Debating Measles Vaccination in a World of Infectious Diseases

Merrill Singer

In the U.S, the Centers for Disease Control declared measles eliminated in 2000 because most Americans were vaccinated with the MMR (measles/mumps/rubella) vaccine. Since then, the illness has been so rare that doctors often were no longer trained to recognize the disease, even if a child presented with a rash and a fever. But measles never completely disappeared; sporadic outbreaks have continued since 2000. And now, since the election of Donald Trump, government support of national vaccination efforts is uncertain even as measles among the unvaccinated is spreading. At special risk are those who have grown fearful or distrustful of vaccines and their children, an attitude promoted by the new Secretary of Health and Human Services, Robert F. Kennedy, Jr. (RFK), the man Donald Trump said he would allow to “go wild” on public health issues during an election rally in New York City. Lost in all of this is the collective memory of living through the anguish and suffering of a measles epidemic.

While often a childhood disease, measles can strike at any age. The virus that causes measles is airborne and spreads easily when an infected person breathes, sneezes or coughs. For Melissa Thomas of the UK, her encounter with measles began in 2018 while she was watching a movie on TV with her boyfriend, Marty. She noticed an itchy rash on her neck. Then she began getting a dry cough. Marty googled “dry cough” and “rash” and measles came up. “You’ve got measles!” Marty joked. The couple laughed, sure it couldn’t be measles, which they thought was a childhood disease. The next day Melissa felt weirdly groggy with a sore throat and headache. She went to the National Health Service walk-in clinic and a nurse sent her home with a nasal spray. She recalls: “I was in tears—I knew something was really wrong.” By the next day, the rash appeared on her forehead and she had vomiting and diarrhea. She visited her general practitioner and asked if it could be measles as she had never been vaccinated. But she didn’t have the red pustules that are the classic sign of the disease. The GP said it was a viral infection at worst and sent her home with antibiotics. She vomited all night and the next day her condition deteriorated to the point of unconsciousness. Marty called an ambulance and Melissa was taken to the hospital, where doctors finally confirmed that she had measles. The rash covered her body. She looked as if she had third-degree burns. Her eyes were swollen shut, her hair was falling out, and pneumonia set in. Her family feared the worst. Fortunately, after spending 10 days in the hospital, four in intensive care, she began to recover.

The term measles is thought to have its etymological roots in the Middle Dutch word masel (pustule). The origin of the disease is believed to be zoonotic—that is, a disease originally spread from animals to humans—tracing back to rinderpest, a disease afflicting cattle, bison, and other hooved animals. But the exact origin of measles as a human disease remains uncertain. Researchers believe that a measles precursor sporadically circulated among humans as early as the 4th Century BC and slowly evolved as a distinct virus capable of infecting humans person-to-person. Muhammad ibn Zakariya al-Razi, a Persian physician, philosopher, and alchemist who lived during the Islamic Golden Age, published a volume called The Book of Smallpox and Measles sometime between 1100 and 1200 AD. Around this time, medieval European cities had grown big enough to sustain an epidemic. In 1757, Francis Home, a Scottish physician, demonstrated that an infectious agent found in the blood of patients caused measles. Ultimately, measles became an endemic disease globally. Among populations never previously exposed to measles, the disease is especially devastating. Measles has been responsible for an estimated 200 million deaths worldwide between 1855 and 2005.

One of the most unique, as well as most dangerous features of measles pathogenesis, is acute immunosuppression that can last from two weeks to two months This puts patients at high risk for opportunistic infections like influenza and bacterial pneumonia. The virus inhibits the immune system’s ability to recognize pathogens from previous exposures to other infectious diseases for as long as three years. When it enters the body, the measles virus fuses with the plasma membranes of host cells. In the respiratory tract it infects macrophages—specialized immune cells that engulf and destroy foreign substances like dust, bacteria, and viral particles. The measles virus hijacks macrophages and uses them to send viral copies to the closest lymph nodes. Immune components like T cells and B cells are destroyed, wiping out cell memory of past infections, a state known as immunological amnesia.

In the decade before 1963, when a measles vaccine first became available, nearly all children in the U.S. contracted measles by the time they were 15 years old. As a result, 3 to 4 million new people were infected annually, 400 to 500 died of the disease, an average of almost 50,000 were hospitalized, and about 1,000 developed encephalitis (swelling of the brain). By 1981, thanks to the MMR vaccine, the number of reported measles cases was 80% less than the previous year. An outbreak in 1989 among vaccinated children prompted calls for a booster vaccination containing a more effective attenuated version of the virus. Following the widespread implementation of this recommendation, reported measles cases continued to decline. And it was clear that the risk of serious complications from measles is far greater than the risk of a serious adverse reaction to the MMR vaccination.

