Unseen Guardians: Measles Outbreak Highlights Public Health’s Crucial Role and Evolving Challenges

Local health officials and CDC work together to stamp out Ohio measles outbreak

In 1912, the United States formally recognized measles—a highly contagious viral infection causing fever, cough, runny nose, red eyes, and a characteristic rash in milder cases, while leading to pneumonia, encephalitis, and death in more severe instances—as a nationally notifiable disease. For centuries, this ubiquitous childhood ailment afflicted millions. In the first decade of reporting, an annual average of 6,000 measles-related fatalities were recorded in the U.S.

The introduction of the first measles vaccine in 1963, with its near-perfect efficacy, marked a turning point. The vaccine was later combined with those for mumps and rubella (MMR) in 1971, and varicella (MMRV) in 2005, providing children protection against several diseases in a single shot. Bolstered by this potent new preventive tool, the Centers for Disease Control and Prevention (CDC) set a goal in 1978 to eliminate measles from the country. This objective was realized in 2000, thanks to robust vaccination campaigns, the introduction of a second dose in 1989 to increase efficacy, and rigorous disease surveillance systems.

In the new millennium, measles appeared a relic of the past, but the specter of outbreaks returned—first in the 2014-15 Disneyland episode, and then in the largest outbreak in decades in 2019. Declining vaccination rates, fueled by skepticism and misinformation, left vulnerable communities exposed. The 2019 outbreak primarily affected unvaccinated children in communities with low vaccination rates across 31 states, such as ultra-Orthodox Jewish communities in New York and vaccine hesitant regions in Washington. Travelers imported the virus, sparking infections among the unvaccinated.

One such measles outbreak erupted in Ohio in 2022. Between November 2022 and February 2023, when the outbreak was declared over, 85 cases were reported, primarily affecting children under five, with 36 hospitalizations. Among the 85 cases, 80 were unvaccinated, including 25 infants too young to receive their first dose.

To quell the outbreak, a team of epidemiologists from the CDC worked in concert with Columbus Public Health to track cases, identify and notify exposed residents, and understand the spread of the virus. Dr. Mysheika Roberts, Columbus’s health commissioner, led the outbreak response, raising awareness of the disease through public information and education, and promoting and easing access to vaccination.

In addition to the on-the-ground work of state and local health departments, the CDC plays a vital, often behind-the-scenes role in supporting those departments and safeguarding public health. It provides robust disease surveillance systems, expert guidance, technical assistance, and financial support, enabling locally targeted interventions and infrastructure improvements.

Though the latest outbreak was successfully contained, the Ohio measles episode may portend further challenges. Vaccine hesitancy, a complex and deeply ingrained phenomenon, threatens to erode hard-won public health gains and could precipitate resurgent outbreaks. The issue has multifaceted roots including mistrust in science and institutions, and misinformation amplified on digital platforms. In communities of color, vaccine hesitancy is compounded by longstanding health disparities and medical mistreatment.

The COVID-19 pandemic exacerbated the problem, with routine vaccination rates falling due to school closures and disrupted well-child doctor visits. A recent Kaiser Family Foundation poll revealed that, amid the politicization of COVID-19 vaccines and school mandates, over a third of parents with children under 18 believe they should have the choice to not vaccinate their children against measles, mumps, and rubella, even at the risk of others’ health. This represents a 52% increase compared to 2019. During the 2021-22 school year, kindergarten vaccination coverage fell to roughly 93%, leaving about 250,000 kindergartners potentially unprotected against measles.

Tackling vaccine hesitancy and strengthening our public health systems requires a multifaceted national approach. Federal, state, and local governments should invest in accessible, science-based education campaigns that dispel myths and foster trust. Working with local partners, public health agencies are developing tailored, culturally sensitive vaccine education and access programs that bridge gaps in understanding and acceptance.

The Ohio measles outbreak serves as a stark reminder that the fight against vaccine-preventable diseases remains ongoing, the indispensable role of the public health workforce, and the critical need for a robust public health system. Increased, sustained, and flexible public health funding is key to having such a system. As is growing a diverse workforce to ensure that those shaping policy and delivering services reflect the communities they serve. By taking these steps, among others, we can reduce vaccine hesitancy, create a more robust public health system, and foster an environment of trust in science. Doing so can protect the hard-won progress made against measles and other diseases, safeguard the health and well-being of generations to come, and pave the way for a more equitable future.

