National

Data: Global Burden of Disease Collaborative Network; Map: Andrew Witherspoon/Axios

The latest findings from the Global Burden of Disease Study (GBD) show 4.57 million children under five living with autism, or about one in 138 kids. The largest numbers of young autistic children live in developing or low- and middle-income countries, including over one million children each in South Asia and Sub-Saharan Africa, while the highest rates of childhood autism are seen in the Middle East, Central Asia and North Africa.

Why it matters: So much of the dialogue surrounding autism is focused on the U.S., Canada, and Western Europe that we often forget much of the world's childhood autism is concentrated in regions where health resources are limited.

The big picture: India has the largest number of autistic children (851,000), followed by China (422,000),  Nigeria (207,000), Pakistan (172,000) and Indonesia (159,000).  Vaccination rates are often low in these regions, further refuting already debunked claims about a link between vaccines and autism. In contrast, about 150,000 kids with autism live in North America and fewer than 140,000 in Western Europe.

Be smart: Some patient advocates might chafe at the idea that being on the autism spectrum qualifies as a “disorder” in the current iteration of the GBD. There is merit to this argument: For many parents, it’s mostly autism’s co-morbidities (including intellectual disabilities) that have adverse consequences. But the data are still valuable in assessing the need for services and assistance.

What’s next: The huge numbers of children on the autism spectrum living in resource-limited countries mean new and better global health policies are needed to ensure that they can receive access to care and support. Both de-stigmatizing  autism and providing resources for the world’s children on the autism spectrum should be priorities for the United Nations.

Peter Hotez is a professor of pediatrics at Baylor College of Medicine, where he is also dean of the National School of Tropical Medicine, and the author of “Vaccines Did Not Cause Rachel’s Autism.”

Editor's note: The map legend has been clarified to show that the autism rates reflected are per 100,000 children under five.

Most countries with highest childhood autism rates lack resources

The highest rates are in the Middle East, Central Asia and North Africa.

Science

Autism

Expert Voices

Health Care

The <a class="gtmContentClick" data-vars-link-text="latest findings" data-vars-click-url="https://urldefense.proofpoint.com/v2/url?u=https-3A__www.thelancet.com_journals_langlo_article_PIIS2214-2D109X-2818-2930309-2D7_fulltext&amp;d=DwMFaQ&amp;c=ZQs-KZ8oxEw0p81sqgiaRA&amp;r=5LfYK49OliIsJzSnooAjOg&amp;m=RVTDbpJzgLWDcGk8DExqludMaUlf4Lajw0r1WCbs7xo&amp;s=vDgKvi62_B4Db8lXOhEFsuirJd_DXe_eOil4LidweJs&amp;e=" data-vars-content-id="b9ec6d04-8adf-4ce9-ac87-3eb476c4ca87" data-vars-headline="Most countries with highest childhood autism rates lack resources" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://urldefense.proofpoint.com/v2/url?u=https-3A__www.thelancet.com_journals_langlo_article_PIIS2214-2D109X-2818-2930309-2D7_fulltext&amp;d=DwMFaQ&amp;c=ZQs-KZ8oxEw0p81sqgiaRA&amp;r=5LfYK49OliIsJzSnooAjOg&amp;m=RVTDbpJzgLWDcGk8DExqludMaUlf4Lajw0r1WCbs7xo&amp;s=vDgKvi62_B4Db8lXOhEFsuirJd_DXe_eOil4LidweJs&amp;e=" target="_blank">latest findings</a> from the Global Burden of Disease Study (GBD) show 4.57 million children under five living with autism, or about one in 138 kids. The largest numbers of young autistic children live in developing or low- and middle-income countries, including over one million children each in South Asia and Sub-Saharan Africa, while the highest rates of childhood autism are seen in the Middle East, Central Asia and North Africa.Why it matters: So much of the dialogue surrounding autism is focused on the U.S., Canada, and Western Europe that we often forget much of the world&#x27;s childhood autism is concentrated in regions where health resources are limited.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

The detention of thousands of migrant children in U.S. government facilities — 2,047 according to an HHS estimate this Tuesday, though as many as 5,000 in Texas alone per another report — has the potential to result in widespread illnesses.

