In Good Health: Why Measles Numbers Are On The Rise

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0:31Nationwide, the school year is gearing up, children and teachers are heading to the classroom, and measles is spreading. So far, the count this year is 2 ,484 cases, according to a measles tracker at Johns Hopkins. That includes 53 new cases in Lancaster County, Pennsylvania, in the latest two-week snapshot that ended Saturday. The U.S. has already logged more cases this year than in all of 2025. It's the highest count in 35 years. That's in large part because measles immunity rates have slipped below 95 percent. The threshold public health experts say is needed to stop community spread. Last week on CNN, Secretary of Health and Human Services Robert F.

1:12Kennedy Jr. said children should be vaccinated for measles after being pressed on camera even as he used the same interview to push a debunked claim about the origins of the virus RSV. But on Monday, President Trump signed an executive order aimed at changing what vaccines children get and when, including for measles and other diseases. Here he is from the Oval Office. Effective immediately, my administration is recognizing gold standard childhood vaccine recommendations for only 11 poor vaccinations against the most serious and dangerous diseases, along with the MMR, which hopefully will be split up.

1:49You have the MMR. We want it in three separate vaccinations, given at separate times. The executive order would upend the childhood vaccine schedule if the plan becomes a reality. But what will actually change at the doctor's office? I'm Jen White. You're listening to the 1A Podcast. We get into that and more after this short break. Stay with us.

2:14This message comes from MidiHealth, a virtual care platform for women in paramenopause and menopause. CEO Joanna Strober shares the mission behind working with women in midlife. It's not just about hormones. It's not just about weight loss medications. We are very much a holistic care platform, and our job is to figure out whatever medications are appropriate for you and offer you those medications. MidiHealth. Committed to helping women in midlife with paramenopause and menopause care. Accessible via telehealth visits. At joinmidi.com. This message comes from BetterHelp. One of the hardest parts about starting therapy?

2:54Not knowing what to expect. Instead of listening to an ad, hear from the people who've actually been there. Visit betterhelp.com slash reviews to explore real client reviews that are updated every day. With an average live therapy session rating of 4.9 out of 5, based on more than 1.7 million client session reviews, the feedback speaks for itself. Visit BetterHelp.com slash reviews. Let's start the conversation with what we know about measles policy with Lena Sun. She's national health reporter with The Washington Post. Lena, welcome. Great to be there with you. We also have two doctors with us in Baltimore, pediatrician William Moss.

3:34He's the executive director of the International Vaccine Access Center at Johns Hopkins University and professor of epidemiology at the Bloomberg School of Public Health. Dr. Moss, welcome to the program. Thank you. And joining us from New York, Dr. Selene Gounder, an infectious disease specialist and epidemiologist. She's the editor-at-large for public health at KFF Health News. Dr. Gounder, welcome back. Great to be here. And a note that we reached out to the Department of Health and Human Services to invite an administration official to participate in this conversation We didn't hear back, but the invitation stands.

4:06Selena, as we heard, President Trump signed an executive order. It calls for recommending childhood vaccines against 11 diseases rather than the current 18. It also recommends splitting up the immunizations and breaking the MMR shot for measles, mumps, and rubella into three separate doses. Now, those separate shots don't currently exist in the U.S., but what would you add about the details of this executive order as it's written? Well, I think I would step back one more beat and say, just because the White House issues an executive order does not mean it's going to rewrite the federal immunization schedule.

4:42That's not how it works. States are the ones who set the vaccine requirements for school about what your kid, what shots your kids need to get. And it is not, he has asked a federal advisory body to look at this, but they're not the ones that make the laws. The policy on vaccine recommendations of what you should get come from an advisory committee to the Centers for Disease Control and Prevention. That's the body. That hasn't changed. So basically, nothing has changed. If you're going to get your annual checkup with the pediatrician's office, I think the pediatricians are going to say, yep, you should still get the MMR vaccine.

5:22That's the best protection. And here are the other shots you need to get. This is the Trump administration's third attempt in less than a year to change the vaccine schedule. Lena, what happened to those first two attempts? They didn't go anywhere. One of those attempts has now been halted by a federal judge. It's in limbo. So officially, the policy is back to what it was before. And just because the White House wants to do it, because the president really, really believes strongly, that does not mean it's going to happen. Dr. Gounder and Dr. Moss, I want to hear from you now, because as Lena points out, just because there's this executive order, it doesn't mean anything will change.

6:03But then there's also the question of messaging and how parents hear this information coming from the administration. So, Dr. Gounder, when you heard about this latest executive order, what was your initial reaction? I was horrified, but I also completely agree with what Lena just said. And if you listen back to that soundbite you played, the president says, recognizing gold standard. That is very different. And gold standard is, I don't know what that is, but it is not a statement of this is going to happen. It's a statement of what he believes. So, you know, my concern here is that we are going to see not just more measles.

