What Next

Getting to the Truth on Measles

Some anti-vaxxers are pushing bogus advice hotlines. But the media may also be highlighting falsities.

A doctor giving a child a shot.
AlekZotoff/iStock/Getty Images Plus

The following article is a written adaptation of a recent episode of What Next, Slate’s new daily news podcast. Listen to What Next for free every day via Apple Podcasts, Spotify, TuneIn, Stitcher, Overcast, Google Play, or wherever you get your podcasts.

In Brooklyn, New York, there’s this hotline parents can call if they’re looking for advice. It’s called Akeres Habayis. It’s a Yiddish phrase that roughly translates to housewife, or keystone of the home, and the advice on this phone line is geared toward Orthodox Jewish people.

Users of the service can click for information on all kinds of things—everything from advice on potty training, child safety, and kidnapping to the “truth” about vaccines.

You see, right now, revealing the “truth” about vaccines is important in this tight-knit community. New York is in the middle of one of the largest outbreaks of measles in decades—there are at least 214 confirmed cases since last October. Back in 2013, there were about 60 cases.

The epicenter of the ongoing outbreak is in Williamsburg—31 cases were confirmed there in just the past week. Many of those infected are part of this sheltered Orthodox community, and the Akeres Habayis hotline has become a place for families to gather.

“You can press certain buttons to ask a question,” says Gwynne Hogan, a reporter for public radio station WNYC. “In some cases, it’s a free-for-all. Anybody can answer it.”

She called the service, and what she found may surprise you. I heard this audio during a recent episode of What Next, the daily news podcast I host for Slate.

“We’ve seen children who just don’t talk as much anymore. They seem a little spaced out. That could be, I would say, the aluminum in the vaccines,” one speaker said on the line.

You can hear the full conversation by clicking the audio player below.

In addition to hyping the danger of vaccines, Hogan says the people answering questions on the hotline are consistently downplaying the severity of measles.

“This outbreak is larger than what we’ve seen since the 1990s in New York City, and years before measles was declared eradicated from the United States,” she says.

This is mostly happening in the Hasidic Orthodox Jewish community. Back in 2013, the community was also at the center of the outbreak.

“There are a couple of reasons for this,” Hogan says. “This is a very tight-knit community. And so even with a small percentage of unvaccinated children, there’s just a lot more insularity, so it’s spreading. And to be clear, it appears that the outbreak began from travelers who in some cases were from Europe, several from those who went to Israel and caught the measles and brought it back. So it’s not just like one person brought it. And now we’re seeing this whole evolving situation.”

In her reporting, Hogan is trying to understand why this community has continually had trouble with measles. Which brought her to the Vaccine Safety Handbook.

“[It’s] a project of PEACH, which stands for Parents Educating and Advocating for Children’s Health,” she says. “This pamphlet has been out for several years, but when the outbreak began last October, it was sent to some Orthodox homes and neighborhoods.”

The pamphlet just appeared in people’s mailboxes. In New York and New Jersey, it was passed between friends and family members and circulated through the community. I’ve seen this pamphlet—it looks professional. It resembles something you might find in a doctor’s office. But it is different.

“It’s full of all these big questions, like Why are autism rates going up?” Hogan says. “It posits all these questions, and then it says all this information about vaccines—it sort of puts vaccines in parallel to all these, every possible ailment. So it asks these questions and gives you this information about vaccines, sowing these kind of seeds of fear. Well, maybe it’s vaccines, you know—the reader jumps to that conclusion.”

In the pamphlet, one thing that stood out to me was a cartoon of a doctor with a needle telling a mother that vaccines are totally safe. And then in the next panel, the doctor drops the vaccine and it spills on the floor and he says to the nurse, It’s biohazard. Call the EPA! Everything here we can’t touch! It sets up this conflict and pushes the reader to ask, Is this vaccine good? Is what was in the vial safe?