Why it matters: While there is no exact precedent for the current situation along the U.S.–Mexico border, large-scale detention of individuals, especially children, under conditions of crowding and emotional stress has historically been linked with infectious disease outbreaks.

Upper respiratory infections and pneumonia: Acute respiratory infections were common in evacuation centers during Hurricane Katrina and also after the 2011 earthquake and tsunami in Tohoku, Japan (these groups included both adults and children). Reports of pediatric infectious disease illnesses among last year’s Hurricane Harvey evacuees have yet to be published.

Tuberculosis and drug-resistant bacteria: A significant long-term infectious disease risk, including new strains that are resistant to multiple antibiotics. Children tend not to transmit TB as frequently as adults, but a number of Katrina evacuees were found to harbor other types of multidrug-resistant bacteria.

Measles, pertussis and chickenpox: Close, crowded conditions can ignite outbreaks of these and other highly transmissible, vaccine-preventable diseases. At greatest risk are infants who are too young to have received their vaccinations. For example, a 2-month old was diagnosed with pertussis following Katrina, and measles cases have been reported among refugee populations in France, Saudi Arabia and elsewhere.

Enterovirus: This group of viruses cause fever, flu-like illness, rash, and respiratory and gastrointestinal symptoms. Transmission peaks in late July and August, and complications can include late summer meningitis.

The bottom line: The mass detentions currently underway will inevitably result in young children falling ill. Most will only contract short-term respiratory and diarrheal diseases, though some could develop pneumonia or acquire other serious illnesses.  The risk of measles in young children is worrisome, because it can often result in hospitalization.

What’s next: Surveillance activities must be conducted to determine which diseases are emerging in the detention centers. There’s particular urgency to release children ahead of the summer enterovirus season.

Peter Hotez is a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, where he is also director of the Texas Children's Hospital Center for Vaccine Development.

The dangers of disease in migrant children detention centers

Risks include pneumonia, tuberculosis, measles and other illnesses.

Children and workers at a tent encampment  in Tornillo, Texas. Photo: Joe Raedle/Getty Images

Politics

Immigration

World

The detention of thousands of migrant children in U.S. government facilities — <a class="gtmContentClick" data-vars-link-text="2,047" data-vars-click-url="https://www.axios.com/hhs-reunite-children-separated-from-parents-aa3f8bbf-a09c-45c1-8b84-064ab1ee780e.html" data-vars-content-id="c29a135c-83ca-45f5-8ad1-eeec8f72e5fe" data-vars-headline="The dangers of disease in migrant children detention centers" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/hhs-reunite-children-separated-from-parents-aa3f8bbf-a09c-45c1-8b84-064ab1ee780e.html" target="_self">2,047</a> according to an HHS estimate this Tuesday, though <a class="gtmContentClick" data-vars-link-text="as many as 5,000 in Texas alone" data-vars-click-url="https://urldefense.proofpoint.com/v2/url?u=https-3A__apps.texastribune.org_features_2018_texas-2Dmigrant-2Dchildren-2Dshelters_&amp;d=DwMFaQ&amp;c=ZQs-KZ8oxEw0p81sqgiaRA&amp;r=5LfYK49OliIsJzSnooAjOg&amp;m=JIpgKIiQjQPX0fJX3fyc45li2uHlV8f0QYFKGVFK9EI&amp;s=ny1Vd5IASYScBmnWT8dwn64jtaxXzwMfODkR9p0RzPo&amp;e=" data-vars-content-id="c29a135c-83ca-45f5-8ad1-eeec8f72e5fe" data-vars-headline="The dangers of disease in migrant children detention centers" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://urldefense.proofpoint.com/v2/url?u=https-3A__apps.texastribune.org_features_2018_texas-2Dmigrant-2Dchildren-2Dshelters_&amp;d=DwMFaQ&amp;c=ZQs-KZ8oxEw0p81sqgiaRA&amp;r=5LfYK49OliIsJzSnooAjOg&amp;m=JIpgKIiQjQPX0fJX3fyc45li2uHlV8f0QYFKGVFK9EI&amp;s=ny1Vd5IASYScBmnWT8dwn64jtaxXzwMfODkR9p0RzPo&amp;e=" target="_blank">as many as 5,000 in Texas alone</a> per another report — has the potential to result in widespread illnesses.Why it matters: While there is no exact precedent for the current situation along the U.S.–Mexico border, large-scale detention of individuals, especially children, under conditions of crowding and emotional stress has historically been linked with infectious disease outbreaks.