6:43Measles is the most infectious of the diseases that the childhood vaccines protect against, which is why that is what you see first. But now I'm concerned, well, are we going to see mumps? Are we going to see kids having deafness as a result of mumps infections? Are we going to see the return of congenital heart malformations because of rubella? Are we going to see children with paralysis related to polio again? You know, that is what has me very concerned now. Dr. Moss, what about for you? Yes, I agree with what Lena and Selina have said. And, you know, I don't see the United States going forward with single-dose measles, mumps, and rubella vaccines, the monobalant vaccines.

7:31That's going to, as you mentioned, those vaccines are not available. in the United States. There's a whole development and regulatory process that pharmaceutical companies would have to go through. And I just don't see that they would have any incentive to do so. So I don't see that happening. But as you alluded to, it's the messaging that's the problem. And what this does is it further sows doubt, perhaps, in some people in the United States about the safety of the measles, the measles, mumps, and rubella vaccine. I mean, to say that the combination vaccine is dangerous and if you split it, it's safe and effective is just completely preposterous.

8:19And it's an idea that goes back to Andrew Wakefield and his infamous 1998 Lancet paper that was later retracted, where in the press conference following the publication of that paper, he made this claim that the MMR vaccine should be broken up into component parts. And there's no scientific basis for that. And it turns out he actually had a conflict of interest in a patent on a monovailant measles vaccine. So this is an old idea that has no foundation at all. Lena, the president also directed the Justice Department to pursue legal challenges against states with laws on their books that the administration says conflicts with parents' authority over whether and how to vaccinate their children.

9:08What does that mean at the state level for parents in those places and for the states themselves? Well, as I said, states are the ones who set the requirements for school. And states can also decide if they want to give non-medical exemptions, like for personal reasons or religious reasons, so that your kids don't have to get those shots. What we think is that there might be political pressure on states to enact more of these regulations where they say, OK, you don't need to have X, Y, Z vaccines to go to school. That's up at the state level, because then they could put pressure and say, we're not going to give you funding for this project unless you do this.

9:56It might not be that explicit. And the other point I wanted to make about the MMR shot is that Merck stopped making these single dose shots in 2009 because there was no evidence that it made any difference. It's better to combine them. Kids would have to go to many more doctor's visits. And the president and Secretary Kennedy have also said they want to follow countries in Europe because those are, you know, they're the peers. Those countries all give the MMR shot in a combination vaccine. Well, this order, again, it lands in the midst of measles cases reaching their highest number in 35 years.

10:38And we'll talk more about that a little later. But Dr. Gounder, what do you make of the timing here? It's really quite strange that you would do this when we really need to be doubling down on vaccination and the importance and value of vaccination. The Pan American Health Organization is going to be reevaluating our measles elimination status this fall. Assuming that that is a truly scientific process evaluation and not a political one, we frankly have already lost our measles elimination status. And just briefly explain what that means. That means that we have community transmission of measles here in the United States.

11:21It's not just importations from outside. And that means it's becoming re-entrenched here in the United States. And that's very concerning. I think a lot of people dismiss measles as a very mild childhood infection. They think of it like chickenpox or something else like that, which, by the way, we also vaccinate against chickenpox for good reason now. But measles causes something called immune amnesia, which is essentially wiping out your immunity to various different infections. So in a sense, turning back the clock for a child back to what their immune system might have been as an infant, putting them at risk for numerous infections, pneumonia, diarrheal illness.

12:02This can have a huge impact on their nutritional status as well. And then there are other longer term complications like SSPE, which is a neurologic infection that can manifest years later. And so it's not necessarily the deaths in the moment. you have a long tail of complications with measles. We got this from a pediatrician in Cincinnati. Watching a child deal with measles is heartbreaking. Symptoms include high fever, uncomfortable rash, and severe eye irritation. Whooping cough in a six-year-old can lead to respiratory failure, requiring that child to be intubated, paralyzed, and sedated to not fight the vent.

12:38I've been fortunate through my career to witness declines in these serious illnesses and others. I've also observed how immunocompromised children have been protected when they could not be immunized due to herd immunity. It's horrifying to see the trajectory of these diseases change due to people without expertise offering opinions not founded in science. We'll be back with more from our guests and from you right after this.

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13:50Follow Trump's Terms on the NPR app or wherever you get your podcasts. Tanya, I think you did the best interview that I've done. Seriously. Oh, that's a great question. I think I'm going to think about that question for the rest of my life. Oh, good question. This is Tanya Mosley, co-host of Fresh Air, and the questions are only the half of it. Listen to Fresh Air on the NPR app or wherever you get your podcasts. Back to our look at the new executive order that aims to change what vaccines children get and win. Lena, President Trump admitted on camera that he has no evidence that the combined MMR shot could be dangerous.

