Vaccines are our greatest public health tool in the war against emerging and re-emerging bacteria and viruses, a war that is being fought and won, or fought and lost, across the globe every day.
The war against measles is still ongoing, and we have lost several key recent battles. Measles is one of the most contagious viruses in nature. Keep in mind there is a 90 percent chance of an unvaccinated individual getting infected with measles simply by entering a room where a measles patient had been up to two hours earlier.
Eradicating measles from a community requires as high a community compliance rate as possible. Since it is a live-virus vaccine, we can’t give it to immuno-compromised patients or pregnant women or the severely ill. We must protect these groups by immunizing everyone around them.
This is why it is so disturbing to see a resurgence of measles in pockets of the U.S. where it was previously stamped out. Since 2000, measles has been traced purely to travelers bringing it here but, over the past year, vaccine non-compliance in areas ranging from Brooklyn, N.Y., to Washington state has increased and threatened to allow measles once again to have a foothold in our country. There have been close to 1,300 cases of measles in 31 states in the U.S. this year.
The problem is far worse overseas with more than 100,000 deaths per year still linked to measles, most of these occurring in children. The U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO) have just reported that more than 140,000 people died worldwide from measles last year alone, up by 30,000 from the year before, with most of these deaths occurring in children under age 5. This finding is particularly disturbing when you consider that the Measles Mumps Rubella (MMR) vaccine is extremely effective and safe and has been around for decades. Yet, “WHO and UNICEF estimate that 86 percent of children globally received the first dose of measles vaccine through their country’s routine vaccination services in 2018, and fewer than 70 percent received the second recommended dose.”
Samoa, in the South Pacific, has had a poor vaccine compliance rate, which has led to a large measles outbreak. The government there has now promised to bring compliance up close to 90 percent. The outbreak has killed 65 (the vast majority under 4 years old) over the past few weeks and there have been more than 4,500 cases of measles since late October.
The government is engaged in a door-to-door vaccination campaign to combat non-compliance, asking the public to hang red fabric to mark unvaccinated households. It is questionable how successful this will be to combat distrust, misinformation and fear.
We can’t ignore these issues here in the United States. We don’t live in a vacuum and, more than ever because of air travel, we are part of an international biosphere. A resurging disease elsewhere can quickly become our problem too.
In addition to measles, 2019 has seen a resurgence of Ebola, a far different kind of virus. Ebola is far more deadly (close to 50 percent of cases) but much more difficult to spread. There has been a surge of cases of the Zaire strain in the Democratic Republic of Congo, where warlords have attacked the very facilities that have attempted to control the spread of this dreaded disease. According to the WHO, there have been more than 3,300 cases with 2,100 deaths since August 2018.
Merck’s new Ebola vaccine has been effective in helping to overcome the outbreak, with more than 250,000 people receiving it. A stockpile of 500,000 doses of Ebola vaccines (beginning with this one) is now being established by GAVI, the global vaccine and immunization alliance, with plans for poorer countries to be able to have it without charge.
As vaccine engineering evolves, public utilization needs to evolve along with it. As a practicing internist, I understand the irrational fear a patient may have of putting a manufactured protein into his or her body. But this fear needs to be combated with rational information along with a smattering of public conscience. Patients should be more afraid of the various diseases that vaccines are meant to protect us all against rather than fearing the vaccines themselves, whether the pathogen is the wildly spreading measles virus or the highly deadly Ebola.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent. Follow him on Twitter: @drmarcsiegel.