New Report Measures States’ Emergency Preparedness and Makes Recommendations About How to Strengthen the Nation’s Public Health System

Sustained Investment in Public Health Infrastructure and Preparedness is Needed to Protect Lives During Disease Outbreaks and Natural Disasters

(Washington, DC – March 23, 2023) – As infectious disease outbreaks and extreme weather events threaten the health of more Americans, a new report shows the need for strengthened national and state public health emergency preparedness.

Ready or Not 2023: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America’s Health, measures states’ readiness to respond to a spectrum of health emergencies and to provide ongoing public health services. The report gives federal and state health officials and policymakers actionable data and recommends policies to improve the nation’s emergency preparedness at a time when health emergencies are increasing. During 2022, the U.S. surpassed 1 million deaths due to COVID-19 and saw decreasing rates of routine vaccinations and increasing prevalence of health misinformation.  In addition, the past year was the eighth consecutive year the U.S. experienced 10 or more billion-dollar weather-related disasters.

The report tiers states and the District of Columbia into three performance levels for health emergency preparedness: high, middle, and low. This year’s report placed 19 states and DC in the high-performance tier, 16 states in the middle performance tier, and 15 states in the low performance tier.

High Tier19 states & DC

CO, CT, DC, DE, FL, GA, KS, ME, MD, MA, MS, NJ, NC, OH, PA, UT, VT, VA, WA, WI

Middle Tier16 states

AK, AL, AR, CA, IA, ID, IL, IN, MO, ND, NE, NH, NY, RI, SC, TX

Low Tier15 states

AZ, HI, KY, LA, MI, MN, MT, NM, NV, OK, OR, SD, TN, WV, WY

“Increased and sustained investment in public health infrastructure, emergency preparedness, and health equity will save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Federal, state, and local officials as well as leaders in the healthcare and business sectors should use our findings to identify and address gaps in public health preparedness. Neglecting to do so will mean that the country will not be as prepared as it needs to be for the next public health emergency.”

The report’s findings showed both areas of strength within the nation’s public health system and areas that need attention.

Areas of strong performance include:

  • A majority of states have made preparations to expand healthcare and public health laboratory capacity in an emergency.
  • Most states are accredited in the areas of public health or emergency management. Some states are accredited in both.
  • Most U.S. residents who received their household water through a community water system had access to safe water. However recent water system failures in Jackson, Mississippi and Newark, New Jersey demonstrate the importance of continued attention to the integrity of municipal water systems.

Areas that need attention include:

  • Too few people were vaccinated against seasonal flu last year despite significant improvement in flu vaccination rates in recent years. During the 2021-2022 flu season, 51 percent of Americans ages 6 months or older received a flu vaccine, well short of the 70 percent goal established by Healthy People 2030.
  • Only half the U.S. population is served by a comprehensive public health system. Comprehensive public health systems ensure that necessary health services are available to all residents.
  • Only 26 percent of hospitals in states, on average, earned a top-quality patient safety grade in 2022. Hospital safety scores measure performance on such issues as healthcare-associated infection rates, intensive-care capacity, and an overall culture of error prevention.

The report contains recommendations for policy actions that would create a stronger public health system at all levels, including:

  • The Administration, Congress, and state lawmakers should modernize public health infrastructure, including by investing $4.5 billion annually to support foundational public health capabilities. In addition, Congress should continue to increase funding for the Public Health Emergency Preparedness cooperative agreement and public health data modernization to allow for earlier and more accurate detection of emerging health threats.
  • Policymakers at all levels should act to protect and strengthen public health authorities and should prioritize rebuilding trust in public health agencies and leaders.
  • Congress and state legislatures should invest in effective public health communications, including countering misinformation.
  • Congress and states should ensure first-dollar coverage for all recommended vaccines under commercial insurance and for uninsured people. States should minimize vaccine exemptions for school children, and healthcare facilities should increase rates of vaccination for healthcare workers.
  • Congress and states should provide job-protected paid leave for employees due to illness or family caregiving demands.
  • Congress and states should invest in policies and capacity to address the social determinants of health such as secure housing, access to transportation, and access to healthy food.
  • Congress should fund the entire medical countermeasures (MCM) enterprise, including the distribution and dispensing of MCMs. Congress should also create incentives for new products to prevent and fight antibiotic-resistant infections.
  • Congress and states should strengthen readiness for climate change, extreme weather, and environmental health threats.