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

A changing picture has emerged of the U.S.' susceptibility to epidemics of infectious diseases over the next decade — driven by organized anti-vaccine activity and the lack of incentives to develop new or more effective vaccines, along with inadequate mosquito control measures.

The big picture: Reducing the risk of new epidemics will require expanding the use of existing vaccines, especially for measles and seasonal influenza, as well as introducing new vaccines for any vector-borne or zoonotic diseases that emerge.

The main infectious disease epidemics to look out for: 

Measles: More than 40,000 measles cases occurred in Europe in the first half of 2018. With regular travel between North America and Europe, it's possible that on any given week measles cases are being imported into the U.S. Several western states with strong anti-vaccine movements —including Washington, Oregon, Idaho and Texas —  are highly vulnerable to outbreaks because of low vaccine coverage, in some cases well below the 90%–95% immunization rates needed to achieve adequate herd immunity for measles.

Seasonal influenza: Influenza is one of the most fatal infectious diseases in the U.S., especially among the very old and very young. Most of the 180 American children who perished in the 2018 flu epidemic were not vaccinated, despite strong recommendations from public health officials. (An anti-vaccine lobby may have promoted misleading information about both flu and the flu vaccine.) Flu is now being reported in the Southern Hemisphere this summer and will return to North America this winter. Given that influenza kills up to 50,000 Americans every winter, flu vaccinations, especially for children, are paramount.

Vector-borne diseases: Diseases from infected ticks (e.g., Lyme disease), mosquitoes (e.g., West Nile, dengue and Zika), and fleas (e.g., typhus) have tripled over the past 13 years. Nine new disease pathogens spread by mosquitoes or ticks have also been either newly discovered or introduced into the U.S. over this period. A yellow fever epidemic in Brazil could emerge in U.S. Gulf Coast states where the Aedes aegypti mosquito — the most efficient mosquito vector — is found. There is probably a need for vaccines to prevent Lyme Disease, West Nile virus and Chagas disease — among others — but they are not being developed because of perceived market inadequacy. Also, as the recent HPV vaccine has shown, it’s increasingly difficult to introduce new vaccines in the U.S.

Peter Hotez is a professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine, where he is also Dean of the National School of Tropical Medicine.

Why the U.S. faces a growing risk of epidemics

Anti-vaccination movements and poor mosquito control are both major threats.

A family physician prepares a measles vaccine during a consultation on April 16, 2018 in the Romanian capital, Bucharest. 

A physician prepares a measles vaccine. Photo: Daniel Mihailescu/AFP via Getty Images 

Infectious disease

Public health

A changing picture has emerged of the U.S.&#x27; susceptibility to epidemics of infectious diseases over the next decade — driven by organized anti-vaccine activity and the lack of incentives to develop new or more effective vaccines, along with inadequate mosquito control measures.The big picture: Reducing the risk of new epidemics will require expanding the use of existing vaccines, especially for measles and seasonal influenza, as well as introducing new vaccines for any vector-borne or zoonotic diseases that emerge.

Vaccine coverage continued to decline in parts of the developed world last year, resulting in 60,000 measles cases in Europe — the most this century — and a record number of pediatric flu deaths in the U.S. In several Western U.S. counties, up to 30% of children have not received their full vaccine schedule — a trend that's been worsening since 2009.

The big picture: This drop-off in vaccinations owes primarily to parental exemptions for non-medical reasons, typically because of false beliefs that vaccines cause autism or illness. There are signs the anti-vaccine movement's misinformation campaigns will strengthen in 2019, leading to further declines in vaccine coverage and possibly more outbreaks of infectious disease.

Released in 2016, the propagandist film "Vaxxed" accused the CDC of covering up evidence that vaccines cause autism and propelled the anti-vaccine movement. A sequel is slated for 2019.

