Pediatricians walk a delicate line with parents in measles vaccination debate

One mom told her pediatrician she was skipping a checkup for her 4-month-old because she was afraid the baby would catch measles from the doctor’s office before he could be vaccinated — even though there were no cases reported in the area. Another parent said he was refusing to inoculate his 1-year-old because he didn’t want to “experiment” on his child.

These and other recent discussions about measles vaccinations at Dr. Alex Cvijanovich’s Albuquerque, New Mexico, pediatric practice have been fraught since the highly contagious virus started making national headlines — and they’re only getting more challenging.

“The people who are willing, are willing to give it early,” said Cvijanovich, who is also a spokesperson for the American Academy of Pediatrics. “But the people who have dug in their heels, it just becomes a more frustrating conversation.”

As virus cases rise and the U.S. recorded its first measles death in a decade, pediatricians are in a dilemma. How do they convey the seriousness of the virus to vaccine-skeptical parents while also quelling the anxieties of families who want to immunize their newborns, but can’t yet?

It’s a delicate balancing act, according to six doctors in practices from West Virginia to Washington state. The measles, mumps and rubella vaccination has a proven track record against the highly contagious disease, with two doses of the shot 97% effective against measles, according to the Centers for Disease Control and Prevention. Decades of studies have shown it to be safe and have refuted false claims that it is linked to autism.

The measles outbreak so far has been concentrated in West Texas. But it comes at a pivotal moment for the country: Vaccine hesitancy, on the uptick for years, accelerated during the Covid pandemic. And now misinformation about vaccines has been spreading, fueled in part by Robert F. Kennedy Jr., who led a large anti-vaccine advocacy group before becoming head of Health and Human Services last month. Shortly after his confirmation, Kennedy vowed to investigate the schedule for childhood vaccines that prevent dangerous diseases like measles. 

Pediatricians say they’re seeing a lot of fear, both from parents who trust vaccinations and those who don’t, and they worry the anxiety from both sides will create confusion that will hamper public health efforts. The death of an unvaccinated child in Texas last month has not been enough to sway everyone to immunize their children, and pediatricians are worried more kids will get sick.

“I feel like this is still snowballing,” said Dr. Lesley Motheral, a pediatrician in Lubbock, Texas. “I think we still have a lot of work to do, to be very honest with you.”

The CDC recommends administering the first MMR shot at around age 1 and the second at ages 4 to 6. In cases where an infant has been exposed to measles or is traveling to a known outbreak area, pediatricians can administer a dosage as early as 6 months old — something some parents have pleaded for as more measles cases are reported.

Most children in the United States receive their MMR vaccinations on schedule, with nearly 93% receiving the shots by kindergarten, according to the CDC.

But in West Texas, where the measles outbreak is concentrated with at least 159 reported cases, vaccination rates are significantly lower. In Gaines County, the epicenter of the outbreak, the immunization exemption rate was more than 17% for the 2023-2024 school year, according to health department data.

Experts say that at least 95% of a community must be vaccinated to protect against a measles outbreak.

“We rely on herd immunity for measles prevention,” said Dr. Christina Hermos, division chief of pediatric infectious disease and immunology at UMass Memorial Children’s Medical Center. “Measles is so incredibly contagious that you only need one person flying in or traveling to a region to give a nonimmune person a case.”

The respiratory virus spreads rapidly because it is transmitted through droplets that can linger in the air or on surfaces for up to two hours, meaning an infected person doesn’t have to remain in a room to contaminate other people. Measles causes a telltale rash, but an infected individual can spread the virus up to four days before the rash appears.

Measles also causes fevers and red, watery eyes and can lead to complications such as pneumonia or, in rare cases, brain damage and death. For every 1,000 children who get measles, about one to three will die from respiratory and neurologic complications, the CDC says.

The U.S. declared measles eliminated in 2000, despite some cases being reported since.

Pediatricians now fear the country could backslide in its containment efforts, especially because Kennedy has long criticized childhood vaccinations. 

As the measles outbreak has unfolded under his watch, he has not urged widespread vaccination, drawing ire from health experts and politicians. In an op-ed published on Fox News’ website, he called the decision to vaccinate “a personal one” and wrote, “All parents should consult with their healthcare providers to understand their options to get the MMR vaccine.”

Dr. Elizabeth Meade, a Seattle pediatrician, said she finds it “enormously concerning” to have a vaccine-skeptic person as the nation’s health secretary. 

“I think there is this real sense among people in the United States that they are not at risk for these diseases, especially if they’re not traveling outside of the U.S.,” said Meade, who is also an American Academy of Pediatrics spokesperson. “Unfortunately, it is just not true.”

Some parents who once supported immunization have since changed their minds.

“I see incredibly intelligent people coming in,” said Hermos, who in addition to being an infectious diseases doctor is an associate professor of pediatrics at UMass Chan Medical School. “Their child has a full vaccination record, and then they’re due for their next one, and they’re completely convinced that they’re making a decision between two potentially harmful things for their kids, like, ‘I could potentially harm them with this vaccine versus I could potentially harm them with this disease of the vaccine.’” 

In Morgantown, West Virginia, pediatrician Dr. Lisa Costello has found that acknowledging the common ground she has with vaccine-hesitant parents is helpful.

“Everyone’s coming from the space that they’re trying to do what’s best for their child that they love, and it’s a matter of having those conversations and sharing from the medical literature we have on this,” said Costello, an assistant professor of pediatrics at West Virginia University. 

But it’s keeping some parents of newborns home out of fear that, because others in the practice might not be vaccinating their children regularly, their tiny babies who are too young to get the MMR shot could be at risk. 

The doctors said there are steps that parents can take to protect their children if they are too young to get the vaccination, such as asking the adults who spend time near their kids if they are vaccinated themselves; asking at their day care if all children who are eligible for vaccinations have been immunized; and not being around anyone who is or recently was sick. They also recommended bringing up early vaccination with their pediatrician.

“There are those folks now that are calling that are anxious about it and want to get it even earlier than the recommended schedule,” said Dr. Steven Abelowitz, medical director of Ocean Pediatrics in Orange County, California. “It’s OK to do it after six months, but make sure the insurance covers it and it’s not out of pocket.”

In Texas, Motheral said her local health department has been giving free MMR vaccinations. She hopes more people will agree to receive them.

“It is so sad that a disease that we once felt was eradicated in this country, and really still should be, is making a resurgence,” she said. “Even one death for measles is too many.”