Read the full report

Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. 

 

 

 

 

 

TFAH’s Portal of COVID-19 Resources

The following is a list of TFAH resources and documents related to the novel coronavirus read of COVID-19 and better equip the nation’s public health system to deal with this and future health emergencies.

Press Releases and Statements

20 Public Health Organizations Condemn Herd Immunity Scheme for Controlling Spread of SARS-CoV-2   The virus that causes COVID-19 has infected at least 7.8 million people in the United States and 38 million worldwide. It has led to over 215,000 deaths domestically, and more than 1 million globally – with deaths continuing to climb… read more (October 14, 2020)

Newly Announced Order for Hospitals to Bypass CDC and Send Coronavirus Patient Information Directly to Washington Database Likely to Worsen Pandemic Response Rather than Improve It  The U.S. Centers for Disease Control and Prevention (CDC), as the nation’s lead public health agency, is uniquely qualified to collect, analyze and disseminate information regarding infectious diseases… read more (July 16, 2020)

Nearly 350 Public Health Organizations Implore HHS Secretary Azar to Support CDC’s Critical Role in the COVID-19 Pandemic Response  The expertise of the U.S. Centers for Disease Control and Prevention (CDC) and all public health agencies is critical to protecting Americans’ health during the COVID-19 crisis, said a letter to Health and Human Services Secretary Alex Azar from 347 health and public health organizations released today… read more (July 7, 2020)

Public Health Needs Our Support “As our nation’s struggles to manage the continued surge of COVID-19 cases, we need to strengthen the public health response… read more (June 23, 2020)

Summary of CDC Morbidity and Mortality Weekly Report on COVID-19 Impact Patterns This is the first data reported on U.S. patients and is consistent with findings from other countries. Key takeaways… read more (March 31, 2020)

Trust for America’s Health Statement in Response to Congressional Passage of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)
“Congress took an important step today to begin giving public health the resources it needs now to respond to the COVID-19 pandemic. We are seeing in real-time the impact of the chipping away at public health budgets over the past 15 years… read more (March 27, 2020)

Cross-Sector Group of Eighty-eight Organizations Calls on Congress to Address Americans’ Mental Health and Substance Misuse Treatment Needs as Part of COVID-19 Response
A cross-sector group of 88 organizations from the mental health and substance misuse, public health and patient-advocacy sectors are jointly calling on the Trump Administration and Congress to address the immediate and long term mental health and substance misuse treatment needs of all Americans as part of their COVID-19 response… read more (March 20, 2020)

55 Organizations Call for Passage and Fast Implementation of Paid Sick Leave for all Workers as a Critical Part of COVID-19 Response
A cross-sector group of 55 public health, health, labor, business, and social policy organizations are jointly calling on the Trump Administration and Congress to pass and quickly implement a federal paid sick leave law that provides 14 days of such leave to all workers, available immediately… read more (March 13, 2020)

TFAH Applauds Passage of Supplemental Funding for COVID-19 Response: Now Funding Must Move Quickly to States and Other Entities
TFAH applauds Congress’ fast action in approving the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R 6074). We now call on the tasked federal agencies to move quickly to send the appropriated monies to the agencies and localities working at the frontlines of the COVID-19 crisis… read more (March 5, 2020)

TFAH Statement on COVID-19 Preparations
Now that the U.S. has transitioned from the planning phase to the response phase of the COVID-19 outbreak, the Federal Executive Branch and Congress as well as state and local governments and other stakeholders should prioritize… read more (March 3, 2020)

Congressional Testimony and Sign-on Letters

Commentaries and Op-Eds

Additional News Coverage We Recommend

Coronavirus in the U.S.: Latest Map and Case Count

as compiled by the New York Times

 

 

CDC COVID-19 Information Resources

COVID-19 and Response: Webinars and Briefings

Related Reports

TFAH Recognizes National Minority Health Month

Trust for America’s Health (TFAH) is proud to support National Minority Health Month (NMHM) 2022 and its critical focus on addressing health inequities. This year’s NMHM theme Give Your Community a Boost! notes the importance of ensuring that everyone eligible to receive the COVID-19 vaccine is vaccinated, including all eligible booster doses. Being vaccinated is the best way to protect yourself and your loved ones against severe illness from COVID-19.