Knowing about the history of this community, the way information moves through it, I asked Hogan how public health officials have responded to this outbreak. They took drastic steps. Back in December, the city barred unvaccinated children from attending yeshivas in Brooklyn. And then, just in the past couple of weeks, we’ve seen even more steps in Rockland County, New York, which is another place where there’s a significant Orthodox Jewish population.

“The Rockland County executive declared a state of emergency for a period of 30 days, which he could potentially extend, [and now] unvaccinated children are banned from public places,” Hogan says.

She continues: “They say they’re not planning on enforcing this. To be clear, they’re banned from public indoor spaces. They can go to parks and they can be on the streets, but restaurants, malls, that kind of thing, they’re not allowed there. They’re saying they’re not going to be patrolling, they’re not gonna have a list of immunization records, you don’t have to have an ID card that says you’ve been vaccinated. But it seems that there could be enforcement retroactively.”

If the measles spreads and an unvaccinated child was in a public place, then the parents could be held liable.

These standards seem rigid. But Rockland County Executive Ed Day says this seems to be working. But Hogan has also talked to some families who say the new measures taken by local officials haven’t changed their minds. Rather, they’re enraged that the government is trying to control their families.

But at least one woman seems to think this is making a difference. And she’s doing something really different. Her name is Blima Marcus, and she’s a member of the Orthodox Jewish Nurses Association. She argues that for women in this community, this is an emotional issue.

“She is coming at this from a totally different angle,” Hogan says. “She’s like, we need to acknowledge [people’s] fears, and then we need to debunk the anti-vaccination propaganda. What she and a group of Orthodox nurses have been doing for several months, they’ve basically dissected the PEACH manual, line by line, and exposed its faults and fallacies. They already have back orders on this book. They have people in Orthodox communities all over the country who want copies of it. And they plan on sort of presenting this to show mothers, like, Your fears are valid—this book is terrifying. And here is why these things that you read and learned from this book are not true.”

It seems like there are two approaches here. The first is about rigidly banning people, and the second about engaging them deeply. While this could be a possible lesson for other anti-vaccine communities, I’m also thinking about how the media is covering these measles outbreaks that have cropped up recently, and how that is impacting the conversation.

My colleague Daniel Engber has been thinking about all this too. He’s a science columnist here at Slate. A couple of months ago, he wrote a story with the headline, “Stop Talking About Measles.” He argues that the national coverage of measles outbreaks has been somewhat out of hand.

“The way it’s talked about, I think, introduces a lot of exaggeration and fear, and there’s even a risk that it exaggerates the influence of the anti-vaxxers, which may be to their advantage,” he says. “I’m not sure that covering this as a national catastrophe does more good than harm.”

Engber has talked about this data point that’s in almost every story about the measles: that back in the year 2000, the U.S. declared measles eliminated. But he says that’s misleading.

“Some news reports use the word eradicated instead of eliminated,” he says. “I don’t think the way those words are used has any technical meaning in media coverage, but when I hear them, I think, Oh, measles is completely gone, no one was getting measles. That’s actually not the case.”

Engber says that back in 2000, experts with the Centers for Disease Control and Prevention decided that measles was no longer in regular circulation in the U.S.

“They knew that there would still be measles outbreaks imported from overseas—in fact, all the measles outbreaks we’ve seen recently are imported from overseas—but it wasn’t gonna sort of spontaneously pop up here anymore,” he says. “That still seems to be true—it is still eliminated in that sense, as best we can tell. But I think it’s interesting—even at the time, some people worried that using that language would create a false sense of security.”

I asked him: What’s the risk of this kind of media coverage? Because it is not great that kids aren’t getting vaccinated, even if it’s only happening in these small pools of people.

“I’m not gonna argue that there’s anything good about people getting measles—of course it’s terrible,” he says. “But if you look at vaccination numbers across the country, 91.5 percent of 3-year-olds have received their first MMR [measles, mumps, and rubella] vaccination in the U.S. That’s the same rate that you saw five years ago and 10 years ago, and I think 15 years ago. The rate is not changing.”

