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Congressional hearing on measles outbreak highlighted by anger, disruptions

CDC director concedes that the pro-vaccine movements to counter misinformation campaigns have not been robust enough.
Image: MMR vaccine
A health care worker prepares syringes, including a vaccine for measles, mumps, and rubella (MMR), for a child's inoculations at the International Community Health Services on Feb. 13, 2019, in Seattle.Elaine Thompson / AP

As cases of measles continue to rise across the United States, lawmakers met Wednesday to confront the growing public health threat.

The sometimes raucous hearing, held by the House Committee on Energy and Commerce, laid out one of the main challenges: stopping the spread of conspiracy theories and misinformation about the measles, mumps and rubella vaccine that have contributed to vaccine-hesitancy in many communities. At least twice, Rep. Diana DeGette, D-Colo., stopped the hearing when audience members, both for and against immunization, shouted down speakers over vaccine safety.

Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases at the National Institutes of Health, acknowledged that there hasn’t been effective countering of the anti-vaccine movement.

“Misinformation is an important problem,” Fauci said. “The spread of misinformation that leads people to make poor choices, despite their well-meaning, is a major contributor to the problem we’re discussing.”

Since the beginning of the year, the Centers for Disease Control and Prevention has confirmed 159 cases of measles in 10 states — California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas and Washington. The most alarming outbreak is in the Pacific Northwest where 65 measles cases — more than 40 percent of all U.S. cases — have occurred. In January, Clark County health officials declared a public health emergency. Almost all of the cases are unvaccinated children.

In 2000, measles was declared eliminated in the United States, a major public health victory. Nationally, 91 percent of children younger than 3 are vaccinated for measles. But in some communities, the rate has been declining. In Washington's Clark County, where the outbreak is up to 65 cases, about 76 percent of kindergartners are unvaccinated.

Dr. Nancy Messonnier, director for the National Center for Immunization and Respiratory Diseases, conceded that the pro-vaccine movements to counter misinformation campaigns have not been robust enough, despite the CDC’s efforts to provide the most “scientifically accurate information to providers on the front lines.”

“Vaccine hesitancy is the result of misinformation and misunderstanding of the MMR vaccine,” Messonier said.

The first dose of the MMR vaccine is given to children, ages 12 months to 15 months. The second dose is given when a child is between 4 and 6 years old.

“The vaccine is incredibly safe,” Fauci said. “The only way to protect those who are not old enough to get vaccinated or immune suppressed is to be part of that herd immunity.”

Herd immunity occurs when enough people are vaccinated against an infectious disease to protect others in the community who are not.

“When that umbrella of herd immunity lifts, it’s truly a catastrophe waiting to happen.”

The hearing comes just as major social media platforms, YouTube and Pinterest, have announced efforts to stop the spread of anti-vaccine misinformation.

When that umbrella of herd immunity lifts, it’s truly a catastrophe waiting to happen.

Facing mounting pressure, YouTube announced a change in its recommendation algorithm this month, saying it would stop suggesting conspiracy videos. YouTube also stopped some anti-vaccine videos from showing ads and earning money, and started providing more information about the threat of vaccine hesitancy in a window below anti-vaccine videos. Pinterest blocked all searches on vaccinations to stop the spread of misinformation, while the site figures out a solution.

Lack of access

However, misinformation isn’t the only factor contributing to the growing number of vaccination hot spots in the U.S. Inadequate access to vaccines in low- and middle-income communities remains a problem in the U.S. and children in families without insurance make up a disproportionate amount of those who go without shots, Messonnier said. Religious and cultural beliefs also play a big role.

“We know that anti-vaccination hot spots tend to be in more rural areas. Vaccination hot spots are also clustered in areas where people hold similar beliefs,” Messonnier said.

Image: Heat map of county-level non medical exemption rates in 2016 to 2017.
Heat map of county-level non medical exemption rates in 2016 to 2017.Olive et al / Baylor College of Medicine

Because there is no cure, the only way to stop measles is to get the vaccine, the health officials told the congressional panel. The measles vaccine is 97 percent effective when both doses are given.

“The vaccine has been so effective that parents wonder if the vaccines are even necessary and because of our public health success, fewer and fewer doctors see the serious consequences of measles,” Messonnier said.

“There is no cure for measles but it is completely vaccine preventable. The most important piece of advice we can give to parents to protect their kids is to vaccinate your children,” Fauci said. “It’s for the safety of your own child and a responsibility to your community. We all have a responsibility to be part of that umbrella of herd immunity.”