In light of this dramatic success, scholars have described vaccination for measles and other diseases as one of the major achievements of public health in the 20th century. Then along came the modern anti-vax movement, echoing anti-vax organizing dating back to the 1800s. The anti-vaccination movement first arose in response to Edward Jenner's publication of an article by the Royal Society of London in 1796 describing his success preventing smallpox through inoculation with live infectious material from the scabs of people infected with cowpox. The process caused the patient to contract cowpox, a mild disease that conferred immunity to deadly smallpox. Jenner called the cowpox material “vaccine” (from the Latin for cow, vacca) and termed the process vaccination. His success led to the passage of a series of laws requiring childhood smallpox vaccination. Resistance to these laws began in 1853 with violent riots in several towns and the founding of the Anti-Vaccination League in London. Improvements in vaccine practice and popular acceptance of the state and federal roles in public health led to the collapse of the first wave of the anti-vax movement.

A leading figure of the modern or second wave movement is a British doctor, Andrew Wakefield, who argued for further investigation of a possible relationship between bowel disease, autism, and the standard vaccine for childhood diseases. Wakefield’s work, although published, was subsequently re-examined and he was dropped from the medical register by the General Medical Council of the UK for “serious professional misconduct,” including a conflict of interest. In January 2011, the British Medical Journal published a series of reports by the journalist Brian Deer that presented evidence that Wakefield committed scientific fraud by falsifying data. The reports also showed that Wakefield hoped to financially benefit from his anti-vax efforts. Yet despite the discrediting of Wakefield, RFK was attracted to Wakefield’s false assertions about adverse reactions to the MMR vaccine, assertions also heralded by the anti-vax movement.

RFK built his name as an environmental lawyer and activist, including battling industrial mercury poisoning. But, in recent years, he has focused a lot of attention on mercury in vaccines, especially use of the preservative thimerosal to protect vaccines from microbial growth. He has touted his concern on talk shows and in public hearings—consistently condemning thimerosal—even writing a book on the topic. In the book, Kennedy cherrypicked studies to support his argument that thimerosal in vaccines causes autism. However, he failed to differentiate between two different compounds that contain mercury: methylmercury and ethylmercury. The former (when found in food or in the built environment) stays in the body and causes neurological and other damage, including in utero. The latter, ethylmercury, is formed when the body breaks down and clears thimerosal from the body. The World Health Organization considers small doses of ethylmercury to be safe. Even so, to eliminate all doubt, thimerosal was completely removed from the vaccine schedule in 2002 and appears now only in some flu vaccines that are not permitted for children. Nonetheless, the rate of autism has continued to rise since 2002. A large body of peer-reviewed scientific studies conducted over 20+ years in both the U.S. and other countries, the kind of literature Kennedy brushes off or simply ignores, finds no link between vaccines and autism.

RFK’s anti-vax stance has proven to be lucrative. Government ethics forms that he signed as part of his HHS nomination show that he earned about $10 million over the past year from speaking fees, leading an anti-vaccine nonprofit, and legal fees he charged anti-vax groups. He also founded the Children’s Health Defense, an anti-vax nonprofit, served as the organization’s chairman, and was the organization’s chief litigation counsel from 2015 until 2023. Kennedy has likened childhood vaccines to the Holocaust and to pedophilia in the Catholic Church.

Kennedy has not slowed his anti-vax claims. As the BBC reports, although Kennedy on several occasions has denied that he is anti-vaccination, and even stated that he and his children are vaccinated, he continues to repeat widely debunked claims about vaccine harm. In the forward to The Measles Book, a Children’s Health Defense publication, he suggested that measles was not deadly and that outbreaks have been “fabricated.” On Fox News in 2023 he stated: “autism comes from vaccines.” He cited a paper, withdrawn from The Lancet, that had been written by the discredited Andrew Wakefield, to support his ongoing claim. According to Dr. David Elliman, a consultant in community child health at Great Ormond Street Hospital in London, and an active participant in vaccination efforts for decades at the national level, RFK has perpetuated myths around vaccination with “an utter disregard for the evidence.”

To earn the Congressional vote he needed to be appointed the lead health official in the U.S., Kennedy promised he would not change the nation’s current vaccination schedule. But when he spoke for the first time to thousands of U.S. Health and Human Services agency employees, he vowed to launch an investigation of the childhood vaccine schedule that prevents measles and other dangerous diseases. “Nothing is going to be off limits,” Kennedy emphasized. That nothing is off limits is an ominous statement; as a presidential candidate during the COVID era, Kennedy appeared at an anti-vax event in Georgia, where he made a macabre promise: “I’m gonna say to NIH scientists, ‘God bless you all, thank you for public service, we’re going to give infectious disease a break for about eight years.’” For anyone familiar with infectious disease, Kennedy’s comment sends shivers up your spine.