“Ensuring that communities of color have equitable access to and reliable sources of information about the COVID-19 vaccine is vital to promoting and protecting the health and well-being of the community,” said TFAH President and CEO, Dr. J. Nadine Gracia. “People of color have been disproportionately impacted by the pandemic, due to longstanding social, economic, and health inequities that led to higher rates of job loss, less access to essential resources for remote learning, and higher rates of infections, hospitalizations, and deaths. We need to focus on two priorities: protecting everyone from COVID-19 now and ensuring that no community is at heightened risk during the next public health emergency. ”

Additional Readings:

TFAH’s 2020 policy brief Building Trust in and Access to a COVID-19 Vaccine Within Communities of Color and Tribal Nations reports on challenges to building vaccine trust and access in communities of color and tribal communities and recommends solutions.

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism reports on state-level public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity recommends policy action that if adopted will address the social determinants of health that currently drive poor health in many communities.

Read more about TFAH’s policy recommendations to rebuild the nation’s public health system and invest in the social determinants of health and health equity in our Blueprint report: The Promise of Good Health for All: Transforming Public Health in America. A Blueprint for the 2021 Administration and Congress.

Congressional Briefing and National Webinar: Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

As the nation enters its third year of the COVID-19 pandemic, this year’s report calls for urgent investment to create a public health system able to protect all Americans’ health during emergencies. The report measures states’ degree of preparedness to respond to a wide spectrum of health emergencies and to provide ongoing public health services.

A panel of subject matter experts discussed the nation’s readiness for public health emergencies, examined the findings of the report, and discussed key recommendations for policymakers.

Resources:

Trust for America’s Health

Office of Minority Health, Centers for Disease Control and Prevention

Articles shared by Céline Gounder, MD, ScM, FIDSA

TFAH Recognizes National Public Health Week, April 4 – 10, 2022

Trust for America’s Health is proud to participate in National Public Health Week and its 2022 theme “Public Health is Where You Are.”

Public health’s mission is to promote health and protect people from health risks, including diseases and natural or man-made disasters. Prevention and disease surveillance are central to that mission, as are population-level health interventions including addressing the social determinants of health. Public health practitioners work at the community level to ensure that everyone has an opportunity for optimal health. A critical premise of that work is engaging with and empowering communities, including identifying and addressing root causes of health inequities and barriers to good health.

The COVID-19 pandemic has illustrated the urgent need to grow the public health workforce and ensure that it has the tools it needs to fulfill its mission. TFAH and other public health leaders have called for an annual investment of $4.5 billion to support public health infrastructure and workforce. Much of what we spend as a nation on healthcare today is spent on preventable illness and injury. Rebuilding the public health system would help address health inequities,  would make the country better prepared for future health emergencies, and would improve health outcomes.

Additional Readings:

TFAH’s 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism report for more information on public health emergency readiness and the connection between health equity and emergency preparedness.

TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021 tracks the dearth of funding for public health and the impact that scarcity has had on the public health infrastructure, readiness, and workforce.

 

New Report: Fewer States Placed in Top Performance Tier for Public Health Preparedness in 2021

COVID–19 Pandemic Continues to Illustrate the Critical Need to Invest in Public Health Infrastructure and the Social Determinants of Health

(Washington, DC – March 10, 2022) – As the nation enters its third year of the COVID-19 pandemic, a new report calls for urgent investment to create a public health system able to protect all Americans’ health during emergencies. The report, released today by Trust for America’s Health, measures states’ performance on 10 key emergency preparedness indicators and identifies gaps in states’ readiness to respond to emergencies. The report includes policy recommendations for strengthening the nation’s health security.

The report, Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, measures states’ degree of preparedness to respond to a wide spectrum of health emergencies and to provide ongoing public health services, including disease surveillance, seasonal flu vaccination, safe water, and expanded healthcare services during emergencies. It tiers states and the District of Columbia into three performance levels: high, middle, and low, placing 17 states and DC in the high-performance tier, 20 states in the middle performance tier, and 13 states in the low performance tier. The 2021 report placed, 20 states and the District of Columbia in the high-performance tier.

