J aneth Ibarra didn’t know what to do. She was a first-time mom at 22 years old, and now the Phoenix resident was responsible for protecting two twin boys from the harms of the world. New parents drink from a firehose of child-rearing sugges- tions — mommy blogs and car seat reviews, feeding tutorials and daycare ratings — but after her boys were born last year, Ibarra was especially tortured about one big decision. Whether to vaccinate her babies. The world is awash in vaccine misinfor- mation, and it’s no wonder if new parents like Ibarra have a hard time discerning which way is up. The anti-vax trend started in 1998, when The Lancet published a widely debunked study linking childhood vaccines to autism — the publication retracted it, though anti-vax proponents often fail to mention that — and went into overdrive during the COVID-19 pandemic. Once consigned to the fringes of society, the anti-vax movement is now depress- ingly mainstream. Robert F. Kennedy Jr., perhaps the single biggest purveyor of vaccine misinformation on the planet, runs the Department of Health and Human Services. Under his leadership, the depart- ment has axed crucial funding that helps state and local governments promote vaccine awareness and respond to outbreaks of disease. At the same time, the country is suffering through its biggest measles outbreak in decades. The super-contagious disease — once considered eradicated by, you guessed it, vaccines — has popped up in 29 states as of May 2. At least 935 measles cases have been reported nation- ally since January. The disease, which is especially deadly to young children, has already killed three people, including two young children. They were the first measles deaths in the U.S. since 2015. So far, Arizona has been spared a measles case. But Arizona’s vaccination rate is low. When it comes to measles, a vaccination rate of 95% is considered enough to ensure herd immunity, giving the disease nowhere to spread. But in Arizona, only 89.3% of kindergartners have received both doses of the vaccine against measles, mumps and rubella. In some communities, the rate is far lower. It’s in the middle of a cyclone of conflicting information — Are vaccines life-savers? Mortal threats? — that Ibarra found herself in her pediatrician’s office. She had begun to “reconsider some vaccines,” she said, and needed help plot- ting a course through the fog. Pediatricians are veterans of these talks. Ibarra says hers patiently told her “the facts of things” and promised to “inform me of the correct things instead of what I see on the internet.” Ibarra decided to vaccinate her kids. Though her 10-month-old boys are too young for the first dose of the MMR vaccine — the first dose comes at one year, the second at four — she’ll get them vaxxed against measles when the time comes. “Vaccines are important,” Ibarra said. “They are very important to me, especially for my kids to have.” Until then, though, her children are vulnerable. One of the fictions of the “vaccines are a personal choice” move- ment is that when it comes to diseases like measles, they’re really not. Measles kills the youngest among us, and those very same young cannot be fully immunized until they’re on the cusp of grade school. When a community has herd immunity and measles cannot spread, those children face little danger. When a community dips below that — as Arizona has — measles can attack the kids of even the most pro-vax parents. For the next two months, until her kids can receive the first dose of the MMR vaccine, Ibarra will be on guard. Though Arizona hasn’t had a case yet, measles is surely coming. State and county public health departments have been bracing for it, but they have a hand tied behind their backs. In Gaines County, Texas — where the outbreak began, leading to at least 390 cases in the county — the MMR vaccine rate is 82%. In some corners of Arizona, the vaccine rate is lower. And RFK Jr.’s department just slashed funds for vaccine campaigns and epidemic preparedness. An outbreak “will happen,” said Dr. Clarisa Smith, a pediatrician in Yavapai County. “I think that’s inevitable.” Is Arizona ready? A POWDER KEG Long before it was controversial, the MMR vaccine was tantamount to a miracle. Until it was developed in the late 1960s, measles outbreaks were a fact of life in the United States. Measles is one of the most contagious diseases on earth. One person infected with COVID-19 can spread it to roughly three susceptible people. Someone with measles can infect up to 10, a differ- ence with geometric consequences for the potential spread. For some, the disease is mild — a rash, a fever, a cough and a runny nose. But according to the Centers for Disease Control and Prevention, 20% of unvaccinated people end up in the hospital. Many of those will get pneu- monia, and some will die. A serious measles case is a grim thing to see. If a child contracts measles — espe- cially an unvaccinated child — they are increasingly susceptible to life-threatening complications. Kids who start with a nasty rash and cough can quickly find them- selves gasping for air and being hooked up to a ventilator. Skin becomes pale. Due to a lack of oxygen, lips and fingertips turn blueish-gray. Some children will recover, but others won’t. Instead, their parents will sit beside their hospital beds, holding their child’s small hand as they slip in and out of consciousness. Maybe that beloved son or daughter will stay awake long enough to hear a last goodbye. In the end, the child’s muscles give in. Their chest falls. It does not rise again. In 1962, before the measles vaccine was licensed, there were 500,000 measles cases in the United States. Roughly 400-500 people died each year, about 1,000 suffered brain swelling and 48,000 required hospi- talization. In 1990, when a second measles vaccine dose was recommended, there were fewer than 100,000 cases a year in the country. By 2000, the disease was consid- ered eliminated. But who doesn’t love a comeback story? This millennium, measles cases have become more common. There were 667 cases in 2014 and 1,274 cases in 2019. This year, the country is on pace for roughly 2,800 cases, which would be the most since 1992. For generations of kids, measles presented no threat. Now it’s on the hunt again. The biggest reason for that is madden- ingly simple. More and more parents decided not to give their kids the shots that confer 97% protection against one of the most contagious diseases in the world. Arizona is among the laggards. Bracing for Impact A measles outbreak in Arizona is inevitable. Are we ready? BY MORGAN FISCHER Health and Human Services Secretary Robert F. Kennedy Jr., who visited the Arizona Capitol last month, is arguably the single biggest spreader of vaccine misinformation on the planet. (Morgan Fischer) >> p 12
