Paul Offit, MD, on Measles in the Magic Kingdom and the Anti-Vaccine Movement

February 02, 2015

Measles are the newest attraction at Disneyland this season, and unfortunately the only thing magical about them is how quickly they’ve begun to spread throughout California and neighboring states. Although measles were eliminated in the U.S. by 2000, the misinformation of the anti-vaccine movement has caused a return of a full-fledged outbreak.

Here to discuss the severity of the problem is Paul Offit. He is a Professor in the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children Hospital of Philadelphia. Offit is the author of the book Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine, for which he won the Committee for Skeptical Inquiry’s 2013 Balles Prize in Critical Thinking.

This is point of inquiry for Monday, February 2nd, 2015. 

Hello and welcome to Point of Inquiry. A production of the Center for Inquiry. I’m your host, Lindsay Beyerstein. And my guest today is Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital in Philadelphia and the chief of the Division of Infectious Diseases. He’s also the author of several books, including Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine. 

He’s here to talk about the measles outbreak at Disneyland. About 50 people caught measles at the park in December. Most of them unvaccinated. The outbreak has since spread from southern California to neighboring states. Disneyland is a nostalgic trip, but you don’t expect to come down with the diseases of Walt Disney’s era. Paul, welcome to the program. 

Thank you. So what did epidemiologists first become aware that the happiest place on earth had become this swamp of contagion? 

Well, you know, there were there were those few initial infections cases that spread out very quickly because measles is a highly contagious disease. I mean, person was nine cases then it was 20 cases. 

Now it’s it’s upwards in the high 70 number of cases, then 10, because it’s Disneyland and people travel to and from Disneyland. There are now cases that have gone on in other states, Texas, among others. 

So it’s a bad scenario. In many ways. It’s a perfect storm. 

Why did this happen? 

Well, because people chose not to vaccinate their children in Southern California. That is a phenomenon. It was actually predicted. Interestingly, a few weeks before the outbreak occurred by an article that appeared in all places in The Hollywood Reporter by Gary Bauer. He is good investigative reporter who went around to a variety of elementary schools in wealthy suburban areas like Santa Monica, Beverly Hills, Marina del Rey, and found that the immunization rates in elementary schools was woeful and as low as 50 60 percent of kids. So it’s a bedrock for a very contagious disease. And that’s what happened. 

I think what’s interesting about this outbreak is I think it’s been a tipping point. I have never seen, frankly, so much media coverage for an event as the Disney outbreak. Last year, we had an outbreak of over 300 cases, an Amish community in Ohio, and that didn’t get near the coverage. This is gone. And so the question is why? I think it’s because it’s Disney. Yeah. They’ve now asked people to me all their workers have to be vaccinated. They’ve asked people. California State Health Department has said don’t come to Disneyland if you’re not vaccinated. You know, I think people it’s sort of like biblical. 

You know, you have this fantasy, this eat somehow been soiled by, you know, this awful virus. 

Let’s talk a bit about the biology of measles. How can it kill you? People think of it as being this kind of childhood disease, but the rash. But how does it go from that to people ending up dead? 

Right. I think people think of it in some ways in the same manner. They think of chicken pox. But it’s not chicken pox. I mean, you’re you’re five times more likely to die at meal of the chicken pox or five times more likely to be hospitalized from measles and chickenpox before there was a measles vaccine. Every year there’d be 48000 hospitalizations and about 500 deaths in this country from measles. If you’re old enough and I’m old enough of you, you’ve got measles. But, you know, I survived. Which is why we’re able to talk to me on the phone. Those who didn’t survive weren’t available for an interview. It’s so it starts as a congestion, cough, runny nose, conjunctivitis or bloodshot eyes, a rash that starts at the hairline and then works its way down on the face, the trunk, the arms and legs. It’s an intensely uncomfortable illness. When I’m asked to come down and look in the emergency department to see whether or not someone with a fever and rash has measles, I can tell within a few seconds whether they have measles because they’re miserable, much more miserable, that that’s something other than what actually causes that characteristic rash. Well, so the virus reproduces itself in skin cells as well as cells that line the mucous membranes, the inside of the mouth that produces the so-called KOPLIK spots. That’s just where the virus tends to replicate well. 

