Over the past few years the rate of measles vaccine coverage among kindergarteners has dropped nationally from 95% to 92.7% in the latest school year. This decline started during the COVID pandemic but has persisted ever since. The exemption rate for kids increased this year from 3.0% to 3.3%.
But national numbers understate the problem. Only 11 states have measles vaccine rates above 95%, where we'd like them, while 15 are under 90%. Here's a list by state:
It doesn't matter that much if the national vaccine rate is 92.7%. It matters more if you live in a populous state like, say, Ohio, Georgia, or Florida that have vax rates around 88-89%. With numbers like those you're going to have outbreaks.
The national number is a good bellwether, but it's state efforts that get it up to where it should be. It's states we should all be focusing on, not the CDC.
Why go to the state level? Isn't really much more a local problem? metro areas / county groups?
state law mandates vaccinations for school-age kids. that's why state data matters.
Excellent point. But it doesn't help when HHS is led by an anti-vaxxer.
Pretty wild that WV has the highest vaccination rate. I would have expected the opposite. What's the story there?
Their last governor was Republican Jim Justice. During covid he was aggressively pro-vaccine and had a highly regarded program to reach all communities. He may sound like a good ol’ boy but he’s not insane as this hilarious video shows.
https://youtu.be/TMK7ocTk9I0?si=pFvoLBSdUvHQHw3z
Justice also participated in Biden’s Medicaid expansion. He has replaced Joe Manchin in the Senate so I’m curious to see how he responds to the House’s drastic cuts to Medicaid.
And Mississippi, too.
Looks like a good topic for a research project by one of the top university programs in Public Health. Find out why West Virginia and Mississippi rank so high, and whether it's transferrable to other states.
Greater reliance on government-provided public health, which encourages vaccination maybe
Mississippi has some of the strictest school vaccine rules in the country. Very few exceptions.
That’s the key. Differences among states are mostly about how easy or difficult it is to be excepted from vaccine mandates.
Which is determined by the wealth of religious groups, generally.
Poor doesn't mean wealthy religious groups to lobby for exemptions.
Not the whole story; fifteen states allow exemptions for personal or ‘philosophical’ reasons.
Yes, mandates work, and MS is the prime example. Also high rate of Medicaid in WVA, especially for kids, 45%, as Krugman was pointing out this am on his Substack, might play a role. OTOH that ID number: wow.
I doubt Justice will break ranks now that he’s a senator, it’s a totally different role. Governors are held to at least some extent to a level of responsibility to their citizens. GOP senators only feel responsibility to the GOP.
West Virginia is also one of the five states that allows only medical exemptions from vaccine mandates. No personal- or religious-belief exemptions. (The others are California, Connecticut, Maine and New York; four of these in the top five, all above 96%)
Mississippi is consistently ranked towards the bottom in pretty much all health care metrics, so I am skeptical of that number
Well, check out the comments on West Virginia, above. There may be some similar dynamic at work in Mississippi.
Yes, mandates work, and MS is the prime example. Also high rate of Medicaid in WVA, especially for kids, 45%, as Krugman was pointing out this am on his Substack, might play a role. OTOH that ID number: wow.
I doubt Justice will break ranks now that he’s a senator, it’s a totally different role. Governors are held to at least some extent to a level of responsibility to their citizens. GOP senators only feel responsibility to the GOP.
No, that high rate in MS is real, and it’s because of the strict mandate. I work in peds and had heard about this previously. I’d love to know how it got enacted. My understanding is the primary difference between states is whether they allow fuzzy “personal choice” type exemptions. The stricter states only allow documented medical reasons or some narrowly defined religious ones. The states with fuzzier allowed exemptions have lower rates because that allows for people avoiding vaccinations for all kinds of reasons. That’s my understanding anyway.
Mississippian here - we *used* to have a mandate, but in the wake of the covid vaccination fearmongering, we passed a "religious exemption" & we're falling in the rankings because of it. With the number of fanatics in this state, we'll be in the middle of the pack before long.
Up until recently, antivaxers were mostly far left liberal hippy types.
And MN (and Wi) are way at the bottom! I knew there was a big problem with "vaccine cause autism" among the Somali/East African immigration community but that can't be all it is. We are a very polarized state, just usually with enough to get a statewide Democratic majority (whereas Wisconsin is lately usually tilted to the other side). I think it is pretty easy to get a religious/whatever exemption for vaccines, back from when that seemed a reasonable question if conscience.
Minnesota allows exemption “based on their beliefs, from one or more immunization requirements, the parent or child may submit a statement to this effect, signed by the submitting person and notarized.” The Department of Health helpfully (?!) puts a link to a list of notaries on its webpage.
States with large Amish populations probably aren't going to enjoy super high vaccination rates
I was surprised to see MN, one of the top healthcare states in the country, rank so low. My first thought was the local Somali population. But they make up less than 2% of the population so it’s obviously more than that. I’ll blame all those out state (meaning not Twin Cities) residents who can be as red as any Republican state.