He continues: “The national rate is incredibly stable. I mean, doing a lot of health reporting, it’s surprising to see something so stable. The norm for vaccination in the U.S. is very strong and unchanging. And so there’s this media narrative that the anti-vaxxer menace is growing, is spreading through social media. It’s just not borne out by the facts. You asked what’s the danger. Well, I think the danger, when you start amplifying the message and reach of very fringe groups, is that you’re perhaps eroding that norm. That’s one danger.”

Engber has also argued that anti-vaccine stories take up a lot of oxygen in the health and science space—that the media spend a lot of time talking about anti-vaxxers. National headlines have touted that the number of unvaccinated kids has quadrupled in the United States in recent years.

“That sounds terrible,” he says. “[But] to be clear, it’s quadrupling from a very small number to something that’s still a small number. But the CDC report at that time made it very clear that the source of that quadrupling was not anti-vaxxer propaganda, but social inequality—it’s kids who don’t have health insurance, kids who don’t have access to good health care, and the racial disparities in who is getting vaccinated in the U.S.”

Here’s where I think we disagree. Engber says the problem of vaccination is a localized problem, it’s a problem in smaller communities, and so it doesn’t necessarily warrant this larger national attention. But we wouldn’t argue that a chemical spill in Arkansas isn’t worth our attention because it’s local. Journalists would go there; we’d cover it because it’s an important story that warrants a response. And I think the same thing is true with the measles.

But Engber says that when we see these measles outbreaks, there’s usually a local government response.

“Sometimes a statewide government response, [saying] OK, we need to wipe out the philosophical exemption [to getting vaccinated]. That’s what happened in California after the Disneyland outbreak some years ago. I mean, the United States as a whole still is very encouraging of vaccination, and that’s why vaccination rates, national vaccination rates, have stayed the same at very high.”

However, there are still ways for parents to get exemptions, ways that are easy in some states, and the government could close those loopholes. In Washington state, a recent measles outbreak prompted laws to be tightened. I wonder if that would have happened if the story didn’t get attention. That question, Engber says, is the source of our disagreement. He says laws still would have been tightened, even without a spotlight from, say, USA Today.

“What’s relevant there is what people think in that county in Washington state and maybe Washington as a whole. I just don’t think what you and I say in New York City matters to those local vaccination rules,” he says. “I have two objections to the coverage. One is factual, and one is tone. The factual part is, there’s just no evidence that the anti-vaxxer movement is stronger today than it was 20 years ago. So as a journalist, as a science journalist, it’s just wrong—that kind of coverage that paints this as a growing menace.”

He continues: “I do have a problem with the tone. It’s not that it’s fearmongering—I think in local communities, fearmongering is very effective. That’s why there have been 17,000 vaccinations in Rockland County. That’s why there was a 500 percent increase in Washington state around the area of that outbreak. Parents are scared and they’re getting vaccinated, and that is just a self-correction of this silliness of parents not getting vaccinated and not thinking it’s important. The tone problem, as far as I see it, is that there’s this outrage around it. Since 91.5 percent of kids are vaccinated and that is unchanging, we can say that almost all parents are on the right side of this issue. But I mean people are really, really furious, and that bothers me ’cause I think it is just like a useless outrage at our fellow citizens.”

But when Engber published his story in Slate, arguing that news reporting on the measles outbreak has a spotty record, he says he got some feedback that disturbed him.

“When I wrote the piece, there’s a paragraph in there where I say, Similar points could be made by anti-vaxxer propagandists. And to be clear, vaccinate your damn kids. I mean, there’s a section in my piece that said that,” he says. “And yet still, I heard from anti-vaxxer activists who were very pleased by my piece. So that’s upsetting to me because I couldn’t have been more explicit in the piece about what I think of that movement. That’s something that I have had to reckon with since I published the piece. I thought I was being as clear as possible, but there are anti-vaxxer groups apparently who very much liked the piece that I wrote.”