So it breaks down the blood vessels when it replicates or breaks down the skin cells when it replicates. 

You know, how is the measles vaccine work? 

The vaccine is made by taking the natural strain of measles virus, weakening it so that instead of reproducing itself thousands of times of the body, it’s just be produced. So probably 10 or 20 times in the body induces an immune response without causing disease and thereby immune response. What I mean is antibodies that are directed against surface protein of the virus so that when you confront the virus, for example, in Disney, you have antibodies in your circulation that doesn’t allow the virus to enter the circulation or whether that means the circulation is very quickly neutralized by those antibodies. 

And how effective is the vaccine? 

This remarkably effective. I mean, you know, we went from three to four million cases before 1963, which is when the first vaccine was introduced to 27000 cases by 1980. What happened was there was an outbreak between 80, 90, 91, mostly because children weren’t getting their first dose. And we had like 55000 hospitalizations, about 166 deaths during that three year period. So that’s where the second dose recommendation came from. We went from probably ninety two to ninety four percent effective after the first dose to ninety nine percent effective with that boost those. 

What’s the difference between people who are vaccinated and the vaccine takes in works for them versus that tiny percentage of people whom the vaccine doesn’t work. What’s going on with them? 

Well we’re an outbreak population. So, you know, we all have different so-called HLA backgrounds, lymphocyte or leukocyte antigen background. So we’re we’re different biologically. We respond differently to our environment. And so there is a very, very small percentage of people that just aren’t able to recognize those proteins, those measles proteins, as foreign and appropriately respond to them. 

And when people don’t respond, it means that they don’t raise the antibodies that would protect them from the virus. 

That’s right. They don’t respond. They will make an antibody response. 

Is it true that even if you happen to be one of those people, you’re still better off being vaccinated? 

Well, if you’re a person who doesn’t respond, it doesn’t matter what have gotten vaccinated. But you’re certainly you dramatically decrease your instances like that or getting infected. If you vaccinate yourself, I mean, that’s clear, you know, when you look at these outbreaks. Measles is very highly select for the unvaccinated person. 

I read in Wired, I know if this is true, maybe this is misinformation. But they said that sometimes people have a response that’s not good enough to prevent them from being infected at all. But they can still have enough of a response that they have a less severe case of measles. Is that true? 

I think what you’re thinking of is during measles outbreak, sometimes you will find people who don’t have any antibodies in their circulation or they do have is they have memory B and T cells, memory immune cells, so that those memory cells can be activated, differentiated enough time to still protect you against disease. I mean, sometimes people aren’t completely protected against reinfection or even mild disease associate infection, but they’re still protected against moderate to severe disease. 

If you aren’t vaccinated, you think you might have been exposed to measles? Can you help yourself by rushing out to get vaccinated after the fact? 

Yes, you can’t. I mean, measles is a fairly long incubation period disease. So if you can get immunized, certainly within a couple days of exposure, you can decrease your risk of getting disease. 

Let’s talk about herd immunity. What is it? And what kind of vaccination rates do we need to sustain to keep herd immunity strong for measles? 

Right. So herd immunity just means enough people are vaccinated in the population so that the virus of the bacteria has a lot of trouble spreading from one person to the next because so many people are vaccinated in terms of the level of herd immunity that it’s necessary depends on the nature of the contagiousness, the virus or bacteria you’re trying to prevent for these highly contagious viruses like measles, mumps or chicken pox. You really need to have between 92 and 94 percent of the population immunized. And in order to prevent that spread for disease, they’re less contagious. You don’t need as high a percentage. But what happens is when herd immunity starts to fade, you see exactly what you’re seeing now, which is the most contagious diseases come back first. Measles, mumps, whooping cough. It’s just what you would expect. 

And who are the people that really need herd immunity? People who can’t be vaccinated for measles. Who are they? 

That’s exactly right. I mean, we have about, whatever, 310 million people or so in the United States, but about 500000 can’t be vaccinated because they’re getting chemotherapy for their cancers, because they’re getting immune suppressive therapy for their chronic diseases, like little life diseases or in some cases just because they’re too young. I’m using going to vaccinate all children over your age. 