The story is that not everything is as simple red and blue 🙂
After a number of school-based pertussis outbreaks the Maine state legislature passed a law essentially eliminating religious or philosophical objections to vaccination mandates for school enrollment.
There was an immediate attempt to repeal the law via referendum (The "People's Veto").
The measure was defeated 65-35 or so. The law remains in force.
But the vote was in the first week of March 2020 -- and the state and the world shut down two weeks later.
Does that People's Veto pass today? Probably not. But now that it's a party-line issue and the state is basically split 50-50, it wouldn't lose by that kind of margin.
My grandfather lost his six youngest siblings in a diptheria epidemic in NYC in the late 1800s. After learning about that I stopped complaining about getting my DPT booster shots. That is another deadly, highly contagious disease that Trump and RFK Jr could bring back as part of making America great again.
This. My mother lost her best school age girlfriend to Diphtheria, and was terrified of it her whole life. The people it kills strangle from their swollen throat tissues closing their airway.
People who live in extremely low-population density areas maybe aren't as likely to have a measles outbreak as people who are in contact with many other people over the course of a day.
While the statewide data matters, I think it probably is not a good model for predicting where there will be outbreaks.
In Kevin's chart, for instance, Texas stacks up pretty well. But it has local areas that are vulnerable.
The current measles outbreak is in rural (low population density) Texas. So much for your theory.
No, the theory is correct. It all depends on the reinfection ratio, and lower population density will lead to a lower ratio. Unfortunately, measles has the highest inherent reinfection ratio of any disease that I'm aware of. COVID is around 2. Measles is 13. So even if the lower population density reduces that somewhat, it's still high enough to spread rapidly.
No, you misunderstand me. Perhaps I wasn't clear enough.
The people in West Texas are, by and large, Mennonites. They go to church with each other on a regular basis, and as a group have low vax rates. As I understand it, this is more of a habit-and-availability thing than an ideological thing, which matches with the (considerable) contact I have had with Mennonites.
My point is that statewide vax rates are not useless, but not that good at predicting outbreaks, since Texas as a whole has a high vax rate. So the case you point to supports my thesis.
After all, if you live by yourself in the forest, and never see another human being, you aren't going to get measles.
I was thinking about Idaho, and how that vax rate is truly bad, and why aren't they seeing outbreaks? Maybe the higher-density areas have higher vax rates?
Unfortunately, it’s likely just a matter of time. Measles was declared eliminated in the U.S. in 2000 — https://www.cdc.gov/measles/data-research/index.html — all first-cases since were contracted elsewhere. Sooner or later, some traveler will return with an active case, and if they happen to live in a low-vax-rate area, it will start an outbreak.
As I have a degree in microbiology, I know a little bit about viral epidemiology. You posted:
"People who live in extremely low-population density areas maybe aren't as likely to have a measles outbreak . . . "
While that's a reasonable hypothesis in principle, in the Texas case, the epidemic is in a low-population density area. The fact that the victims are primarily Mennonites doesn't change that. The fact that they have vaccine exemptions is more important than the population density of the area they live in. And yes, if you have people close to one another, whether it be in church, a restaurant, a movie theater or a bar, there is a higher probability of infection, but that's independent of the population density of the area in which these venues occur. So the current Texas outbreak obviously doesn't support your thesis as stated.
Hope that helps.
"maybe aren't as likely"
That means the odds are less, not that it can't happen or that other factors can't play a bigger role.
As I understand it, this is more of a habit-and-availability thing than an ideological thing, which matches with the (considerable) contact I have had with Mennonites.
I doubt that it's ideological, as the Mennonites I know (in low vax rate Minnesota) are militantly pro-vaccine.
That isn't how that works.
Rural or urban, you're still only likely to interact with the same number of people. Diseases rarely jump to strangers.
And its those close interactions that diseases jump between.
While the number of people one single person interacts with (interaction meaning more than just ordering food at a restaurant, or sitting next to someone at the bus or movie theater) can remain fairly constant regardless of population density, the higher the density, sooner rather than later one person will interact with someone infected, and then that newly infected person will pass it on to someone else within their own circle, and so on until it is considered an outbreak.
I disagree. People in rural areas are more likely to work in facilities with few employees as opposed to larger office buildings with many people. Rural towns have little or no mass transit, which is a great disease spreader. Restaurants have fewer patrons. Grocery stores are smaller with fewer customers. People in urban areas interact with far more people than those in urban areas.
The one caveat about interactions is that there is a time component to them when it comes to how high or low the risk of transmitting a disease like COVID, Flu, or Measels is. For example sitting for two hours next to someone at the movies is riskier than talking to a cashier or waiter for 5 minutes while ordering food. I think that Crissa was referring to the more prolonged type of interactions (house members, co workers, friends, etc.) in the comment.
I think you have to count more than just close, direct interactions. Indoor spaces are worse than outdoor spaces. If you're spending an hour in a grocery store, you're "interacting" with everyone who's been in the same store in the last hour or more, not just the cashier. Ditto for restaurants, office spaces, etc.
