Public Health Nurses Call for Better Policy During the Measles Outbreak

Unfortunately, the measles has persisted into the 21st century, and stigma surrounding vaccines in the United States has increased due to myths, such as vaccines or mercury being associated with autism. Some of this health misinformation may be promulgated by “trolls,” individuals who misrepresent their identities, and “bots,” accounts that automate content promotion with the intention of promoting discord.

A strong response has been mounted by health care professionals across the United States, encouraging everyone to get vaccinated against the measles. Yet, more measles outbreaks have continued to occur; most recently, officials have warned of a measles outbreak in Michigan.

Measles is not just a fever and a rash. Measles is a contagious virus and can potentially be deadly. This virus spreads through the air via coughing or sneezing.

Symptoms can include reddened eyes, a high fever and a rash all over the body. These symptoms can disappear without treatment within approximately two weeks. Yet in 2017, almost 110,000 people died of measles worldwide.

In the United States, from Jan. 1 to March 21, there have been at least 314 confirmed cases of measles in 15 states. Outbreaks of the measles cost taxpayers millions of dollars to contain.

We are nurses who are leaders in the Public Health Nursing Section of the American Public Health Association, with a vested interested in the health of the public. Both of us have many years of experience working in practice and in teaching public health. We’re asking, “What are the actual policy implications of this measles debate?”

We believe measles is making a comeback because of policy failures. Unfortunately, too many states make it way too easy for parents to avoid getting their kids vaccinated.

A majority of people with measles did not receive the measles vaccine. Most of these people live in places that permit non-medical exemptions from vaccines.

When states make it easy to obtain vaccine exemptions, problems arise. In Washington state, mistrust of health officials and pharmaceutical companies has fueled a surge in parents not vaccinating their children, leading to 74 cases in that state.

In contrast, West Virginia closed its existing gaps in vaccine exemption policies, and it has higher measles vaccine rates. Not surprisingly, West Virginia hasn’t had to deal with any outbreaks. There is an ironic shift in health burden here, where Washington state is faring worse than West Virginia — a juxtaposition where the disease burden within these states is in the opposite direction on virtually every other health condition. 

Measles is also one of the reasons we are opposed to H.R. 1597, referred to as the National Nurse Act of 2019. Let us explain why.

On the surface, H.R. 1597 appears to contain great ideas that might lead to health improvements by adding a role to the U.S. Public Health Service Chief Nurse Officer position to spend more effort encouraging healthier behaviors; however, we believe people should be asking what the research evidence is to support the assumptions made in bills such as these.

In short, behavior change within individuals is considered a “downstream” factor, which according to a large body of scientific evidence, only explains a small portion of why people living in some communities are healthier than others, while other “upstream” factors” — including policies that change the conditions in which people live, work and play — explain far more. As such, this bill can be considered one with good intentions, but unlikely to result in improving population health.

Instead of focusing on bills such as H.R. 1597 that are likely to have no direct impact on health outcomes for people, nurses and others need to focus on policy development that follows the work of West Virginians. Ensuring health care policy is evidence-based is paramount. We should all be working on developing policies that have a clear scientific evidence base, such as that enacted by West Virginia.

In the case of measles and other contagious diseases, the scientific evidence clearly and consistently shows immunizations are safe and that we all benefit from policies that support having more people in a community immunized — something we in public health call herd immunity. And we are proud to say the current U.S. Public Health Service Chief Nurse Officer is also focused on eradicating the measles and is doing a fantastic job collaborating with and advising the U.S. Surgeon General.

Nurses, the largest group of health care professionals and the most-trusted professionals, are important players in health policymaking. Public health nurses have an obligation to fight for policies that are soundly based on science and aim to improve health. We take this responsibility seriously, which may mean that sometimes we do not agree with other health care professionals when policies are proposed that do not have evidence-based benefit for the public good.

As nurses, we know ending the stigma surrounding vaccines must be a top public health priority, to improve worldwide health and reduce economic burden. And so, we bring these policies to public attention. Let’s roll up our sleeves and get to work fighting for our patients by fighting for state policies that make it difficult for parents to avoid vaccinating their kids.


Sarah Oerther, MSN, M.Ed., RN, is a nursing instructor enrolled as a Ph.D. candidate at the School of Nursing, Saint Louis University, and she is the section councilor of the Public Health Nursing Section of the American Public Health Association and a fellow of the Royal Society of Public Health.

Shawn Kneipp, PhD, RN, PHNA-BC, FAANP, is associate professor at the University of North Carolina at Chapel Hill School of Nursing and chair-elect of the Public Health Nursing Section of the American Public Health Association.

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