Mar 26, 2019

A new age of epidemics

Illustration: Aïda Amer/Axios

In the 1950s, 400–500 Americans died every year from measles and another 100 from chicken pox. In the last major outbreak of rubella — in 1964–'65 — some 11,000 pregnant American women lost their babies and 2,100 newborns died.

  • The 1960s vaccine revolution all but wiped out these diseases by 2000. But now they are back — in the U.S. and around the world.
  • Much onus for this regression so far has been laid on the global anti-vaccination movement. But experts blame much more sweeping reasons, primarily a tectonic change in how humans live now as opposed to three, four and five decades ago.
  • At the top of the list: we are living closer together in ever-swelling cities, trading and traveling much more, creating climate change, migrating in big numbers — and failing to keep vaccination levels high enough for "herd immunity."

"What changed is that society changed," Jeremy Farrar, an expert on infectious disease and director of the U.K.-based Wellcome Trust, tells Axios.

  • Driving the news: Disease was under control for a few decades, but now the environmental circumstances under which they were contained have utterly changed. So new answers have to be found.

The big picture: For 2019, U.S. officials have confirmed 481 measles cases in 16 states as of Saturday, according to the website Precision Vaccinations. The Centers for Disease Control confirms 151 cases of mumps for January and February in 30 states and the District of Columbia. And Kentucky alone has an outbreak of 32 cases of chickenpox as of last week.

Europe, too, has had a surge of mumps, pertussis, rubella and tetanus over the last two years, reports the World Health Organization. Measles alone killed 72 people in Europe last year, among 82,596 who contracted the disease, according to the agency.

  • In the U.S., the outbreaks are often concentrated in tight-knit communities like former Soviet immigrants in Clark County, Washington.
  • Three states — New York, Texas and Washington — are the "leading measles hot-spots" in the U.S., per Precision Vaccinations.
  • The diseases are often brought into these communities by travelers returning from countries like Israel, Madagascar, the Philippines and Ukraine.

How the revolution happened: The vaccine against measles was licensed in 1963, chickenpox in 1995, mumps in 1967, and rubella in 1969. Jonas Salk's polio vaccine — igniting the vaccine revolution — came into use in 1955, and the oral version, created by Albert Sabin, was commercialized in 1961.

But the revival of these once-unavoidable, disfiguring and sometimes deadly diseases is only part of the new age of epidemics — they are a component of the general breakdown of the decades-old political and social order.

  • This is particularly apparent in the anti-vaccination movement, what has been rebranded "vaccine hesitancy." "People wonder, 'Why am I still getting vaccinated if disease no longer exists?' It's not a stupid question," Farrar said.
  • But the trend includes the other social factors as well: climate change, migration, urbanization and elevated travel, which are spreading disease-carrying species such as mosquitoes, bats and rats.

What's next: Farrar is pressing for governments to create a commercial impetus for companies to figure out how to navigate the new age. But to get started, says Peter Hotez, dean at the Baylor College of Medicine and author of “Vaccines Did Not Cause Rachel’s Autism,” they need to separate out the various factors.

  • Malaria in Greece and Italy have been blamed on climate change, but Hotez says human migration and re-emerging poverty may also be at fault.
  • In Texas, the appearance of Zika and dengue may be attributable to any or all the same factors. "We don't know," he said.

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