While studying medicine at the University of Medical Sciences in Holguín in the early 2000s, I never saw a case of measles. It was one of the diseases eliminated thanks to vaccination, which began in Cuba in the 1970s. In Caracas, Venezuela, during the years I was on an international mission, between 2006 and 2009, I observed a very different reality.
Measles prevention is simple and inexpensive. For decades, the world has had reliable vaccines that have helped save millions of lives. That is why it is difficult to understand that a country like the United States, with all the economic, scientific, and human resources to prevent an outbreak, is experiencing the worst in recent years.
A virulent disease
Measles is an extremely contagious viral disease. It is estimated that an infected person can transmit it to 9 out of 10 contacts.
Before the advent of vaccines in 1963, epidemics occurred every two or three years, causing approximately 2.6 million deaths. According to the WHO, 107,000 people died from measles in 2023, mostly unvaccinated children under 5 years of age living in Africa and Asia.
This figure represents one-eighth of the deaths at the beginning of the century. The joint efforts of countries, the WHO, and other organizations have saved 60 million lives between 2000 and today — in about 25 years.
Measles is transmitted through microdroplets floating in the air and, before spreading throughout the body, they affect the respiratory system, its gateway into the body.
The most significant symptoms are fever, malaise, runny nose, cough, and a fine rash, which initially affects the neck and face and then spreads to the rest of the body.
Most deaths occur as a result of complications, which include ear infections, pneumonia, and brain inflammation, a serious condition known as encephalitis. This disease predominantly affects people with vitamin A deficiency, immunosuppressed, and HIV/AIDS carriers.
There is no specific treatment for this virus. The best approach is prevention. It is estimated that measles vaccination costs less than $1 per child (the vaccine is usually administered during childhood).
According to a publication on the PAHO website, the first measles vaccination campaign in Cuba began in 1971, eight years after the vaccine was developed. Despite the efforts of health authorities, new outbreaks continued to be reported for 15 years, until a new strategy achieved 98% immunization.
According to the 2023 Health Statistics Yearbook, measles mortality rates in Cuba have remained at zero since 1980, and vaccination coverage consistently reaches 100% of the child population. Even during the pandemic, measles immunization was above 97%.
This contrasts with what has happened worldwide. According to the WHO document we referenced, the COVID-19 pandemic affected vaccination rates worldwide. In 2023, only 74% of children received the full vaccination scheme, while 83% received at least one dose, a figure lower than the 86% who received the first dose in 2019. Additionally, an estimated 20 million children were not vaccinated against the disease that year.
The outbreak
The United States is currently experiencing a major measles outbreak. According to a Los Ángeles Times report, more than 250 people have been infected from late January to March 12, primarily in the states of Texas and New Mexico.
So far, two deaths have been reported: an unvaccinated child in Texas with no known underlying health conditions, and an adult in New Mexico whose vaccination status is unknown.
The epicenter of the outbreak is in several counties in West Texas. According to a report from the local Department of Health and Human Services, 223 cases had been reported and 29 people had been hospitalized as of March 11. Gaines County, with 156 cases, is the hardest hit.
Of the total number of cases, 84 had not been vaccinated, and the vaccination status of 134 is unknown. The first cases were diagnosed in late January, and the outbreak has spread rapidly, totaling 25 cases last week.
Closely related to the above is the situation in New Mexico. In this state, according to a report from the local Department of Health, 33 cases have been reported: 32 in Lea County and one in Eddy County. In addition to the deceased, another case required hospitalization.
Additionally, cases unrelated to the outbreak have been reported in eleven other states: Alaska, California, Florida, Georgia, Kentucky, New Jersey, New York, Pennsylvania, Rhode Island, and Washington. U.S. health authorities expect the disease to continue to spread rapidly.
Measles and the anti-vax movement
The current measles outbreak in Texas is causing concern among experts. According to a CNN article, one in five unvaccinated people who contract the disease will require hospitalization, five in every 100 will develop pneumonia, and, worst of all, three in every 1,000 unvaccinated children will die, as has already been happening.
Among the causes of the current outbreak and others that have occurred recently in the United States is the decline in vaccination rates, combined with an increase in international travel. This makes it possible for unvaccinated people to leave the country to areas where the disease is common, become infected, and upon their return, transmit it in their country of origin.
Vaccination rates in the United States fell from 95.2% to 92.7%, which meant that more than 280,000 children stopped receiving the extremely effective vaccine, known in Cuba as PRS, which immunizes against mumps, rubella, and measles. One dose of this vaccine generates 93% immunity; with two doses, it would be above 97%.
Unfortunately, in recent years, vaccination rates in that country have fallen below the desired level, and an increasing number of parents are objecting to vaccinating their children for religious reasons, according to the same source.
According to a report by a Texas university newspaper, the number of unvaccinated children in the country has quadrupled since 2001. In Texas alone, the state hardest hit by the current outbreak, 60,000 children attend public schools without having been vaccinated, and more than 300,000 are homeschooled. Authorities have no vaccination information regarding the latter.
The Anti-Vax Movement (AVM) is so powerful in the United States, which we highlighted in a previous article, that even the Secretary of Health is a member.
According to an article in The Guardian, Robert F. Kennedy Jr., son of the former U.S. Attorney General, is a prominent figure in the AVM. Kennedy has been campaigning against these important health tools for years. One of his favorite targets has been the PRS vaccine, which he has accused of being responsible for cases of autism, according to the same source.
Precisely these positions led the entire Democratic Party to vote against his nomination in the Senate, and he was also opposed by the Republican majority leader in that chamber, Mitch McConnell, a polio survivor. Kennedy manages a $2 trillion budget and oversees agencies such as the FDA and the CDC, among others.
A crisis that could have been contained
The current measles outbreak in the United States is regrettable and difficult to explain. The cause must be sought in the strength of a movement that undermines citizens’ confidence in the wonderful health tool that vaccines are, and which, as absurd as it may seem, is spreading and gaining strength in this and other nations.
As for Cuba, preserving the National Immunization Program despite the crisis and expanding it with the help of international organizations, as will be the case with the human papillomavirus (HPV) vaccine, is crucial to maintaining public health.
No one should die from preventable diseases.
