The measles outbreaks that began in late 2024 has re-ignited measles hysteria in the media. The email accounts of infectious disease experts must be reaching the limits of their storage capacity. Experts who were media darlings during the COVID-19 craze are front and centre again in mainstream media articles and morning news shows.
Are we losing control of measles? Is vaccine coverage across the world irreversibly trending away from public health goals? How terrified should we be?
The requests for interviews have surely spurred much discussion on how to handle the situation. Public health spokespeople are thrilled to be able to reach, at last, thousands of people about this insidious, progressive, and significant public health crisis.
This intense focus has been fuelled by a public health campaign that delivers a straightforward, who-in-their-right-mind-could-possibly-disagree-with-it message: measles is a serious disease, its return is an emergency, every child is at risk of complications, the MMR shot is virtually risk free, and vaccination saves lives.
To an innocent consumer of mainstream media, any reported decrease in measles vaccine uptake amongst children aged 2 years borders on the unethical. Even media articles outside the mainstream – including this platform – have been caught up in the frenzy by stating such things as “Measles is a terrible disease. It has several serious effects, and is highly contagious, hurting mostly children.”[1]
The historical narratives surrounding measles and measles vaccine programs are complicated and require subtlety in public discussion. When people say things like “measles is dangerous” or that “declining vaccine coverage is a public health emergency”, they are speaking beyond what they know.
There is another communication problem. Through the media, public health tends to approach the future by depicting what can happen as what will happen. Rare complications of many vaccine-preventable diseases are presented as the rule rather than the exception. If 1 in 1,000 (0.1%) detected measles cases experience encephalitis, the important message – that 99.9% measles cases do not develop encephalitis – goes unsaid. Instead, there is an implicit warning to parents: “Don’t let your child be the 1 in 1,000!” Such is the standard public health formula: cater to scary things, promote a solution, repeat.
If people can be convinced that measles is a real public health priority, then governments can justify big initiatives and enormous expenditures that are independent of their usefulness or sustainability.
There are some of us in the world of epidemiology who are thinking hard in this time of opportunity about how to boil down what needs to be said, and how to say it with the right degree of certainty. Here, after many months of scary measles tales, is the best I can do:
We know that measles (the virus, not the disease) spreads easily through the air when an infected person coughs or sneezes. In epidemiology, the ease with which spread occurs is sometimes described by the basic reproductive number (R0, pronounced “R nought”).[2] For measles, R0 is typically thought to have a value between 12 and 18, making it one of the most easily transmitted infections.
However, R0 is mostly estimated with various types of complex mathematical models, which makes it an easily misrepresented, misinterpreted, and misapplied concept. Despite its high value for measles, R0 cannot tell us how large or how severe an outbreak will be. Even outbreaks with high R0 values can vanish before any immunity accumulates amongst the population or any interventions are introduced.
We know that most measles cases are benign with many (upwards of 90%) going unreported to public health agencies such as the CDC.[3] [4]
Before mass vaccination programs, it was rare for a child to suffer permanent disability or death. In the 1960s, even strong advocates for measles eradication described measles as a “short, moderately severe, self-limiting infection with low fatality rates.” Making measles a target for global public health action was “because it’s there” rather than from its total disability days or number of deaths.[5]Children were dying from many other things, and at higher rates, than measles before vaccine programs started (see Figure 1).
Figure 1 – Death rates from 18 selected causes in children aged <1 year, 1-4 years, and 5-14 years in the U.S. in 1962 – the last year before measles vaccination began.
We know that when measles was a common childhood disease. The mortality rate amongst children < 15 years decreased by 88-92% in the U.S. before mass vaccination programs started (see Figure 2). There is neither evidence of immediate, nor longer-term declines in measles mortality that coincide with the start of measles vaccine programs, whereas the sharply dropping trends from 1940 to 1962 foretold measles mortality nearly a decade later.
Figure 2 – Age-specific death rates from measles amongst children in the U.S. declined by up to 92% between 1940 to 1962, before the measles vaccine was introduced in 1963 (represented here by the vertical dashed line). Age groups are the same as in Figure 1: <1 year, 1-4 years, and 5-14 years.