Political action committees in the U.S., Italy and elsewhere are ramping up populist rhetoric about parental freedoms to enact legislation making it easier to obtain vaccine exemptions.

Launched in the fall of 2018, Children’s Health Defense has emerged as an influential new anti-vaccine organization. It focuses on American children, but its reach could extend abroad.

Social media continues to amplify misinformation from hundreds of anti-vaccine websites.

Where it stands: The response to the anti-vaccine lobby by U.S. and European government agencies has been modest, leaving much of the defense of vaccines to academics. This situation will have to change if outbreaks of vaccine-preventable diseases continue or increase.

What to watch: The anti-vaccine movement could also move beyond its stronghold areas into Africa, Asia and Latin America. 2018 already saw anti-vaccine activities adversely affect child health vaccination programs in India, Indonesia and Thailand.

Peter Hotez is a professor of pediatrics and dean at Baylor College of Medicine and the author of “Vaccines Did Not Cause Rachel’s Autism.”

Global disease risk worsening as anti-vaccination campaigns spread

There are signs the anti-vaccine movement will strengthen in 2019.

A doctor injects a vaccine to a baby on October 31, 2017 in Quimper, western France. 

A doctor prepares to administer a vaccine to an infant. Photo: Fred Tanneau/AFP via Getty Images

Vaccines

Vaccine coverage continued to decline in parts of the developed world last year, resulting in <a class="gtmContentClick" data-vars-link-text="60,000 measles cases in Europe" data-vars-click-url="https://www.theguardian.com/world/2018/dec/21/measles-cases-at-highest-for-20-years-in-europe-as-anti-vaccine-movement-grows" data-vars-content-id="ed5429ba-fc5f-4848-9144-8258f508a2b2" data-vars-headline="Global disease risk worsening as anti-vaccination campaigns spread" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.theguardian.com/world/2018/dec/21/measles-cases-at-highest-for-20-years-in-europe-as-anti-vaccine-movement-grows" target="_blank">60,000 measles cases in Europe</a> — the most this century — and a record number of <a class="gtmContentClick" data-vars-link-text="pediatric flu deaths" data-vars-click-url="https://www.cdc.gov/flu/spotlights/reported-flu-children-deaths.htm" data-vars-content-id="ed5429ba-fc5f-4848-9144-8258f508a2b2" data-vars-headline="Global disease risk worsening as anti-vaccination campaigns spread" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.cdc.gov/flu/spotlights/reported-flu-children-deaths.htm" target="_blank">pediatric flu deaths</a> in the U.S. In several Western U.S. counties, up to 30% of children have not received their full vaccine schedule — a <a class="gtmContentClick" data-vars-link-text="trend that&#x27;s been worsening" data-vars-click-url="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002616" data-vars-content-id="ed5429ba-fc5f-4848-9144-8258f508a2b2" data-vars-headline="Global disease risk worsening as anti-vaccination campaigns spread" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002616" target="_blank">trend that&#x27;s been worsening</a> since 2009.The big picture: This drop-off in vaccinations owes primarily to parental <a class="gtmContentClick" data-vars-link-text="exemptions for non-medical reasons" data-vars-click-url="https://www.ncbi.nlm.nih.gov/pubmed/28546785" data-vars-content-id="ed5429ba-fc5f-4848-9144-8258f508a2b2" data-vars-headline="Global disease risk worsening as anti-vaccination campaigns spread" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.ncbi.nlm.nih.gov/pubmed/28546785" target="_blank">exemptions for non-medical reasons</a>, typically because of false beliefs that vaccines cause autism or illness. There are signs the anti-vaccine movement&#x27;s misinformation campaigns will strengthen in 2019, leading to further declines in vaccine coverage and possibly more outbreaks of infectious disease.

Between Jan. 1 and March 7, the CDC confirmed 228 cases of measles across 12 states.

Why it matters: These outbreaks — which have been especially large in Washington, Oregon and Texas — were predictable. A 2018 study of vaccination rates identified a dozen likely hotspots, two of which have now seen eruptions of this preventable illness.

Background: The current anti-vaccine movement began more than 20 years ago after a paper published in The Lancet (but later retracted) claimed that the measles-mumps-rubella vaccine could be linked to autism.