States’ Performance by Tiers

Performance Tier States Number of States
High Tier AL, CO, CT, DC, FL, IL, IA, KS, MD, MA, NJ, OH, PA, SC, UT, VA, VT, WA 17 states and DC
Middle Tier AZ, CA, DE, GA, ID, ME, MI, MO, MS, NE, NH, NM, NY, NC, ND, OK, RI, TN, TX, WI 20 states
Low Tier AK, AR, HI, IN, KY, LA, MN, MT, NV, OR, SD, WV, WY 13 states

 

This year’s report found that 12 states improved their performance while 16 states slipped in their ranking. All states’ performance is relative to that of other states.

Three states, Ohio, Pennsylvania and South Carolina, improved their performance by two tiers.

Nine states improved by one tier: Alabama, Arizona, Florida, Illinois, Iowa, Missouri, New Hampshire, New Jersey, and New York.

Sixteen states fell one tier: Delaware, Georgia, Idaho, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, and Wisconsin.

In addition, the report found:

  • A majority of states had plans in place to expand healthcare and public health laboratory capabilities in an emergency.
  • Most states are accredited in the areas of public health, emergency management or both.
  • A large majority of Americans who receive their household water through a community water system had access to safe water.
  • Only about half of the U.S. population is served by a comprehensive local public health system.
  • Seasonal flu vaccination rates have risen significantly in recent years but are still lower than the goal set by Healthy People 2030.
  • Just over half of workers used some kind of paid time-off in a one-month sample. The need for paid time off has become particularly apparent during the pandemic, as many workers became ill or needed to care for a sick family member.
  • Only 28 percent of hospitals, on average, earned a top-quality patient safety grade during the year, down from 31 percent the year prior.

“The major takeaway of this report is that underinvestment in the nation’s public health system, and attacks on its authority, have had deadly consequences during the COVID-19 pandemic. Action and investment are urgently needed. This report’s findings can help federal and state officials identify gaps in public health preparedness and the steps needed to better protect lives and the economy during the next health emergency,” said J. Nadine Gracia, MSCE, President and CEO of Trust for America’s Health.

The report measured states’ performance during a year that presented intense demands on the nation’s public health system. In addition to the ongoing COVID-19 pandemic, 2021 saw record heat in many places, extensive flooding, wildfires throughout the Western U.S., a highly active hurricane season, and unusual and deadly December tornados in eight states. At the same time, hundreds of public health officials having experienced burn-out, threats to their safety, and attempts to limit their public health authorities have resigned, retired, or been fired.

While critical progress was made in fighting COVID-19 during 2021, particularly through the widespread availability of vaccines and a more coordinated federal response, the pandemic continued to illuminate the ways in which health inequities put communities of color and low-income communities at heightened risk for worse health outcomes during an emergency.

“Social, economic, and health inequities undermine a community’s ability to prepare for, respond to, and recover from a public health emergency. If we enter the next public health crisis with the same magnitude of health inequities in our communities as has been evident during this pandemic, the impact will be similar: preventable loss of life, disproportionate impact on communities of color and low-income communities, and widespread social and economic disruption.  It is impossible to separate strong public health emergency preparedness and health equity,” said Dr. Gracia.

Among the report’s policy recommendations:

  • Congress and states should provide stable, flexible, and sufficient funding for public health, including for infrastructure, data systems, and the public health workforce.
  • Congress should create a COVID-19 Commission to review and address gaps in the pandemic response, and leaders at all levels of government should reject attempts to weaken public health authorities.
  • Policymakers should take steps to prevent disease outbreaks by investing in vaccination infrastructure, antibiotic resistance programs, and by providing paid leave for all workers.
  • Congress should create programs to help build resilient communities by investing in health equity and the social determinants of health, including anti-poverty programs and programs that build financial security for families.
  • Congress should invest in the development and distribution of medical countermeasures to enable rapid development and effective deployment of life-saving products during emergencies and federal and state policymakers and healthcare systems leaders should work together to prioritize effective coordination and communication during emergencies.
  • The White House, Congress, and states should develop plans and provide funding to minimize the health impacts of climate change and do so in ways that address health equity.

Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  Twitter: @HealthyAmerica1