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Academy of Pediatrics says he believes the anti-vaccine tide has slowed. “Fortunately, there is no push for expanding exemptions,” he says. “People have realized that we cannot continue with this trend, and there is increased interest in protecting us from disease. It is a slow process and a lot of damage has already been done.”

      Outlook

      Reducing Vaccine Avoidance

      If declining vaccination rates continue to result in an uptick in the number of measles cases, the disease may no longer be considered eliminated in the United States.

      The American Medical Association, the American Pediatric Association and the American College of Physicians support eliminating all religious and philosophical vaccine exemptions for the MMR as the first step to get measles under control.

      Governors have declared states of emergency where outbreaks have occurred in Brooklyn and Rockland County, N.Y., as well as in Washington state. “There has been a 99 percent increase in vaccinations in various areas of Williamsburg, Brooklyn, compared to the same time last year,” says Fauci.

      In addition, new cases appear to be declining, with 54 in June and July of 2019 compared to 177 in April and 166 in March of the same year, according to Fauci. And infectious disease experts say taking an anti-vaccine stance has become increasingly unpopular this year as the nation has grappled with the measles outbreak.

      But health experts worry that unless vaccine avoidance rates are reduced, even worse things are on the horizon.

      “Measles is the most contagious of all the vaccine-preventable diseases, so this is the canary in the coal mine,” says Blumberg, at UC Davis Children’s Hospital. “If we can’t get our hands on this, we will see outbreaks of rubella or mumps or meningitis. We may even see the return of something like diphtheria,” which was eradicated in the 1920s.

      Notes

      1. Julia Belluz, “New York’s Orthodox Jewish community is battling measles outbreaks. Vaccine deniers are to blame,” Vox, April 10, 2019, https://tinyurl.com/y8znlarg.

      2. Kirk Johnson, “ ‘A Match Into a Can of Gasoline’ ”: Measles Outbreak Now an Emergency in Washington State,” The New York Times, Feb. 6, 2019, https://tinyurl.com/y7trcubd; “Measles 2019: Measles in Washington State,” Washington State Department of Health, undated, https://tinyurl.com/y438vmo9.

      3. “What are the immunization rates for children in Clark County?” Clark County Washington Public Health, Dec. 31, 2018, https://tinyurl.com/y3dwrwgu; Asia Fields and Paige Cornwell, “Trips to Sea-Tac Airport may link cases in new measles outbreak in Seattle area; Issaquah, Bothell schools affected,” The Seattle Times, May 16, 2019, https://tinyurl.com/yxo9lmwp.

      4. Peter M. Strebel and Walter A. Orenstein, “Measles,” The New England Journal of Medicine, July 25, 2019, https://tinyurl.com/y6dc4lbm.

      5. YL Ge et al., “Measles outbreak in pediatric hematology and oncology patients in Shanghai, 2015,” Chinese Medical Journal (English), 2017, https://tinyurl.com/y3762tax.

      6. “Measles Cases and Outbreaks,” U.S. Centers for Disease Control and Prevention, Sept. 9, 2019, https://tinyurl.com/y39perlm.

      7. Ibid.; “Mayor de Blasio, Health Officials Declare End of Measles Outbreak in New York City,” press release, City of New York, Sept. 3, 2019, https://tinyurl.com/yxj8fgml.

      8. “New measles surveillance data for 2019,” World Health Organization, Aug. 15, 2019, https://tinyurl.com/y4w42atw.

      9. Morgan Krakow, “A flight attendant who contracted measles has died amid a global rise in outbreaks,” The Washington Post, Aug. 13, 2019, https://tinyurl.com/y33fdeub; “El Al flight attendant dies 4 months after contracting measles on a plane from NY,” The Times of Israel, Aug. 13, 2019, https://tinyurl.com/yy4yr72f.

      10. “Vaxxed: From Cover-Up to Catastrophe,” IMDB.com, 2016, https://tinyurl.com/y5r4kf9l.

      11. Rep. Adam Schiff, letter, March 1, 2019, https://tinyurl.com/y636vrnp; Hilary Brueck, “Amazon just took down a controversial documentary that links vaccines to autism,” Business Insider, March 4, 2019, https://tinyurl.com/y6jc7uhu.

