program had essentially eliminated disparities based on race, location (urban/rural), ethnicity, and language. But now, experts fear a return to the “bad old days” when infectious diseases caused drastic shifts in the quality of life of regular Americans.
For many American families, the health of their loved ones is at stake.
Undermining science
The American Academy of Pediatrics and the American Academy of Family Physicians will continue to recommend comprehensive vaccination programs; however, it appears that individual states can now establish their own protocols based on their resources and commitment to ensure continued access.
Publications like The Lancet are being undermined, said Dr. Ben Neuman, Professor of Biology at Texas A&M University, with Health Secretary Kennedy suggesting that his department would now create scientific journals of their own. “I think a change to these high-profile journals is probably aimed at degrading science,” said Dr. Neuman, who called the move “a shame,” because America is good at science. “This is one of our big exports to the world in terms of ideas, products, and services and undermines an important sector of our economy.”
The current push to limit access to vaccines is essentially going to weaken American and global health, warned Dr. Neuman. “This doesn’t have any scientific support behind it.” The repercussions of COVID-19 are a stark reminder of a world that lost freedoms offered by modern medicine during a global pandemic.” Moreover, global health protocols are interconnected, and changes in American policy can have far-reaching consequences, advised Dr.Neuman. “Money, nationality, and religion play a very big role in whether or not a person is going to be vaccinated. None of these matters at all to the infectious disease that you’re vaccinating against.”
Unfortunately, added Dr.Schaffner, the COVID-19 vaccine has picked up a political veneer. Though ministries of health in America and other countries have reviewed vaccine data, endorsed them, and safely administered millions of doses, it was difficult to comprehend the level of mistrust growing among vaccine skeptics.
Multinational health programs under siege
The current US administration has announced a 90-day pause on all foreign aid. Defunding public health programs and multinational disease prevention organizations like USAID, PEPFAR, and Gavi would have devastating outcomes worldwide, said Dr. Neuman.
Infectious diseases could wreak havoc in less advantaged countries. For example, while measles has been under control in America, over 100,000 people still die from it each year in the rest of the world.
Lack of preventative programs would make it easier for outbreaks to cross borders, said Dr. Neuman. “If you can stop the Ebola outbreak before a person gets on a plane, you have stopped the spread, and you have limited the risk to countries around the world, including ours. We are heavily connected to the rest of the globe.”
Global HIV response under attack
Funding cuts to PEPFAR, started in 2003 under President George W. Bush, have resulted in a direct hit to global HIV response, said Dr. Jirair Ratevosian, an Associate Research Scientist at Yale University. He also holds appointments at the Duke Global Health Institute and the Center for Strategic International Studies. He called PEPFAR one of the most impactful global health programs ever created. “It has saved 25 million lives and helped control HIV in over 50 countries by providing antiretroviral therapy (ART). ART is simple, powerful, and transformative, a once-daily pill. It suppresses the virus, saves lives, and it stops HIV transmission. So people on treatment not only live longer, they actually don’t pass on HIV.”
While some waivers were announced, poor implementation has meant that millions across the world did not get access or had delayed access to their life-saving, daily medication.
HIV prevention programs that are the very backbone of epidemic control, explained Dr. Ratevosian. “So without treatment, viral suppression is lost, transmission increases, and lives are put at immediate risk.” His team published an assessment that showed the 90-day pause would cause up to 100,000 preventable deaths in just one year and tens of thousands of new infections. “This is not a hypothetical; it’s actually an unfolding reality now,” he said.
Without a 5-year reauthorization path for PEPFAR, ending the program could result in up to 11 million additional new HIV infections and 3 million additional deaths by 2030, warned Dr. Ratevosian.
He urged Congress to act quickly, noting that advocacy and activism for HIV-AIDS have reached levels not seen since the peaks of the 1980s and 90s. “You see HIV activists disrupting congressional hearings, protesting, marching to the State Department and other areas here in Washington. I’m optimistic that that energy will transition to, hopefully, a more effective policy soon.”
Cuts to GAVI affect vaccine development
The U.S. is the largest donor to Gavi, the global vaccine program (13% of Gavi’s resources), and cuts would undermine the international fight against infectious diseases, while shifting the very methodology used by vaccine specialists for decades. Programs like Gavi have to be implemented in places where a virus is endemic, said Dr. Neuman, to obtain accurate tests of whether a vaccine works. “If you’re in a place where there is no risk from a particular pathogen, you can’t know the effectiveness, only the safety. You really need to know both for a good vaccine. By the time an outbreak of something new gets to the United States, it has passed through many people, and it may actually be too late to do anything about it.”
Dr. Peter Chin-Hong, Professor of Medicine and Associate Dean for Regional Campuses at the UCSF School of Medicine, is a leader of institutional and community education around COVID-19 and mpox. He directs the immunocompromised host infectious diseases program and is concerned about the new protocols for the development and distribution of the COVID-19 vaccine. The new vaccine, explained Dr. Chin-Hong, will only be distributed to people 65 and older, leaving out vulnerable groups like the pediatric population who are healthy, including those under 2 years old, and pregnant people who are healthy and have no comorbidities.
“There’s a reason why we’re worried about those two populations in particular,” said Dr.Chin-Hong, “Pregnant people are relatively immune-compromised because your immune system doesn’t want to recognize the growing fetus too much. That puts them at risk for lots of other infections in general, including serious COVID. The second group is those who are under 2 years old, specifically those under 6 months. Their immune system is not mature enough, and they rely on the antibodies going across the placenta from the mother.” He added that there have been 150 pediatric deaths from COVID last year and a little over 200 from the flu. There is also a lack of occupation-based eligibility for vaccines, so healthy healthcare workers under the age of 65 would also not have access.
Ill-conceived messaging
The panel found it odd and confusing that the administration chose to disseminate this vital piece of information through a 1-minute video on X. Dr. Chin-Hong advised American citizens to make appointments to get their latest COVID vaccines as soon as possible to avoid missing out once the new protocols are executed. For people concerned by news connecting mRNA vaccines and myocarditis (inflammation of the heart), he clarified that most myocarditis was detected “when the second shot was taken within a one-month period,” and few people got successive shots at that frequency. He worried about confusion over eligibility to be vaccinated, especially since Americans with comorbidities over the age of 65 accounted for a third of the population (100-200 million people).
The CDC’s Advisory Committee on Immunization Practices will meet on June 25th and 26th to vote on COVID vaccine recommendations going forward, said Dr. Schaffner. He urged Americans to trust their medical professionals and scientists to separate the truth from the rumors, fear-mongering, and anti-scientific rhetoric swirling around the topic.
The stakes for global health and the U.S. Foreign assistance abroad have never been higher, said Dr.Ratevosian. “The COVID pandemic showed us that global health is local health, and for decades, the U.S has led the world in global health and humanitarian aid. So the real question isn’t whether we can continue this aid, but it’s whether we can afford not to.”
When the state begins to interfere and take ill-conceived and half-baked decisions on the health of entire populations, the repercussions can be local, global, and catastrophic, warned Dr. Neuman. “Freedom begins with freedom from disease. Hearing anything else from elected officials is probably unconscionable.”
Some things are best left to trained experts.