So people who don’t vaccinate are putting babies and cancer patients at risk of getting measles. 

That’s right. And then interestingly, there’s a father now and in California, I think, who is getting lawyers involved because he has a child with leukemia. He wants his child to go to a an elementary school where, you know, we’re immunization rates are high so that his child will be protected should a virus or bacteria enter that that classroom. I’m curious how it plays out. I mean, you could argue he could actually bring a lawsuit with the American disabilities that that his child is disabled because of leukemia and that the school then needs to set up for his son to make sure that he is in the safest position possible, which would mean other children would need to be vaccinated. 

That is a really interesting question about what constitutes a reasonable accommodation for someone’s disability, whether it extends to having other people be vaccinated because of somebody with an immunosuppression issue. 

It’s an interesting I mean, if the lawsuit were to be successful, that would be very interesting and would change the conversation, I think, in this country about how we choose to treat our neighbors. 

Do you think that parents who don’t vaccinate their children should be open to civil lawsuits from, say, cancer patients or the parents of infants who get whatever disease that they fail to vaccinate their child for? 

Yes, I do, because I think it should not be considered to be your inalienable right to catch and transmit a potentially fatal infection. We went well. I know how appalled everybody was when the man who had extremely drug resistant tuberculosis got on a plane and was coughing. I mean, that story was carried for weeks. We were appalled by the fact that he would be that selfish, that he would spew out these bacteria, which we knew to be very highly resistant to antibiotics or the Ebola people, the people who had been exposed to Ebola, who took flights that people were furious about. 

Right. Interestingly, that’s far less contagious than measles. You know, measles is extraordinarily contained. Ebola. Remember the guy who died of Ebola in Texas? His wife never got sick. That would not be true with measles. It’s interesting, though, for the fear that was generated for Ebola. They think that one person died of Ebola. That it’s that. Well, why which I think is true is that you’re actually at greater risk of being married to Kim Carr Dashner than you are back from Ebola. But I really do think the fear created by that means that probably more people would be willing to get an Ebola vaccine than an HPV vaccine, a human papillomavirus vaccine, which can prevent upwards of 25000 cases of cancer at 4000 deaths a year in the United States. That’s very real. But it’s funny how how we aren’t very good at judging risk. 

If you were to put a number on it, say, measles versus Ebola, what would the relative contagiousness be bullied? 

Frankly, you’re not contagious early on. And all this is really not till your later an illness when you’re have vomiting and diarrhea. And people handle that. The Rs zero so-called meaning the infectivity rate for something like a bull is very small butcheries left two, which is to say that if you have Ebola and you get on an airplane and no one else has been infected with the. Oh, which was true, actually, a couple of those cases. What percentage? What number of people with you? In fact, I’m sure it’s less true for Beatles. It’s 16, 18. 

Is it? The measles virus can just not even form droplets, hang in the air for hours and continue to infect people after the patient has left? 

Yes, usually about for about two hours. I mean, that’s probably the best example. This was wasn’t an epidemiological survey that was there or outbreak. It was investigated by the CDC that was reported in doing the Journal of Medicine the number of years ago. Was it? It occurred in Indiana in 2005. So a girl from from a church group goes to Romania unvaccinated. She does an orphanage. She visits a hospital, she catches measles and then gets back on a plane and comes back to a church picnic. So there’s 500 people on the picnic. She’s there for only two hours of the 465 people in the picking through either being naturally infected or vaccinated with measles, three got sick. So that’s less than one percent of the remaining 35 people who were at the picnic, 31 who meaning who had never been national infected or immunize with measles. Thirty one to thirty five. That’s it. That’s a 90 percent infection rate. Which tells you you didn’t have to have direct contact with her. All you had to do was inhabit her airspace within two hours of her being there. 

What is it about the virus that makes it so contagious? Is it because of its size or its weight? How does it spread so efficiently? 

It’s spread by small droplets. So when you release very tiny droplets from your mouth, when you talk or sneeze or cough and the small droplets tend to hang in the air, it’s actually much more contagious smallpox. 

I mean, this is the same, you know, when you go outside, it’s called those are the droplets that you’re seeing when they condense. Right. 