In a glimpse of what can happened among unvaccinated populations, in January 2025 a measles outbreak began in Texas. As reports in the media began to appear, Kennedy initially downplayed the outbreak, calling it “not unusual.” Within a few weeks, however, there were over two hundred cases, which definitely is not normal. Since then, according to the Texas Department of State Health Services, many cases have been identified in the South Plains and Panhandle and other areas of Texas. The children suffering from the virus had not been vaccinated because their parents distrusted the vaccine, or their vaccine status was unknown. One school-aged child, age six, who was not vaccinated died in Lubbock after contracting the measles virus (the first measles death in the U.S. in ten years). The Loop school district, one of the local public school districts in Gaines County TX, has seen especially low vaccination rates. The district only had 143 students in 2023-24 but had the highest vaccine exemption rate in Texas with almost half of Loop school district students unvaccinated. These conditions are ripe for a highly contagious disease like measles. Soon thereafter an unvaccinated adult in Lea County, New Mexico, just across the state line from the West Texas region, also died. Multiple other states also have reported measles cases.

As the real-life consequences of vaccine resistance became clear, Kennedy did an about face. On March 2, he described the benefits of the childhood MMR vaccine for measles, mumps, and rubella. In an op-ed for the Fox-News website, he described the MMR vaccine as crucial to avoiding potentially deadly diseases. He added, “I have directed the Centers for Disease Control and Prevention (CDC) and the Administration for Strategic Preparedness and Response (ASPR) to work closely with the Texas health authorities to provide comprehensive support. HHS’ efforts include offering technical assistance, laboratory support, vaccines, and therapeutic medications as needed.”

Not surprisingly, MAGA influencers, always happy to find a new target for their vitriol, did not respond well to RFK’s op-ed. They quickly took to their social media platforms to condemn him in unambiguous terms, even comparing RFK to one of their nemeses, Dr. Anthony Fauci. If criticism of Kennedy from the right catches on, it will likely lead him to waffle on his Fox op-ed message, creating additional confusion and risk.

Kennedy sought to assuage anti-vaxxers by promoting their favored measles treatment, regular doses of Vitamin A. In explaining how the federal government is helping contain the current measles outbreak, Kennedy stated during a Fox News interview, “We’re delivering vitamin A” and “cod liver oil, which has high concentrations of vitamin A.” The World Health Organization has supported the use of Vitamin A to help treat measles in low-income countries where malnutrition-related immune deficiency is a factor. In the U.S., however, most people have adequate levels of the vitamin and do not need supplemental doses. Vitamin A is fat-soluble, meaning it accumulates in the body rather than exiting during urination. Consequently, the more vitamin A you ingest, the more it accumulates in organs like the liver. Too much of the vitamin is toxic. Kennedy, in short, has tried to address the measles crises by talking out of both sides of his mouth and endangering children even further.

Adding to the damage he is doing to science and public health, under Kennedy’s direction the NIH abruptly terminated at least 33 research grants for projects studying vaccine hesitancy or evaluating strategies designed to encourage vaccine uptake. An additional nine grants may be modified or lose partial funding. In line with Kennedy’s quashing of research, the NIH has requested lists from its institutes of projects that involve messenger RNA (mRNA) vaccines, which some anti-vaxxers believe, without credible evidence, are not safe because they could modify human DNA.

Kennedy’s handling of the measles crisis is not occurring in a vacuum. The Trump administration is aggressively gutting the public health and medical research infrastructure on which the U.S. has relied to identify and respond to outbreaks of deadly pathogens. Beginning with the U.S. withdrawal from the World Health Organization to the gagging of the CDC, the disruption of USAID’s Ebola containment, the roadblocks placed on PEPFAR’s vital AIDS work, and the denial of climate change, the Trump administration has unleashed a major threat to health around the globe and at home. As Craig Spencer argued in The Atlantic, “The diseases are coming,” and with each day that goes by Trump’s policies and actions speed their arrival.

Counterfactual efforts to politicize public health often end in disaster. Perhaps this time disaster can be averted by not “going wild” with U.S. public health. One does not have to trust Big Pharma, we know it always puts profit above people. But we also know, often from direct experience, this does not mean its products don’t work. Caution, rigorous government-funded independent research, and an informed public are antidotes both to blind trust and mistrust of vaccines.

For Further Reading

CDC 2025. Expanding Measles Outbreak in the United States and Guidance for the Upcoming Travel Season. https://www.cdc.gov/han/2025/han00522.html

McNeill, William 2010. Plagues and People. Random House.

Piot, Peter 2012. No Time to Lose: A Life Pursuit of Deadly Viruses. W.W. Norton & Company.

Rosenbluth, Teddy 2025. Kennedy Links Measles Outbreak to Poor Diet and Health, Citing Fringe Theories. The New York Times. March 10. https://www.nytimes.com/2025/03/10/health/measles-texas-kennedy-fox.html

Senthilingam, Meera 2020.Outbreaks and Epidemics: Battling infection from measles to coronavirus. Icon Books.

Singer, Merrill 2014. The Anthropology of Infectious Disease. Left Coast Press.

Merrill Singer, who specializes in the critical anthropology of health, is an emeritus professor in the Department of Anthropology at the University of Connecticut. He is the author or editor of over 35 books and 225 peer reviewed articles.