14:34So what reasoning did he provide for this order? He has always wanted to have children get fewer shots. And he said that his own son, you know, had his shots spaced out. And I think for a lot of parents, you know, from one perspective, you think like, oh, we don't want to give the kid so many shots at the same time. But and I think Dr. Gounder and Dr. Moss can explain this much better. You are giving those vaccines at a time when the body is best able to develop an immune response and to have protection. If you space out like MMR, you know, that's six visits, six shots. And that means you might have to take off work and that you might not go.

15:20And then your kid is much more vulnerable to the disease. He just believes strongly that there should be fewer shots. but just because he believes it doesn't mean there's any science to back it. There is no science to back it. The science hasn't changed. The kids haven't changed. The virus hasn't changed. All that's changed is people are more confused. So when they're confused, their tendency is, you know, maybe I'll just wait. And maybe the confusion will make people think, oh, three individual shots are coming. I'll just wait. That's not going to happen. I talked to an industry spokesperson yesterday, and they are not planning to do this.

15:58This would require clinical trials, FDA approval. It would take years. It's not going to happen. Dr. Masa, I want you to just explain a little bit more about what a potential change in this vaccine schedule means from a practical level. As a parent, as Lena just laid out, we're talking about multiple visits to the doctor. If you have a child who's not a fan of needles, and I don't know many children who are. You know, for a parent, it may be distressing to see your child have to get multiple shots. So just practically speaking, before we get to the science, what kinds of complications does that raise for families?

16:37As Lena said, it creates a lot of confusion. And so, you know, by actually splitting up combination vaccines like the measles and mumps and rubella vaccine, you're actually giving the child more shots, there are more visits, it's more time for the parent or caregiver, and it's more expensive. So it's hard to see from a parent's perspective why this would be something that's beneficial. It also leads, and if there is mistrust or confusion around the vaccine schedule, you know you could imagine a scenario where a child is brought say for one of the three vaccines say the measles vaccine and then if it were spaced out and they had to come back for rubella and then a mumps that maybe those those visits don't take place maybe the child misses out and this is where the risk of disease comes from that Celine was referring to earlier where the children are missing out on some of the components of that vaccine.

17:44The real advantage of these combination vaccines, like a measles, mumps, and rubella vaccine, is that in a single visit, in a single injection, child gets protected against three diseases rather than one at a time. So it really doesn't make sense from either a provider perspective or from a caregiver perspective. And just to pull on a thread that Lena mentioned about how children's immune systems are developing, why is it beneficial to stick with the vaccine schedule as it currently exists, which focuses on a relatively early age to get children vaccinated? Yes. So there are a number of factors that go into creating a childhood immunization schedule.

18:33And it requires very rigorous review of the scientific evidence and consideration of these multiple factors. We have built our current childhood immunization schedule over decades. And as we said earlier, it was developed by groups of experts, the Advisory Committee on Immunization Practices with the CDC, a support and endorsement, along with other organizations like the American Academy of Pediatrics, which now has a schedule that diverges from what certainly from what's being promoted by the federal government. But it involves consideration of the child's immune response and the development of that.

19:19For example, if the measles vaccine is given too early in life, there are antibodies from the mother that are in the child, in the infant, that can inhibit the immune response of that vaccine. So a measles vaccine, we don't give it, say, at two months of age or four months of age when other childhood vaccines are being given. But if you wait too long, then the child's at risk for disease from that pathogen. So the childhood immunization schedule is in large part trying to balance the optimal immune response with the risk of disease. and then other considerations, linking that child visit with other evaluations of the child or other interventions.

20:07Dr. Goundra, I'd love your thoughts as well. Yeah, so a couple comments on what both Lena and Bill have said here with respect to what the impact of spacing shots is. So this is not hypothetical. Researchers have looked at this. They looked at this in Oregon, followed nearly 100 ,000 kids. By nine months, the children whose parents spread shots out had to make more visits, and they received fewer vaccines. So we've seen this in reality. And I know some people might say, well, I'll still go to all the visits. But that is not going to be the case for everyone. And it may be, well, it's the case for you.

20:44These recommendations are to make sure that all children receive the vaccinations they need at the right age. Secondly, one of the reasons people also talk about breaking up the vaccines, MMR, is because they're afraid of some sort of immune overload. Well, again, to put this into perspective, a century ago, a child got one vaccine, the smallpox vaccine, and that carried about 200 viral proteins. The entire childhood vaccination scheduled today carries many fewer viral proteins than just the one smallpox vaccine. And young children also get four to six fevers a year from just regular ordinary infections, each of which is a bigger challenge to the immune system, than vaccinations you might get in a well-baby visit.

