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Massachusetts Medical Society's Physician Focus

March 2015

The Measles Outbreak
and The Value of Vaccines


  • While measles in the U.S. has been rare due to high levels of immunization, hundreds of thousands of children around the world die each year from the disease.

  • Public health officials frame the protection against infectious diseases with the concept of herd immunity - as more and more people are vaccinated, a barrier is built that prevents the spread of disease, even to those unvaccinated.

  • Most of the vaccine-preventable illnesses are those that cannot be treated and could lead to complications, further highlighting the importance of immunization.

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The U.S. declared measles eliminated from this country in 2000 because of an effective vaccine, high immunization rates, and a strong public health system. Yet over the last five years, more cases have been reported. The latest outbreak, which began at Disneyland, in December, has led to more than 150 cases in 17 states as of the end of February.

This latest outbreak, whose specific cause has yet to be identified but may likely be due to an unvaccinated traveler, has intensified because of the spread of misinformation about vaccines, the refusal of some parents to immunize their children, and, doctors suggest, a complacency developed over the years that has created a lack of understanding about their severity.

“We have over the last thirty to fifty years,” says Sean Palfrey, M.D., a pediatrician at Boston Medical Center, “kept so many of these vaccine-preventable diseases under control that people do not understand how serious they are. What people don’t realize is that around the world there are hundreds of thousands of children who die of measles each year. In this country, because we’re vaccinated well, that isn’t the case.”

George Abraham, M.D., an infectious disease specialist and Associate Chief of Medicine at Saint Vincent Hospital in Worcester, agrees. “This generation has not seen many of the illnesses, and because they have not seen them, they have not seen the gravity of them.”

Dr. Palfrey, also a Clinical Professor of Pediatrics and Public Health at Boston University School of Medicine and the founder and director of the Immunization Initiative of the Massachusetts Chapter of the American Academy of Pediatrics, and Dr. Abraham, also a Professor of Medicine at the University of Massachusetts Medical School and governor of the Massachusetts Chapter of the American College of Physicians, appear on the March episode of Physician Focus, joining host and primary care physician Bruce Karlin, M.D. to discuss the measles outbreak and the importance of immunization.

Physicians frame the protection against vaccine-preventable diseases within a concept called “herd immunity” – as more and more people are vaccinated, they collectively build a barrier that prevents the spread of the disease – even to those who may not be able to be vaccinated due to weakened immune systems or other medical issues.

Dr. Palfrey says that the eradication of smallpox, which for centuries claimed millions of lives, is a prime example of the power of creating herd immunity. “We’re trying to do that now with polio and measles, but as long as people push back at vaccination for one reason or another, we cannot eliminate those diseases from the world,” he says.

Both physicians agree that vaccines merit its place in the list of top ten greatest public health achievements in the 20th century. And they note that vaccine development is always a work in progress. Vaccines now exist for such conditions as pneumonia, shingles, and even some types of cancers, and current efforts are targeting diseases like Ebola and AIDS.

“Vaccines are life-saving,” says Dr. Abraham, “and definitely the most remarkable progress in medicine. It is a shame that people opt not to receive it as purely a matter of choice. People decline to receive it for personal reasons that science doesn’t support.”

Dr. Palfrey adds another critical aspect about vaccine-preventable diseases: “Most of the illnesses that we are preventing with the vaccines are illnesses we cannot treat. So we must prevent them.”

The risks of not getting vaccinated, they suggest, may be even greater than just getting the disease: the complications from a disease – getting pneumonia as a result of the flu, for example - can be dangerous and even deadly. And they remind patients of all ages that immunizations are as beneficial to adults as they are to children and adolescents.

For those patients hesitant or skeptical about vaccines, the physicians unequivocally vouch for their safety. “The risks of vaccines are unimaginably low,” says Dr. Palfrey. “They are studied in millions of patients before they are introduced and studied for decades thereafter. We know more about vaccines than we know about any other medication. Ever. Anywhere.”

Watch the above video for more information, including discussion about the differences between “live” vaccines and “killed” vaccines; how herd immunity is determined; how misinformation about medicines can spread quickly, especially in this age of social media; and how physicians may deal with patients who have questions or reservations about vaccines.

MMS/Richard Gulla

Centers for Disease Prevention and Control

Immunization Action Coalition

National Network for Immunization Information

Institute for Vaccine Safety

National Foundation for Infectious Diseases

CDC: Immunization Schedules

Massachusetts Adult Immunization Coalition

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"Measles" PSA

From left, Bruce Karlin, M.D., George Abraham, M.D., Sean Palfrey, M.D.
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