We know that, despite being rare, measles (the disease) can be serious for some people, and there are complications that can arise including seizures, middle-ear and lung infections, brain swelling, hospitalization, and death.
However, we also know that malnutrition, especially vitamin A deficiency, is a primary cause of almost 90,000 severe measles cases in under-developed countries. In the U.S. and other developed countries, 75-92% of hospitalized measles patients are low in vitamin A.[6] [7] [8]
Severe neurological outcomes such as encephalitis and subacute sclerosing panencephalitis (or SSPE) are also more likely tied to pre-existing immune dysfunction or autoimmune disorders that intensify after measles infection.[9]
We know that protection against measles is passed from mother to babies during pregnancy. However, there is evidence to suggest that infants born to mothers who have infection-acquired immunity are protected longer than those born to vaccinated mothers.[10]
We know that measles vaccine programs have significantly reduced the number of measles cases since beginning in the early 1960s. However, national programs are no longer working according to plan because they emphasise “how many are vaccinated” versus “whom”. It is a one-size-fits-all solution that is having wide-ranging, unanticipated consequences. Everyone can act dutifully and rationally, yet these well-meaning actions too often add up to an undesirable result.[11]
Measles vaccination programs were created to combat a natural illness, one people had lived with for millennia. Measles deaths decreased as living conditions improved, but a phobia of microorganisms developed – one in which the adage “sometimes children get sick” is now treated as an assault on the sanctity of public health.
The self-maintaining capacity for high levels of immunity that happened before large-scale vaccine programs has been eroded,[12]and an unwanted consequence has been set in motion. Slowly, over time, population-level immunity from natural re-exposure deteriorates; population-level immunity is increasingly dependent on vaccination, and many nations are unable to maintain “measles elimination” status. Measles vaccination programs have become victims of their own success.
I do not think that the “return” of measles is an emergency – if it is a return at all. When one considers the delayed and surprising effects of most large-scale vaccination programs, the “return” is expected. Current measles-control regimes are a funhouse-mirror distortion of the original vision. Control is not “effective”, and the promise of eradication by 1967[13]has yet to be delivered more than a half-century later.
Notes & References
[1] Hunt L. Accountability and Measles Outbreaks. BIG Media, June 20, 2025.
[2] R0 must be estimated, reported, and applied with great caution because this basic metric is far from simple. R0 is affected by numerous biological, social, behavioural, and environmental factors that govern pathogen transmission. R0 is rarely—if ever—measured directly.
[3] CDC. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington, DC: Public Health Foundation; 2015. Appendix E3
[4] CDC. Measles prevention: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR, 1989; Dec 38(S-9):1
[5] Langmuir AD et al. The Importance of Measles as a Health Problem. Am J Public Health, 1962: 52(2); 1–4
[6] Influenza, SARS-CoV-2, RSV and other Respiratory Viruses Regional Situation, Pan American Health Organization. Washington, D.C.: Regional Office for the Americas of the World Health Organization. Basic measles facts [cited 2019 Jul 30]
[7] Butler JC, et al. Measles severity and serum retinol (vitamin A) concentration among children in the United States. Pediatrics, 1993 Jun 91(6): 1177-81
[8] Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med. 1990 Jul 19;323(3):160-4
[9] Garg RK. Subacute sclerosing panencephalitis. Postgraduate Medical Journal, 2002; 78: 63-70
[10] Waaijenborg S, et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverage. J Infect Dis. 2013 Jul; 208(1): 10-6
[11] Meadows DH. Thinking in Systems: A Primer. Chelsea Green Publishing, 2008
[12] Heffernan JM, Keeling, MJ. Implications of Vaccination and Waning Immunity. Proc R Soc B, 2009; 276(1664): 2071-2080
[13] Sencer DJ, Dull HD, Langmuir AD, Epidemiologic Basis for Eradication of Measles in 1967, Public Health Reports, 1967: 82(33); 256
(David Vickers – BIG Media Ltd., 2025)
