This op-ed by Dr. Abdul El-Sayed appeared on the Detroit Free Press. Read more here.
Tammy Bowman died of measles at Detroit Children’s Hospital in Detroit in 1990. She was the most recent Michigander to die of the disease. Thirty-four years on, I worry she may not be the last.
Her story highlights just how insidious measles is — but also how preventable it can be. When Tammy was about to start school her parents realized her vaccination records had been lost in a basement flood. But, her sister told another news outlet in 2014, Tammy’s parents believed the children had been immunized, so they applied for a vaccine waiver. When a major measles outbreak hit her community, her parents tried to get her that vaccine, bringing her along with her older sister to a vaccine clinic intended for high school students. She was turned away because she was too young. She died of measles a short time later.
A vaccination delayed. Bureaucratic inflexibility. A deadly outbreak of a vicious disease. These conspired to kill Tammy Bowman. And I worry that in 2024, they could strike again.
Measles is making a comeback
The measles/mumps/rubella (MMR) vaccine has been available since 1971. It is one of the best-studied and safest vaccines available. But more parents are deciding not to get the MMR vaccine for their children. In part, that’s because the vaccine has been so successful — almost nobody knows anybody who’s had measles, tricking us into thinking that the disease is gone. Worse, our politicized climate of mis- and disinformation has scandalized vaccines our parents and their parents understood as simple common sense.
Measles is making a comeback now. In fact, it never really left. The single most contagious virus we know of, it has the ability to infect 9 out of every 10 unvaccinated people it encounters. Compare that to another virus we’ve all come to know well: If, at its peak, a case of COVID-19 infected an average of four susceptible people, measles will infect up to 18. So even a slight drop in vaccination rates offers measles the toehold it needs to start spreading.
In Europe, that same combination of generational amnesia about measles risk and post-pandemic mis- and disinformation has led to several major outbreaks. In all of 2022, there were less than 1,000 cases of measles across Europe. Just a year later in 2023, there were 42,000. Here in the U.S., there have been nearly 60 confirmed measles cases in just the first quarter of 2024 — that’s more than there were in all of 2023. Four of those cases have been in Michigan.
3 things Michigan can do to prevent measles outbreak
There will almost certainly be more. And to address it, Michigan needs to do three things now to address the factors that killed Tammy so many years ago.
All children 1 and older are eligible for MMR — and two doses are required for full protection, at age 12 to 15 months and 4 to 6 years. Anyone who is not up to date should get vaccinated as soon as possible.
But MMR uptake is lower than it has been in a decade. Simply put, too many parents are making misguided decisions about vaccines. That must change. My wife and I had our 1-year-old daughter vaccinated as soon as she could be. Our 6-year-old is fully vaccinated. So should all our kids be.
Part of the problem is that in Michigan, it’s far too easy to make a bad decision. Michigan is one of relatively few states that offers a “philosophical” exemption to sidestep getting a child vaccinated. In 2015 the state moved to require that parents electing vaccine exemptions sit down with a local public health professional to assure their understanding of the risks, but our state is still too permissive. Michigan suffered some of the highest rates of measles in America during the most recent outbreak in 2019, and exemption rates are ticking upwards again in the post-COVID mis- and disinformation era.
The risk parents who choose exemptions are taking increases with every new case. Worse still, they’re putting the rest of our kids in danger, too. After all, if an outbreak takes hold, the risk of measles infecting infants who are too young to be vaccinated — and at the highest risk for complications — increases, too. The State of Michigan needs to act quickly to protect us from that outcome by strengthening vaccine requirements.
The final point of action is funding. Most measles symptoms — including fevers, body aches, runny noses and sore throats — aren’t specific to the disease. So, most people don’t know they’re infected with measles until they get the tell-tale rash. Yet they’re infectious for up to four days before the rash sets in; they can spreading measles far and wide without even knowing it.
That makes measles contact investigations extremely time-consuming and resource-intensive. When we had our first case here in Wayne County, there were four possible public exposure events leading to over 140 possible contacts. And that’s just from one case. Imagine trying to trace a hundred cases at the same time.
Unfortunately, local health departments, our first line of defense, aren’t ready for this kind of volume. The challenge is equipping us before we need to be. Too often in public health, funding follows serious events — when we’ve already missed the crucial window to prevent them. That was the case during COVID. Let’s not make the same mistake with measles. The State of Michigan needs to establish an emergency fund for measles now to prepare local health departments for what we all worry is likely coming.
Before last month, Michigan hadn’t seen a measles case for five years. Then we saw four in three weeks. We’re almost certainly going to see more. But we don’t have to — if we do our parts, get ourselves and children vaccinated, and prepare to protect our communities if (and probably when) it hits us. Together, we can make sure that the tragedy of Tammy Bowman’s death from measles is, in fact, the last here in Michigan.
Abdul El-Sayed is the director & health officer at Wayne County Department of Health, Human and Veterans Services.