So it’s very tiny. I mean, you actually don’t see them. I mean, they hang in the air sort of like a ghost, smallpox. On the other hand, it spread only by large droplets. So you really need to be within five feet of somebody who’s talking to you. And, you know, it doesn’t hanging there quickly drops to the ground. So it’s not nearly as contagious. 

Speaking of international travel, I’ve read that we think that of the measles that’s showing up in Southern California originated in the Philippines. What’s going on in the Philippines that’s making measles a big issue over there? 

Yeah. So people aren’t vaccinated to the degree they should be. So I think last year there were offers of 30000 cases of measles in the Philippines and 40 deaths. You’re right. That was a major source. And, you know, it’s not I mean, we basically eliminated measles in the United States in 2000, but measles would still come into the country. I mean, people like people in the Philippines, for example, wherever we come into the country with measles, they just wouldn’t spread it because enough of the population had been vaccinated so that the virus could possibly spread, which changed now is enough. The population is unvaccinated so it can spread. And now you’re seeing these outbreaks and this is, frankly, a direct consequence of the entire vaccine movement. We’ve induced fear in our population. It’s caused them to make bad decisions, which are putting them and their children at risk. 

Is the low vaccination rate in the Philippines a consequence of the anti vaccination movement or some other factor like poverty, resulting in people having low vaccination rates there? 

I think more the latter that, you know, it’s just a matter of access. And the countries will to really trying to vaccinate its population. 

It’s kind of interesting here. It seems like there’s the inverse socioeconomic relationship where it’s the most privileged people who are shunning vaccination. 

Ironic, isn’t it? I would say it’s is if you look at who chooses not to get vaccines. That’s exactly right. Tends to be Caucasian, upper middle class, upper class, very big college educated, off to graduate school educated people that are professionals or at least have jobs, which they exercise some level of control who believe they can Google the word vaccine just as much as anybody who’s giving them advice. 

What do you think that ideology, people with these really great educations seem really smart in other ways. Why do you think that there’s such fertile ground for these crazy ideas? 

I think they don’t fear the disease. I think it’s that simple. I think, you know, in the Southern California, living this wealthy, upper middle class, upper class environment, you to your fear, you’re eating well, you’re exercising. You don’t see this disease. And so you think that, you know, this is not going to happen to me until it happens to you. And that’s the way it always works with these issues. 

And we haven’t had as much measles per year as we do today since 1977. What was going on in 1977 that made measles such a big problem? And is there anything that we can learn from that? 

Well, I don’t even think we have to go back that far. I mean, I lived through the measles epidemic in Philadelphia in 1991. I mean, in a three month period between January and March, we had 1440 cases, the nine deaths in our city. I mean, that people were in a panic. 

I mean, we were you know, we got money from the state to try and help us have clinics stay open over the weekends. We were vaccinated thousands and thousands of children down to six months of age. There were schools that were canceling trips to our city because they were afraid of getting measles. This city was in a panic and it’s actually centered on two fundamentalist churches that chose not to vaccinate their children or frankly, even give them medical care. And it was a nightmare. 

That was a pretty fringe thing in those days. Right. There wasn’t the same kind of mass political power behind the anti-tax movement. This was just two churches. 

Right. The choice not to get the vaccine. And that situation was a quote unquote, religious choice, although I would argue that putting your child in. Harm’s way is a distinctly unreligious act. I think religion teaches us anything, it’s to care about our children. 

I know a lot of people put their children at risk for religion. It seems like it’s perfectly compatible with a lot of religious beliefs. I mean, they’re people who recruit their children to be suicide bombers. 

I don’t know why. I mean, it’s you know, if you look, for example, the followers of Christ Church in Idaho and at least to some extent Oregon or Christian Science, often these things are done in the name of Jesus. I don’t get that view on that religious person. But if one reads the New Testament, you can’t help but be impressed by the figure described as Jesus right of me. Verily, I fancy you what you do want to. One of the least of my brethren, you do it to me, you know, soft suffer. You can put down all the if only entranceway of every children’s hospital in the world. I mean, this was a man who stood up for children at a time when infanticide was common with abandonment was common. Child abuse was a crying voice of the Roman Empire. I mean, you can argue independent whether you believe in God. Jesus was the son of God, the way Jesus is described in the New Testament. He is a breakthrough character in terms of his defense of children. So I don’t I don’t get it. 

