How Should Local Health Officers Respond to Measles Outbreaks?

From 2000 to 2024, there were just over 4,400 cases of measles in the U.S. Since last year, there have been more than 6,300. It’s possible the 2026 total alone will exceed the 2020-2024 number.

This year there

new measles outbreaks (defined by the Centers for Disease Control and Prevention as three or more related cases) in communities around the country. Case numbers have reached the hundreds in Texas, Wisconsin, Utah and South Carolina.

Lagging vaccination rates are driving the spiking case numbers. The largest outbreak is in Pennsylvania and the biggest concentration of cases is in Amish and Mennonite communities in Lancaster County, where vaccination rates are low. But measles has been seen in

, and more than

of those who contracted measles in the state were unvaccinated.

Ironically, the efficacy of measles vaccination has fueled complacency. It has emerged

that many among the Amish misunderstood how bad the disease could be because they’d never seen a case of it.

Secretary of Health and Human Services Robert F. Kennedy Jr. has

years of claims that vaccines cause autism, but continues to say they haven’t been tested enough. In an

on “gold standard” vaccine recommendations for children, President Donald Trump says it’s the policy of his administration to support “maximal parental choice over childhood vaccines.” COVID-19 vaccinations may have

3 million deaths and 18 million hospitalizations, but lingering controversies around their implementation

vaccine hesitancy.

Local health departments, generally more trusted than federal agencies, are best positioned to turn things around, says Jessica Malaty Rivera, executive director of the

. An infectious disease epidemiologist by training, Rivera has focused on science communications for more than two decades. 

“The work of science is not finished until the public understands it,” she likes to say. Fortune named her among the world’s “50 greatest leaders” in 2021 for her COVID-19 data communication. At Infodemiology, she’s working with health organizations and local health officials to monitor communication about measles to learn what can move public health communications beyond a “Whac-a-Mole” game of debunking misinformation.

In a conversation with Governing, she offers insight into the factors complicating communication about measles and the role that storytelling and anecdotes play in paving the way for acceptance of data.

The interview has been edited for length and clarity.

Are there any consistent factors at play in the states with the worst measles outbreaks?

One of the most clear indicators is that kindergarten vaccination rates are declining. Our herd immunity threshold is an incredibly fragile threshold. It has to be 95 percent or higher for outbreaks to not happen.

It's not hyperbolic to say that measles is the most contagious infectious disease that we know of; one person can infect up to 18. But there's also a bizarre trend in the information space. People are downplaying the disease, saying “it's just a rash, it's just a childhood illness, it’s no big deal. We all had it when we were younger.”

That combination of ambivalence toward the disease and a lack of urgency for vaccination is how we're in the situation that we're in right now.

Are there similar policies in states with the worst outbreaks, such as rules about vaccination and school attendance?

The thing that is challenging about being in public health is that because of our constitution, public health has always been a state issue [the 10th Amendment grants powers not specifically assigned to the federal government to states]. When we experienced the pandemic, we experienced 50 epidemics because each state was experiencing it differently from the other states.

One of the things in Trump’s executive order on vaccination schedules that was most problematic to folks like myself is the intention to be punitive towards states that make vaccination exemptions more challenging. They want to allow individuals to have much more freedom to opt into personal or religious exemptions for vaccination, and that's exactly how we have seen outbreaks happen in the past.

What worries you about this?

What they are trying to allow is that a person could opt in or opt out of a school-based vaccination requirement for enrollment. The general consensus has been that the vaccine schedule previously endorsed by the American Academy of Pediatrics and Centers for Disease Control would be what is required to enroll in public and private daycare through elementary school.

I've heard of schools saying they're going to make everything optional because they don't want to tell parents how to raise their kids. That is not at all what a vaccine schedule is doing. It's not telling anybody how to raise their kids; it's telling them how to prevent their kids from having preventable disease, disability and death.

In a world where everybody's talking about biohacking and longevity, most of us in public health are screaming with nobody listening, saying public health is the original longevity science. Our whole job in public health is to help people live longer, happier, healthier lives and the two greatest things that have contributed to expanding or prolonging human life expectancy are vaccines and clean water.

What kinds of communication and communication strategies can increase vaccination rates?

It’s not one-size-fits-all. There's not a perfect formula for a type of storytelling that works; it has to be very diverse. It has to be very culturally competent. It has to be agile and mindful of the audience which you are addressing.

There’s a phrase, “the plural of anecdote is not data,” but anecdote is one of the most compelling things in how humans make decisions and have opinions. A lot of people shy away from storytelling because they just want to spout out facts. Those two things don't have to be separate from each other. Storytelling at first to connect on a human level and infuse empathy, which is often missing in science communication, is critical. Then you can justify those anecdotes with the stats.

I sit on the board of Vaccinate Your Family. They have a

on their website. I

myself about when my son was hospitalized with RSV in 2019, and how much that experience of watching my child needing oxygen to be OK informed my very low risk tolerance for COVID-19. It also radicalized me in evangelizing for Beyfortus [an injectable drug containing antibodies that give babies immunity against severe RSV infections, approved in 2023]. It wasn’t available to me in 2019, and I want people to be aware that this [severe illness] doesn’t need to happen.

What else can local public health departments do to get this outbreak under control?

It’s not just better communication. It's prioritizing communication. Let's zoom back to

[the federal initiative to accelerate the development of a COVID-19 vaccine]. We spent billions of dollars to create incredible life-saving interventions for vaccines. We spent nothing on a communications plan to help them penetrate communities.

(Jessica Rivera)

You need a science communication team of people who are specifically trained in science communication, and that's what departments of health need to prioritize. It’s not the lack of resources like vaccines; it’s the lack of budget to prioritize those types of job descriptions and hires. There’s a very famous quote from Walt Orenstein [former director of the United States' National Immunization Program] that I live by: Vaccines don't save lives, vaccinations do. The difference between a vaccine and a vaccination is a trusted message from a trusted messenger. Otherwise, vaccines are going to be sitting cold in the fridge.

The work of science is not finished until the public understands it. I have shared the statistic that prior to the MMR vaccine [approved

as a single injection to prevent measles, mumps and rubella], 500 kids in the United States used to die every single year from measles. People would be in my DMs, in my inbox, saying that’s not that many kids.

I have to bang my head against the wall and say that if it was one kid it would be too many, because it’s 100 percent preventable. When one person tells their story of losing their one kid, it’s more powerful than hearing a statistic. Unfortunately, people have become number blind.

How can state health officials support local offices?

Based on years of data, trust is always highest at the most local level. I hope that states feel more emboldened to lead locally. Leveraging community leaders, community health workers and other trusted messengers in the population can be really powerful. This could mean partnerships with local religious leaders, community organizers — or barber shops and hairdressers — so that people are having conversations before business hours, after business hours, in between business hours, and doing it in collaboration with the department of health.

How could federal health officials help?

I would really like for this administration to stop politicizing public health. It’s making a mockery of decades of long-standing research, of career scientists who have dedicated their whole lives to answering questions that they're saying nobody's asked. We are in a dangerous situation where we're kind of relitigating facts.

I want us to get back to evidence-based guidelines instead of political guidelines.

Small, incremental change is a core principle in public health. One person changing their mind can mean a whole family changing their mind, and that whole family changing their mind can mean a whole community changing their mind.