The ongoing measles outbreak in west Texas and a neighboring county in New Mexico has grown to more than 200 cases, concentrated in unvaccinated children. Twenty-three people have required hospitalization, and, tragically, a previously healthy, unvaccinated 6-year-old has died of the disease. An adult with measles in neighboring Lea County, New Mexico, has also died.
Measles is the most contagious disease known, spreading through unvaccinated populations with unmatched efficiency. It is also eminently vaccine-preventable. The live-attenuated measles vaccine was developed in the late 1950s — catalyzed by the technological breakthroughs that enabled polio vaccine development — and licensed in 1963. More than 60 years later, and a quarter-century after measles was declared eliminated from the United States, we find ourselves fighting the same viral foe and hoping to avoid losing more children to a preventable disease.
Put mildly, this situation is frustrating for pediatricians. Summer Davies, a pediatric hospitalist who cared for the child who died, was quoted in the Washington Post, “it is really heartbreaking when it’s something you know you could have prevented or that is preventable and ended in something like this.”
I felt those words in my bones. Childhood deaths are wrenching, but there is something especially awful about the ones that might have been prevented.
During a large outbreak in New York City in 2018-2019, I helped care for many children with measles, some of whom required care in a pediatric intensive care unit. We were fortunate that no children died during that outbreak, but the hospitalizations were frightening for parents and physicians alike. There are common themes between the NYC outbreak and what we see in West Texas today: measles spread beginning in a cloistered religious community with significant distrust in public health and medicine, high rates of vaccine hesitancy in the affected communities, and prevalent misinformation about vaccine side effects and the supposed superiority of nutritional supplements for prevention or treatment of measles. In both settings, public health efforts focused — very reasonably — on encouraging families with unvaccinated children to accept the measles-mumps-rubella vaccine, the most effective way to protect those kids and to stop the outbreak. As any pediatrician knows, those kinds of discussions with vaccine-hesitant parents can be lengthy, tense, and not always fruitful.
I am a hospital-based consultant, seeing patients in a wholly different environment from the outpatient pediatric offices where vaccine discussions usually occur. When I spoke to parents whose children were hospitalized due to measles during the NYC outbreak, I learned quickly that these were a different kind of vaccine conversation — one that required a specific, mindful approach. How do you bring up the topic that a child’s illness might have been prevented, especially when that child is still in the hospital? When I wrote about these conversations later, I reflected on my efforts to broach the subject of the family’s decisions about vaccines carefully, with empathy, but clearly.
As RFK Jr. delivers his message on measles, public health experts hear a familiar tune
Carefully, because it is easy for this kind of conversation to veer out of control, with parents feeling defensive, angry, or guilty. I’ve been accused of blaming parents for their child’s illness and of focusing on the past instead of the problem at hand. Neither of these accusations is true. The main goal remains caring for the child who is ill. Bringing up the vaccine decision isn’t meant to be ghoulish or cruel; it’s an opening to a larger conversation about how the family got to this point, and how they might approach similar decisions in the future. I do my best to lead with curiosity, asking the parents to take me through what they have heard about measles or vaccines in the past.
With empathy, because these parents are in a position no one wants to inhabit. Having a hospitalized child is terrifying, and the feelings of guilt and loss of control can be overwhelming. None of us is at our best or most rational when our child is in danger. Vaccine-hesitant parents love and want to protect their children, like all parents do. That is often the precise impulse that led them to decide not to vaccinate in the first place, prompted or encouraged by misinformation. I ask if they would be willing to share some of what they heard that led them to the decision to refuse the MMR vaccine for their child.
Clearly, because this conversation has the potential to change how the parents view what happened to their child, their past decisions, and whether they might vaccinate their children in the future. It can help shape the story that they tell their friends and family when they return home. There is a world of difference between “She got the measles and ended up fine” and “She got the measles and ended up in the hospital. We were scared, and it could have turned out much worse. We wish that we had chosen to vaccinate.” A moment of connection — pediatricians and parents want exactly the same thing, for a child to grow up safe, happy, and healthy. I talk about the many illnesses that we can’t prevent and the handful of things that we can. We focus on the future, not the past.
Efforts to counter vaccine hesitancy tend to focus on conversations with parents of well kids. This makes good sense, as vaccinating the general population is key to preventing and controlling outbreaks like the one in West Texas. What I learned talking to families of children with measles is that these other discussions — the ones with the parents of hospitalized children — are also important. They help families process what has happened, think about what comes next, and compose the story that they will bring back to their communities, perhaps as messengers far more effective than those from the outside.
Adam Ratner, M.D., M.P.H., is a pediatric infectious diseases physician in New York City and the author of “Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health.”