He also it was pro healing and he never said, know you shouldn’t have any healing except for me. He never said, you know, you have to fire all the doctors and only get healed by me. 

That’s right. When you’re sick, go to a doctor. That’s three of the four gospels that made it into the New Testament. That’s what he says. I don’t. I just don’t get it. I think what it bothers me is that when we had that outbreak in Philadelphia, I would have been nice to somebody who represented the church to stand up and say, this isn’t us. This is a distinctly unchristian thing to do would have helped. But I think our respect for religion is great to a point that this is that point. 

Do you think there was an op ed in USA Today recently that was arguing that parents who refused to vaccinate for mandatory vaccines should be jailed? Do you think that that is acceptable or necessary? 

No, I think that goes too far. I think. I think, though, I do think we should. Obviously, we have three ways that you can choose not to get a vaccine in this country. One is a medical exemption. I think that’s fine. I think this so-called personal belief exemption is not set. School vaccines aren’t a belief system. They’re an evidence based system. There’s abundant evidence to show they are with their claim to be. Again, I think a religious exemption is also nonsensical because it’s an unreligious act. So don’t give it the legal protections of religion. I mean, the notion that you’re allowing people to put children at risk in the name of religion is, I think, adverse to all, frankly, religions. So I just wish we’d be more honest about this. I mean, people don’t choose not to get vaccinations that scare the disease and they have false concerns about what vaccines can do. That’s what this is all about. 

So don’t make it so easy for them to exempt themselves because they know these this group that you’ve identified is the vaccine, hesitant parents. And you’ve said that they have a big role to play in improving public health outcomes for vaccination. Who are they? And what can we do to get them onside? 

I think that’s most people. I mean, we talk about the entire vaccine movement, but I think it would be true if the vaccine movement, they’re the professionals. I mean, Warbelow Fisher at National Vaccine Information Center. J.B. Hanley, a generation rescue or people like Jenny McCarthy, I think represented that it’s of their there of conspiracy theorists. They believe there’s a conspiracy between or among the federal government and the pharmaceutical industry and doctors to sort of push product. I mean, you’re not going to convince them. But I think that’s not most people. Most people are there just any high vaccine sentiment? You know, they don’t see diseases are not scare the red scary stuff on the Internet. Not sure what they should do. I think those people are, for the most part, invincible. 

I just think we have to be far more compelling in the way we try to convince people more friendly towards, say, polio vaccinations because they know that polio means paralysis. I get the sense that people are less likely to want to refuse that than a measles vaccine or a diptheria vaccine or some pertussis that they don’t even know what the disease really is. 

It’s interesting, isn’t it? I mean, you know, people are hesitant to get an HPV vaccine, human papillomavirus vaccine to prevent the cause of twenty five thousand cases with cancer, 4000 this year. And yet they’re happy to get a pill polio vaccine. We haven’t had a case of polio since 1979. So you’re right. I think we are a very not very good at judging risk. 

What do you think we need to do in terms of health communications? Do we need ads during the Super Bowl showing what kids dying of measles look like? 

That would be nice. No, I think maybe should have Minnie Mouse and Mickey Mouse get out there, except their you know, their passives are spotted. Maybe that would help. No, I think we just did. Where the rubber meets the road is where, you know, doctors and nurses give vaccines. And I think, you know, when somebody says they don’t want to get one. I think we just have to be far more passionate about how dangerous that choice is. You know, let me love your child. Don’t ask me a practice. Substandard care. It’s a progressively more dangerous world out there. Let’s not put your child at unnecessary risk. 

Do you feel like putting more vaccines in the hands of paraprofessionals might be a way to increase vaccination rates? Like in New York? They changed the rules. You can get a flu shot at the pharmacy. And I got my flu shot a lot faster. I was going to get it anyway, but I got it the first day they had it because the pharmacy across the street with had it. And I thought this was just a really great thing. Do you think that more vaccines could be given out that way? 