Busses, trains, taxis et al mean urban people in particular are likely to have plenty of contact with strangers. And disease doesn’t care whether the people you are in contact with are strangers. All it cares about is the duration and intensity of that contact.
Good point, especially re huge states like TX. However, the mandates are set at the state level.
Even in low population density areas, kids still go to school and adults still go to church. In both cases it means people gathering in dense crowds where a disease as infectious as measles spreads easily.
I wonder how long this stays up on an HHS website:
Measles eliminated? Thanks to vaccines? Oh, really. But ... uh oh, imported cases?
You already can tell who's going to get the blame for these outbreaks.
If you're a kid and get measles, you're going to get pretty sick. If you're adult, it may be ten times worse. Got it my 30s and it nearly did me in (a close call with encephalitis). Spent a week in the hospital, lost more than a month at work, and it took a long time to get back to normal.
Get your vaxxes, folks.
Measles infection can also cause prolonged immune suppression.
Related: Will people in the US be getting flu shots this fall? Don't count on it.
https://www.nbcnews.com/health/health-news/fda-cancels-meeting-select-flu-strains-seasons-shots-rcna193931
Brought to you by the Shit-for-Brains Administration. In the case of the HHS Secretary, it’s worm shit.
Already did our flu shots, pneumonia, Covid booster. Scheduled my MMR shot for next week. I almost died of measles on Maui - my public health and then Navy nurse mother used old school emergency techniques - iced me down like a fresh caught fish and created a turban of towels liberally packed with chipped ice. I was getting rapidly up to brain and heart damage levels.
And when the fever broke - I looked like a perfect dotted quilt.
As a Texas resident (yeehaw), I made sure to get an MMR booster recently, mostly because of the outbreak, but also because under RFKJR, who knows what might happen to vaccine availability going forward . . .
There's even a blood test to see if your measles inoculation worked!
Yes, that’s called a titer, and it’s available for lots of vaccinations, not just MMR. I got several when I was getting the Hep B series. Finally converted (ie developed immunity) on the last, 6th shot.
Be careful relying on a titer. Titers measure antibodies, but there's a lot more to immunity than antibodies. T-cells. B-cells. Antibody levels alone are a poor predictor of immune response.
Well yes and no about focusing state by state.
People do travel
Has the federal government ever had to intervene in a matter that might properly be understood as a "state problem" before?
It can be true that elections are best handled on a state level AND that the federal government has an important role to play in order to safeguard individual states from mishandling voting or deliberately suppressing voters' rights.
It can also be true that the CDC has an important role to play in facilitating and encouraging state vaccination programs.
Pretty sure that's perpendicular to what Kevin was talking about.
Remember from your ancient history books how the federal government intervened to allow certain states to permit black children to attend school? Education was considered one of those "state things" back then.
Measles was considered completely eradicated in 2000. It took the efforts of the federal government to do that because, left to their own devices, the states would not have accomplished this by themselves if it wasn't high on their priority list. Republicans just aren't big on "the common good", but the federal government is mandated to be.
I don't trust the Republican governors and legislatures to take up the slack. Democratic governors and legislatures may want to, but if the CDC has been hobbled in investigation, data gathering and information dissemination, and if the whole of HHS doesn't see fit to coordinate with states to stem these outbreaks, then how much can an individual state do on its own? I'm afraid we're going to find out.
I just hope that enough parents who don't want their children to possibly die from a preventable disease will raise a big stink. RFK Jr. needs to go. NOW.
I suspect tourism from blue states to red states is going to take a hit over the next few years. No way I’d visit FL or TX these days.
The role of the federal government was apparently limited to recommendations — https://www.cdc.gov/measles/about/history.html — along with those from physicians’ associations. In particular, an added recommendation for a second immunization was a significant factor. All 50 states and the District have mandated vaccination, but states vary in the non-medical exemptions they allow. I haven’t found a website (yet) that tracks the legal history of exemptions, so I’ll speculate that the high point for vaccination rate may be behind us, say, late 20th century, when anti-vax was a fringe thing. Thus, eradication by 2000, outbreaks now.
"I’ll speculate that the high point for vaccination rate may be behind us..."
For the time being, yes. But I predict that the pendulum will swing the other way when formerly eradicated diseases start spreading and people suffer the consequences. In the 1950's everyone knew someone who had been affected by polio. A President with polio was fresh in people's mind. Iron lungs. Kids on crutches. When the Salk vaccine first came out, the response wasn't, "Maybe I'll wait and see." It was, "How soon can I get my kids vaccinated?"
If you look at childhood vaccination rates, there's a marked difference by county in California, particularly wimpy in the far northern/western counties. And home schooling abounds, with a markedly lower rate among those school populations. And while it could be seen as a state problem, the people with the disease can certainly travel - kids on spring break or more likely summer vacation may create a spread to other states. Even though vaccination rates are high and herd immunity is effective in most situations, I could see some Texan family visiting Idaho and setting off another large cluster of cases.
This is how evolution gets stupid out of the gene pool.