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Illustration: Sarah Grillo/Axios

The federal government may try to take action if states don't tighten their vaccine exemption laws and measles continues to spread in sections of the U.S., FDA Commissioner Scott Gottlieb tells Axios.

Driving the news: Overall case numbers of measles remain low in the U.S. but the disease is growing in areas of high non-vaccination rates. Some states like Washington are considering tightening their exemptions even as they continue to face a more organized anti-vaccination movement.

"It's an avoidable tragedy," Gottlieb, who says he's usually a proponent of state rights, tells Axios. "Too many states have lax laws."

Background: The highly contagious disease can only be controlled if there's a large vaccination rate in the population, which the World Health Organization says should be 93%–95% of people.

  • States are allowed to adopt their own rules over what types of exemptions are allowed for vaccines. All of them allow exemptions for medical reasons, but many also provide exemptions on religious and/or philosophical grounds.
  • These pockets of unvaccinated people are transmitting measles in the U.S., which is particularly dangerous to those who can't get vaccinated, including babies under 12 months and people with susceptible immune systems.
  • Gottlieb says the vaccine is one of the most effective ones (97% with 2 doses) created so far, and for one of the most contagious viruses.
  • Measles can cause various complications, including pneumonia, brain damage and sometimes death, and it has been linked to longer term immune problems.
What's happening now

WHO reported last week that measles cases tripled globally in 2018 from the prior year, and current reports show multiple deadly outbreaks in the Philippines, Ukraine, Israel and Madagascar.

In Washington state, the number of confirmed cases has more than doubled since Gov. Jay Inslee declared a state of emergency on Jan. 25, to 54 as of Feb. 13.

In New York, there is an outbreak in Rockland County, Monroe County and New York City, and Texas reported 8 cases in 5 different counties as of Feb. 14.

The debate

"It's a self-inflicted wound," says Peter Hotez, dean at Baylor College of Medicine who published a study last year showing possible U.S. "hotspots" of measles due to vaccine exemptions, that he says is already proving to be true.

  • Pro-vaccination groups are "losing the battle" to anti-vaccination groups, who've been very active on social media and forming at least one PAC to promote their message, he says.

The other side: Barbara Loe Fisher, co-founder and president of the nonprofit National Vaccine Information Center often labeled as anti-vaccination, tells Axios that 100 cases of measles in a population of 320 million "is not a public health emergency."

  • "[It] should not be used to justify eliminating the legal right to exercise informed consent to vaccination, which is protected by the inclusion of flexible medical, religious and conscientious-belief vaccine exemptions in public health laws," she says.

Go deeper:

Go deeper

Top general: Calls to China were "perfectly within the duties" of job

Gen. Mark Milley. Photo: Andrew Harrer/Bloomberg via Getty Images

Joint Chiefs Chairman Mark Milley told the Associated Press on Friday that calls with his Chinese counterpart during the final months of Donald Trump's presidency were "perfectly within the duties and responsibilities" of his job.

Why it matters: In his first public comments on the calls that have prompted critics to question whether the general went too far, Milley maintained that such conversations are "routine," per AP.

The consumer's massive "war chest"

Illustration: Megan Robinson/Axios

Economists expect the pace of economic growth to cool off now that government transfer payments like stimulus checks and emergency unemployment benefits are in the rearview mirror. But evidence suggests that the U.S. consumer is sitting on a lot of financial firepower that could be a key driver of growth in the quarters to come.

Why it matters: U.S. consumer spending is massive, representing about 70% of GDP.

The Fed takes on its own rules amid stock trading controversy

Photo: Al Drago/Bloomberg via Getty Images

New disclosures that showed Fed officials were active in financial markets set off a firestorm of criticism. Now the Fed may overhaul the long-standing rules that allow those transactions.

Why it matters: What officials actively traded was sensitive to the Fed decisions they helped shape, including the unprecedented support that underpinned a massive financial market boom.