I mean, I think that pharmacies are now starting to give more. I actually I get my vaccines at the pharmacy, at the Rite Aid pharmacy near where I live. So, yeah, I think it makes it a lot easier to get doctor’s. It’s suspense to get a doctor’s appointments on. Times, depending what insurance covers. I think the pharmacies are a great way to get vaccines. I think it has helped. Yes. 

Let’s talk a bit about the flu vaccine this year. What happened with it? 

Yeah. You know, I would say we’re generally pretty good at figuring out what strains are about to circulate. And we do that usually a few months before we make the vaccine. We predicted based on with circulating in South America, because usually that’s what comes up here. And that was what was circulating. The problem is, is that one of the strains of the H3 and to strain mutated enough away from what the vaccine strain was so that protective efficacy this year was, Wolf. I mean, it was a 23 percent range, which is terrible. Well, I don’t remember you’re like this, actually. I mean, since I started to follow this flu last 20 years, this is the worst year we’ve had for protective efficacy in my memory. 

How do you calculate protective efficacy? 

So you look at people, do they got the vaccine, those that didn’t. And then you look at the infection rate and those that got the vaccine that those that didn’t. And then you can figure out what the efficacy was. So if 25 percent of people in the non vaccinated group got sick and then only two percent got sick, that’s protected up to 90 percent. 

Are you seeing the effects of that in the emergency room now where people were vaccinated coming in? 

So the actually, my daughter was once my daughter got vaccinated and I think she got the flu when we were away the last few days. Yeah. So it even happens to us vaccine types. 

Have they sort of analyzed that and seen anything that they can learn from the low protective efficacy or the unexpected mutation that they could use to make the vaccine better in future years? 

It’s you know, you’re making it on the fly every year. You make a new flu vaccine every year. That’s hard. And you’re trying to make a prediction about a virus that mutates enough from one year to the next or the demonization or natural infection the previous year doesn’t protect. Usually, the circulating strain circulating in South America are a great predictor, and they have been this year while making the vaccine that that strain starts to mutate and it’s too late. 

So it’s just like essentially going to a casino. I mean, you can calculate the odds and, you know, it in general works, but there can just be a random fluctuation that nobody can predict. 

That’s true. That’s what happens. 

How would you say are the biggest players in the anti vaccine movement now if you’re sort of looking at the people who are responsible for the sad state of vaccine, public opinion? 

Well, I think it the national vaccine information that I mean, they were born in the early 1980s. At the time, they were called dissatisfied parents together or DP t they were concerned that the wholesale pertussis vaccine, which was used then pertussis being whooping cough, caused permanent brain damage, which was absolutely not true, was shown in many studies not to be true. But so it’s been more than 30 years. And that kind of launched the notion that vaccines may be doing more harm than good. It’s interesting if you look at the measles outbreak in Southern California, none of those people were over 20. I think those are the first generation of children born of that sort of anti vaccine sentiment in early 1980s. 

And these groups. Would you say that they’re losing ground now, that finally the inner sanctum of Disneyland has been has been breached? 

Yeah, I definitely think that the actually movement is losing ground. I mean, if you look at the end, I think the media’s got far more about covering this story. If you look at the way it was covered fifteen years ago, there was always this sort of false mantra balance, which is, you know, tell two sides of a story when only one side is supported by the science. So, you know, the CDC rep said to the CDC official said this, but, you know, this doctor said this with his parents said this. That’s not true anymore. I mean, I think the media is much more responsible about this, either because younger journalists are being trained in perspective and not false balance or because the outbreaks are so egregious that you can’t help but see that the choice not to get a vaccine was a bad one. 

And. Andrew Wakefield is kind of a great granddaddy of measles vaccine skepticism. What’s he doing now? Where is he? 

I’m sorry. Oh, Andrew Wakefield. 

Oh, the two in terms of the great flowthrough vaccine fears these based in Texas. I mean, he’s created something called the Autism Media Channel, which just puts out, you know, bad information about vaccines. That’s what they do. He’s still in the scaring people about vaccines business. 

He’s not a doctor anymore, though. Right. Or at least he’s not licensed to practice medicine. 

No, no. He’s always Spreckels medicine, United States or anyone. 

That’s reassuring. So what’s going on public health wise in terms of the effort to contain measles now in California and the neighboring states where the outbreak seems to be mushrooming? 