21:29Lena, we've got to let you go in just a moment, but this executive order lands just months ahead of the midterms, and Trump's own pollsters have reportedly warned him that this issue of vaccines is unpopular. So why keep pushing this now politically? We have seen that the polling shows that to be unpopular with parents, and in general, most parents believe in vaccinations, Our own reporting and polling have shown that. But he really, really believes it. And he has been pushing. He and Health Secretary Kennedy have been working sort of behind the scenes to use all the levers of federal government to do more, to re-look at issues that have been looked at and studied for decades over millions of children in many, many countries.

22:22because this is what he believes. This is truly what he believes. And because he's the president and can use the bully pulpit and can make a lot of noise with executive orders, I think they have achieved the goal of creating the confusion. And also this plays to his base, which feels very strongly about vaccines, some of his base. And in some ways, critics will say they have achieved the goal, which is to create confusion. That's Lena Sun. She's a national reporter covering health for The Washington Post. Lena, thank you for your time. Thank you for having me. We heard from Jeffrey, who emails, I've been a practicing physician for over 35 years and have watched children die of bacterial meningitis, which has now been prevented with vaccines.

23:09These decisions are reckless, political, and absolutely dangerous to our children. It's all personal opinion, and we should absolutely disregard and continue very strong and effective communication to parents. We also heard from Ian, who emailed, one concern that I have with breaking up the vaccine is that parents might not want to see their kids in pain more times. As a parent, I remember when my child first got vaccinated, the visceral reaction I had to her being in pain. I can only imagine if you had to do that more times. They might say, you know what, we'll wait until they're a little bit older, which would elevate the risk of that child contracting one of these diseases.

23:43Dr. Gounder, just tell us more about where things are right now. We noted that public health officials report nearly 2 ,500 cases so far this year. How would you describe the scope of the measles outbreak? Well, it has largely been focused in South Carolina, Texas, and Utah so far. But whether that continues to be the case remains to be seen. I have real concerns heading into the school year this year that we will see additional outbreaks, perhaps in other parts of the country. I think it's also really important to reiterate that the executive order really has no impact on reality on the ground right now.

24:26Requirements about vaccination and public health powers in general, I think something people also still don't understand, sit with the state and local health departments and school districts. For example, decisions made during the pandemic, COVID pandemic, those decisions were, with respect to schools and other mandates, were made at that local level. And so while federal guidance can inform it, it is still really up to locals to decide whether they're going to execute on it. We got this question from Stephen, who asks, does the immunity amnesia effect of measles include vaccinations completed before being infected by measles?

25:07Dr. Moss, what can you tell us? Yes. So we've known for a long time that there's a state of immune suppression following measles. It actually was first described in the early 20th century. And this accounts for many of the complications of measles that we've talked about, the pneumonia, the ear infections, the diarrhea that are often due to secondary bacterial infections. This concept of immune amnesia came from a study several years ago that was done in the Netherlands that looked at antibody responses to multiple pathogens that were measured before and after children had measles. And what they showed was that both the breadth of the antibody response and the magnitude of that antibody response decreased significantly after measles.

26:03And this is because measles virus actually kills the white blood cells that are responsible for our immunologic memory, what we call our immunologic memory. It is variable across children, but to the question being asked, yes, it could potentially impact the antibody response that was generated by prior vaccination. Now, again, because of the variability of this, the World Health Organization or the CDC or other bodies that make vaccine recommendations have not recommended, for example, that children get revaccinated against these other pathogens after they've had measles. But I think that's a reasonable question to ask, you know, given the fact of this, quote, immune amnesia that follows measles.

26:58We got this email from Valoris, who says, I'm a special educator and parent of two young children. I have students who are put on home and hospital status due to medical issues. This service is a part of the public school mandate to provide access to free and appropriate public education. If more medically fragile students have to be put on home and hospital due to a drop in herd immunity, or if they need that service after becoming sick with measles, mumps, or rubella, how will it impact education costs? Now, Dr. Gounder, I don't know that you can necessarily answer that specific question, but we talked a little bit about some of the downstream effects of the confusion around vaccines.

27:37What other downstream effects are you concerned about? Well, she makes an interesting point. I think one of the things people are most angry about, frustrated with respect to the COVID pandemic, was school closures. Or rather, really, when schools reopened. Because schools all across the country close around the same time. And people are angry about what the impacts have been on educational measures, as well as what that meant for socialization. And so you are now forcing these kids who have underlying medical conditions, perhaps they're immunocompromised, maybe it's a cancer-related diagnosis, you're forcing them to have to stay at home and homeschool.