In the shadow of Covid-19 lurks the threat of a fearful measles outbreak

I grew up in the 1940s and 1950s. My mother had polio. I and all of my friends got the typical childhood viral illnesses like measles, chickenpox, and the mumps because there were no vaccines to protect us from them. Some children became very sick with these common illnesses, and some died.

In the 1960s and 1970s, I trained as a medical scientist and pediatrician. During those and subsequent decades, the practice of pediatrics changed dramatically as vaccines were perfected for one after another of these common but serious childhood illnesses. Childhood meningitis, sepsis, pneumonias, and gastroenteritis vanished. The number of cases and deaths dropped almost to zero wherever vaccines could be administered.

Pediatricians’ attention switched to other illnesses we were unable to prevent, like cancers, diabetes, and mental health disorders.

Measles was declared eliminated in the United States in 2000, and relatively few cases have occurred in most countries in the world, thanks to global vaccine campaigns.

Yet in 2019, even before the Covid-19 pandemic roared across the globe, the number of measles cases began to rise. In Nigeria, Brazil, the Congo and many other countries, thousands of cases broke out. The reasons for these surges varied, but the bottom line was that the rates of immunized individuals had begun to fall below the community immunity rates required to prevent the spread of the illness.

With this sudden and unexpected rise in measles cases on several continents, the disease again came to the Unites States, after only a handful of infected individuals entered the country. About 1,300 people in 31 states came down with measles.

The Covid-19 pandemic puts the world at great risk of this deadly infectious disease. But it also holds the threat of a fearful outbreak of measles, an extremely contagious and sometimes fatal illness. For the first time in my 45 years as a pediatrician, I fear that we will see a serious national outbreak of a vaccine-preventable illness that we had, until recently, all but eliminated.

To maintain population protection against measles, between 90% and 95% of a population needs to be fully vaccinated. Luckily, natural measles infections and measles vaccines have proven to be very effective in generating immunity when boosted as recommended. But, as shown in the U.S. and elsewhere, when faced with intense exposures, even vaccinated individuals can develop measles.

The Covid-19 pandemic has drastically disrupted normal immunization efforts around the world, leaving fewer children vaccinated against infectious diseases. Some countries have even suspended their routine vaccination efforts. In the U.S. and elsewhere, parents are hesitant to bring their children in for preventive health care, and even for acute care visits, meaning that normally healthy, previously fully vaccinated children have fallen behind the recommended schedule of routine vaccinations.

Complicating matters is that measles, like other formerly rare childhood illnesses, have not been seen by younger clinicians and younger parents, and may be misdiagnosed.

Parallel global vaccination efforts need to be initiated not just for Covid-19 but for measles and other vaccine-preventable illnesses as well.

During the Covid-19 pandemic, Boston Medical Center, where I work, and other health care centers established mobile vaccine units to vaccinate children in their communities to keep vulnerable children up to date with their vaccinations. Sadly, such efforts are few and far between. Telehealth has largely replaced in-person health during the time of coronavirus, but it is no substitute for direct patient examination and lacks the ability to provide vaccines.

Difficulty accessing care is compounded by the fact that under half of U.S. adults may be committed to getting a Covid-19 vaccine, and vaccine hesitancy has generally risen across the board. Some of this can be attributed to concerns that Covid-19 vaccines are being developed too rapidly and might be released before their safety and effectiveness has been fully established. On social media, opposition to Covid-19 vaccination is being whipped up by anti-vaccine proponents, though some of this may settle down now that the Food and Drug Administration has given emergency use authorization to the Pfizer-BioNTech vaccine, which is now being distributed across the country, and granted an EUA to Moderna’s vaccine on Friday. The divisive political environment during the recent national election has also increased concerns about vaccines in general.

When it comes to vaccinations for young children, parents are the most powerful influencers. For older children, the influence of friends, social media, teachers, pastors, and pop stars can also be substantial. Conflicting public statements on vaccines by politicians, pundits, and their backers have so blurred the lines between factually verified information and purely opinion-based advice that children, young people, and adults may follow whoever is closest to them or who speaks the loudest.

If there is a worldwide outbreak of measles, which appears quite possible, many more infected individuals may enter the U.S. and cause widespread outbreaks of measles among underimmunized children and adults. As we are in a desperate battle to aid people with Covid-19 and health care resources are primarily focused on caring for them, scant attention might be paid to a measles outbreak and cases may not even be recognized until they cause widespread outbreaks.

We need to anticipate the possibility of a perfect storm. As Covid-19 cases decreased this summer, national efforts were undertaken to bring children back up to date with vaccines they were not able to get earlier in 2020. But with cases of Covid-19 now on the rise, we are likely to fall far behind again.

Once Covid-19 vaccines become widely available, it will be essential to press on with efforts to vaccinate everyone against this infection. If outbreaks of measles or other vaccine-preventable illnesses occur, we should also consider simultaneously administering other necessary childhood and adult vaccines.

Children will likely be in line to receive Covid-19 vaccines after high-risk populations and essential workers. At that time, they should also be vaccinated against measles and other vaccine-preventable illnesses that are flaring. We have seen wars stopped during global vaccination campaigns, and the situation we are in now is not unlike a multipronged war for the health of the world. Protection against potentially deadly childhood illnesses like measles must not be forgotten in the fray.

Sean Palfrey is a pediatrician at Boston Medical Center and a clinical professor of pediatrics and public health at Boston University School of Medicine.