Making Microbes Great Again

The Texas measles outbreak is just the beginning

Source: CDC

I’m almost certain that I had measles as a child. My memories are a bit vague, and unfortunately my parents, who would surely have remembered the incident, have passed on. But I was born in 1953, and grew up in an era when, according to the Centers for Disease Control and Prevention, “nearly all children got measles by the time they were 15 years old.”

However, measles cases declined precipitously after 1963, when a vaccine was licensed. (My wife, born in 1959, never caught it.) By 1980 all states had laws requiring that children entering school be vaccinated, although most allowed exemptions for religious beliefs. Measles vaccines don’t just protect the person vaccinated; by ensuring that very few children catch the disease, they also break potential chains of infection. So in 2000 the CDC declared measles in the United States eliminated.

But now there’s a significant outbreak in Texas. Only 48 cases have been identified so far (13 of whom have been hospitalized), but officials believe that there are hundreds more that haven’t been reported.

As far as I can tell, nobody following disease trends is surprised by this development, nor does anyone think it’s a one-time event; this is probably just the first of many outbreaks of measles and other infectious diseases we thought had been eliminated.

The reason is simple. Measles was eliminated, for a while, because vaccination was near-universal. The “target” vaccination rate, sufficient to prevent community transmission, is 95 percent. But much of the nation has now fallen well below that target:

Source: KFF

So the widespread return of measles was just a matter of time.

How did this happen? The answer, of course, is politics, specifically Republican politics.

As an illuminating article in Lancet notes, anti-vaccine activism was originally a fringe movement with a “natural-living, left-leaning base.” Translation: it was more or less a hippie thing. In fact, you can still see some traces of those roots in Robert F. Kennedy Jr.’s incoherent views on health policy — views that unfortunately matter a lot now that he’s in charge of the Department of Health and Human Services.

But the anti-vax movement became powerful and deadly when it took over much of the political right.

The groundwork for that takeover was laid in the Reagan years. Reagan wasn’t specifically anti-vaccine. But he was anti-science — because, as I wrote recently, once you start rejecting scientific research that tells you things you don’t want to hear, you’re basically rejecting the whole scientific enterprise. And he also rejected the idea that the government can ever be a force for good.

So when it comes to childhood vaccinations, what you have is the government telling you that your children must get their shots, because that’s what medical science says must be done. From right-wingers’ point of view, that’s a perfect storm of everything they hate.

And if evidence shows that vaccines and vaccine mandates work — if we went from a nation where almost every child caught measles to one in which the disease had effectively been eliminated — well, people who believe in looking at evidence are probably radical left-wing Marxists who hate America.

Which helps explain the perverse political reaction to what was, by any reasonable standard, one of medical science’s greatest triumphs: the incredibly rapid development of vaccines against Covid-19.

What’s especially perverse about the politics here is that Operation Warp Speed, the public-private partnership that helped accelerate the development and deployment of Covid-19 vaccines, was an initiative of, yes, the Trump administration. In a halfway rational world Trump would be claiming credit for the vaccines and crowing about their effectiveness.

For yes, they were effective — I’d say undeniably effective, except that what we’ve learned these past few years is that many people will deny what’s right in front of their nose if it’s inconvenient for their ideology.

How do we know that the vaccines were effective? There are multiple kinds of evidence, but the easiest one to explain is the fact that the United States inadvertently performed what researchers call a “natural experiment.” Vaccination rates varied hugely across U.S. counties, and as the indefatigable Charles Gaba has showed, there was a strong negative relationship between vaccination rates and death rates:

And why were there such large differences in vaccination rates? Covid vaccines became bound up with identity politics, with a strong negative correlation between the share of a county’s votes that went for Trump and the willingness of its residents to get their shots:

I can’t resist posting one memorable Twitter exchange:

Americans should have taken two big lessons from the Covid experience. First, scientists do know what they’re talking about. Second, taking medical advice from people who reject science is bad for your health. In fact, it can kill you.

What happened instead was a hard turn by Republicans against vaccination. Only 26 percent of Republicans now say that childhood vaccinations are important; 31 percent say that they’re more dangerous than the diseases they were designed to prevent.

Trump has just signed an executive order cutting off federal funds to schools that impose Covid-19 vaccine mandates — probably an illegal action, but does that even matter anymore? We have RFK Jr., a vaccine skeptic and conspiracy theorist, in charge of the nation’s health system. And hostility to Covid vaccines has, um, infected attitudes toward vaccination in general — hence those declining rates of MMR (measles, mumps and rubella) vaccination and the Texas outbreak.

It's not clear how far this will go. So far the Trump administration appears to be singling out Covid-19 vaccines as a target, not vaccines in general. At the state level, however, things are going much further: Louisiana has announced that the state health department “will no longer promote mass vaccinations,” while lawmakers in multiple states have been pushing to expand the range of vaccine exemptions.

Furthermore, the MAGA base doesn’t seem to be making a distinction between Covid and other vaccines, and, again, RFK — whose anti-vax proselytizing helped fuel a measles outbreak in Samoa that infected 5700 people and killed 83, mostly children — is in charge of HHS.

So it seems to be a real possibility that the second Trump administration will go down in history for, among other things, making microbes great again.

MUSICAL CODA

I almost feel bad for liking Chvrches so much. I mean, it’s a bit of a cliché: two ordinary-looking guys and an attractive young woman. But their stuff feels deep to me, and this one seems appropriate