Yes. Would you do as you fly? If you identify a case, then you have to identify everyone with whom that case came in contact and then you have to quarantine those people, as well as the primary case for 21 days, which is the longest incubation period would be incubation period, time from being time from exposure to time from disease expression. And that’s how you try and contain an epidemic. You can also people who are exposed immediately. You can give them things like immune saw Robyn, which contains measles antibodies that at least will pass will be protected for a period of time. And I think to the credit of the California Health Department, they’ve done a great job, as well as other local health departments that quarantining people and limiting this outbreak. 

When people are quarantined, do they live at home or do they have to go to some kind of facility so they use their quarantine in their home? What do they do if homeless people are exposed or people that don’t have somewhere to go? 

That’s a good question. I don’t know. I don’t know. And I’m not sure what’s with the. That presumably they would have to. The state would have. The city would have to provide a place where that person could live so that they are coming into contact with those that would have to. 

Are there any estimates yet about how much this whole outbreak is going to cost in terms of dealing with it? 

Usually it’ll cost hundreds of thousands of dollars and it’ll it’ll be paid for by public health departments where, you know, obviously they could use the money to do other things. 

Now, the state of California could certainly have used that money in its public health budget to save all kinds of other lives. Terrible waste. 

How long do they think it’s going to take to get this outbreak under control? 

Don’t know. I mean, it’s you know, you now you’re looking at secondary and tertiary cases. I think it’ll probably take take months before it clearly has died down. If it does. 

And of course, it could just happen again anywhere. Right. I mean, this is this is a constant threat with any plane that comes in from the Philippines or somewhere else where this disease is endemic. We’re constantly at risk. 

And that’s always been true. The difference now is that, you know, we’re we’re spreading virus from one American child to the next. That’s new. I mean, the outbreak we had in the United States this year, 640 cases plus that was the biggest outbreak we’ve had in 20 years. I think we’re just finally learning this lesson. I do think this is a tipping point. 

We’ll say if you’re a parent and you’re concerned about vaccination levels at your kid’s school. What can you do to change that, to help protect people? 

I think that you can at a PTA meeting, you know, say, look, I think, you know, we should all care about each other. We are all responsible for each other. I mean it when a Jehovah’s Witness, for example, chooses not to get a blood transfusion, when they have a white threatening with blood, they made a decision for themselves and their cells only they can’t make that decision for the child. But you can make that decision for yourself. I mean, fine, that’s fine. It doesn’t affect anybody else. Well, you choose not to get the vaccine. That’s a different story. Now you’re saying it’s my right to spread a potentially fatal infection. And that’s not to say you’re right. So I think people do have to care. I don’t know. I’d like to think I’m naive about these things. I like to think that one could appeal to the better angels of our nature and get us to realize that we’re all in this together. But sometimes it’s hard. 

Can you get somebody if you were to call, say, your local health department? Could you get someone from the Department of Health to come in and talk to your PTA meeting? 

Sure. I think it’s possible. 

So anything else you think people should be doing right now to raise awareness about vaccines or don’t, you know, try and ameliorate the situation? 

Dangerous. I mean, you know, I think there’s no venue too small for people to go out and try and educate about vaccines and the important to vaccine preventable diseases and their potential burden. But my daughter was little. I spoke to her. You know, eighth grade class people can write op ed pieces and get their voice heard. That may make a difference. I’ve been on a couple of national public radio shows and the callers are generally angry. They’re angry that people are making decisions for their children. So I think that’s different. It used to basically scared to be on these shows, but these days the callers are much, much more supportive. 

Well, let’s hope we really reach that critical tipping point that you’re talking about. Thank you so much for coming on the show. Thank you. My pleasure. 

Lindsay Beyerstein

Lindsay Beyerstein

Lindsay Beyerstein is an award-winning investigative journalist and In These Times staff writer who writes the blog Duly Noted. Her stories have appeared in Newsweek, Salon, Slate, The NationMs. Magazine, and other publications. Her photographs have been published in the Wall Street Journal and the New York Times’ City Room. She also blogs at The Hillman Blog (, a publication of the Sidney Hillman Foundation, a non-profit that honors journalism in the public interest.