      12. “Ten Threats to Global Health in 2019,” World Health Organization, accessed Sept. 6, 2019, https://tinyurl.com/y66mn4sx.

      13. Barbara Loe Fisher, “Freedom to Dissent and the New Black List in America,” National Vaccine Information Center, July 1, 2019, https://tinyurl.com/yxor2g9b.

      14. “Data and Statistics,” Health Resources & Services Administration, updated Aug. 1, 2019, https://tinyurl.com/y5l4mktx.

      15. Jennifer Reich, “What’s wrong with these anti-vaxxers? They’re just like the rest of us,” The Conversation, May 22, 2019, https://tinyurl.com/y4mdagw4.

      16. Karin Roberts, “When it comes to vaccines, celebrities often call the shots,” NBC News, Oct. 28, 2018, https://tinyurl.com/y43u8smq.

      17. Donald Trump, Twitter post, March 28, 2014, https://tinyurl.com/pzyue8h.

      18. Sheila Kaplan and Dylan Scott, “Vaccine critic Robert F. Kennedy Jr. says he will chair Trump’s vaccine safety panel,” Stat, Jan. 10, 2017, https://tinyurl.com/jtyj2rm.

      19. Dartunorro Clark, “Trump on measles vaccine: ‘They have to get the shot,’ ” NBC News, April 26, 2019, https://tinyurl.com/y4enwgow.

      20. John Aloysius Cogan, Jr., “Vaccinations will take a hit if Trump administration topples the Affordable Care Act,” Stat, May 22, 2019, https://tinyurl.com/y5ym8kr6.

      21. Lecia Bushak, “A Brief History Of Vaccines: From Medieval Chinese ‘Variolation’ To Modern Vaccination,” Medical Daily, March 21, 2016, https://tinyurl.com/y4265l4f.

      22. “Immunizations Policy Issues Overview,” National Conference of State Legislatures, May 22, 2019, https://tinyurl.com/zuyztg5; and Aleksandra Sandstrom, “Amid measles outbreak, New York closes religious exemption for vaccinations—but most states retain it,” Pew Research Center, June 28, 2019, https://tinyurl.com/yy38r8wa.

      23. “Data and Statistics,” op. cit.

      24. Alexandra Minna Stern and Howard Markel, “The History Of Vaccines And Immunization: Familiar Patterns, New Challenges,” Health Affairs, May/June 2005, https://tinyurl.com/y6lgzgzq.

      25. Laura Eggertson, “Lancet retracts 12-year-old article linking autism to MMR vaccines,” Canadian Medical Association Journal, March 9, 2010, https://tinyurl.com/z6q85j5; Alice Park, “Doctor behind vaccine-autism link loses license,” Time, May 24, 2010, https://tinyurl.com/pb6pdgq.

      26. Ashley Welch, “GOP debate fact check: Claims about vaccines and autism,” CBS News, Sept. 17, 2015, https://tinyurl.com/y52ecxj5.

      27. “Immunizations Policy Issues Overview,” op. cit.

      28. “Inslee declares local public health emergency after identifying outbreak of measles,” news release, Washington Governor Jay Inslee, Jan. 25, 2019, https://tinyurl.com/y6oconjd; “MMR Vaccine Exemption Law Change 2019,” Washington State Department of Health, undated, https://tinyurl.com/y3nlyve8.

      29. “Senate ends non-medical exemption for vaccines amidst historic measles outbreak,” news release, New York State Senator Brad Hoylman, June 13, 2019, https://tinyurl.com/yytgbvv2.

      30. David Siders, Alexei Koseff and Jeremy B. White, “Jerry Brown signs California vaccine bill,” The Sacramento Bee, July 1, 2015, https://tinyurl.com/y4ygf45c.

      31. “Dr. Richard Pan Introduces SB 276 to Combat Fake Medical Exemptions that Put Children and Communities at Risk,” news release, Dr. Richard Pan, California State Senator, March 26, 2019, https://tinyurl.com/yysfce8b.

      32.

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