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Measles was least expected in the United States. The disease is generally concentrated in poor countries, low resource settings and areas of war and conflict. The measles vaccine is considered to be the best preventive measure with the vast majority of vaccinated children never having the disease even with a single dose of vaccination. Since the advent of measles vaccine in 1960s, the number of measles cases in the United States has been reduced by more than 95 percent. Rightfully so, vaccination is considered one of the greatest American public health achievements in the 21st century with millions of disease cases being prevented each year. Worldwide, since 2000, measles vaccine has saved more than 20 million lives.

So, what has happened? Did we become a war zone? Do we have low resources? We ran short of vaccines? Or there is a sudden genetic change in the American population that makes us vulnerable to measles like infections? Unfortunately, none of these can serve as an explanation; we were not facing a crisis, but we invited one or to say the least we are risking a public health calamity. A dangerous, but preventable cocktail of medical misinformation, conspiracy theories, fake news, political dialogue, anti-vaccination movements, religious and personal beliefs are responsible for this global wave of many infectious and vaccine preventable diseases that have surged worldwide, with United States being an unlikely victim. Given this dangerous cocktail and its rapid spread via social and mass media, it is not surprising that the World Health Organization lists vaccine hesitancy as one of the top ten global health threats in 2019. Measles cases are expected to rise and continue to spread across the world, and the single major reason is gap in vaccine coverage as per the WHO.

In the United States, parents have to take major responsibility for spread of and lack of prevention of measles as they are the major stakeholders and decision makers. In addition, parents are propagating or believing in the dangerous cocktail mentioned above. To make the situation worse, parents are using exemptions to not get children vaccinated. While all American states have laws on student vaccination, the majority of the states also allow exemptions based on personal belief, religious values or medical grounds.  Unscrupulous physicians are also adding fuel to the fire by helping exemptions. This is despite the fact that powerful and responsible professional organizations such as the American Medical Association have always supported limited exemptions and strongly opposed immunization opt outs. 

We have little time for action and as vaccines have been shown to be effective, we need to close all these loopholes that prevent vaccination of American children. Currently, many states are trying to get new bills and legislations passed to deal with the measles crisis caused by lack of vaccination and exemptions. Pediatricians and medical societies are urging parents to shun all myths and get children vaccinated. In a few instances, children are trying to get vaccinations on their own despite parents’ disapproval and resistance. Dr. Scott Gottlieb, the FDA Commissioner is warning that the federal government may have to take action to ensure and enforce vaccination for children. Finally, there are criminal and civil negligence laws for parents related to children and firearms, delinquent youth, and failure to get medical care for children. Is it time to include vaccination within that umbrella of negligence and liability on the part of parents? Especially, when they risk other children’s life by not vaccinating their own children? 

Maybe, that’s our final resort to save the children of our nation from preventable cause of disease and death.

- Jagdish Khubchandani, MD, PhD, MPH, Community Health Professor, College of Health