Where it stands: Since then it's spawned a media empire that includes almost 500 anti-vaccine websites, each amplified on social media. Almost all of Amazon's best-selling vaccine books are by anti-vaxxers, though the company has removed some anti-vaccine documentaries from its Prime streaming service.

The anti-vaccine movement has also added political arms, with PACs in multiple Western states lobbying legislatures to maintain or expand vaccine exemptions — moves that would all but ensure future outbreaks.

U.S. public health agencies have been reluctant to launch highly visible advocacy campaigns to combat anti-vaccine messaging. Meanwhile, Australia's government has launched a 12 million Australian dollar ($8.5 million) initiative.

What’s needed: Countering the anti-vaccine movement would require dismantling its media presence through a partnership between the federal government and the major social media and e-commerce platforms. In parallel, states with outbreaks underway could help stem their growth by closing non-medical vaccine exemptions.

What to watch: The House Energy and Commerce Committee and the Senate HELP Committee have each held hearings on the outbreaks, but have yet to formulate new policies. If no action is taken, the number of cases will likely continue to climb.

Peter Hotez is a professor of pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine and the author of “Vaccines Did Not Cause Rachel’s Autism.” He met with congressional staffers ahead of the recent hearings.

U.S. measles cases mount as anti-vaccine influence goes unchecked

The CDC confirmed 228 cases in the first 9 weeks of 2019.

A parent protesting vaccinations outside a recent U.S. Senate committee hearing

An anti-vaccination parent outside a vaccines hearing held by the Senate Committee on Health, Education, Labor and Pensions on March 5, 2019. Photo: Jim Watson/AFP/Getty Images

Measles

Between Jan. 1 and March 7, the CDC <a class="gtmContentClick" data-vars-link-text="confirmed 228 cases of measles" data-vars-click-url="https://www.cdc.gov/measles/cases-outbreaks.html" data-vars-content-id="f4ab46c9-21a4-4f5c-9101-9d7af2235ca1" data-vars-headline="U.S. measles cases mount as anti-vaccine influence goes unchecked" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.cdc.gov/measles/cases-outbreaks.html" target="_blank">confirmed 228 cases of measles</a> across 12 states.Why it matters: These outbreaks — which have been especially large in Washington, Oregon and Texas — were predictable. A 2018 <a class="gtmContentClick" data-vars-link-text="study of vaccination rates" data-vars-click-url="https://urldefense.proofpoint.com/v2/url?u=https-3A__journals.plos.org_plosmedicine_article-3Fid-3D10.1371_journal.pmed.1002578&amp;d=DwMFaQ&amp;c=ZQs-KZ8oxEw0p81sqgiaRA&amp;r=5LfYK49OliIsJzSnooAjOg&amp;m=gHzroLAyrzIeKltMtYustsukiL0mkDmOT2cMua89g8s&amp;s=wCbU_PFjHcv2dYsvsK9L1eV9FYrfwPB-v8Xs_skM0T8&amp;e=" data-vars-content-id="f4ab46c9-21a4-4f5c-9101-9d7af2235ca1" data-vars-headline="U.S. measles cases mount as anti-vaccine influence goes unchecked" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://urldefense.proofpoint.com/v2/url?u=https-3A__journals.plos.org_plosmedicine_article-3Fid-3D10.1371_journal.pmed.1002578&amp;d=DwMFaQ&amp;c=ZQs-KZ8oxEw0p81sqgiaRA&amp;r=5LfYK49OliIsJzSnooAjOg&amp;m=gHzroLAyrzIeKltMtYustsukiL0mkDmOT2cMua89g8s&amp;s=wCbU_PFjHcv2dYsvsK9L1eV9FYrfwPB-v8Xs_skM0T8&amp;e=" target="_blank">study of vaccination rates</a> identified a dozen likely hotspots, two of which have now seen eruptions of this preventable illness.

Peter Hotez

Stories

U.S. measles cases mount as anti-vaccine influence goes unchecked

Global disease risk worsening as anti-vaccination campaigns spread

Most countries with highest childhood autism rates lack resources

Why the U.S. faces a growing risk of epidemics

The dangers of disease in migrant children detention centers