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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

Mike Allen, author of AM
3 mins ago - Economy & Business

Small businesses see hiring as No. 1 worry

Illustration: Aïda Amer/Axios

Almost every small business owner in a Goldman Sachs survey is having trouble hiring — and two-thirds think the federal government has done too little to ease their hiring, supply-chain and inflation worries.

Why it matters: The Goldman Sachs research gives a vivid window into the continuing headwinds and hardship for entrepreneurs.

NATO sends ships, fighter jets to eastern Europe over Russia threat

Service members of Russia's Eastern Military District units attend a welcoming ceremony as they arrive at unfamiliar training ranges in Belarus. Photo: Russian Defence Ministry/TASS via Getty Images

NATO said Monday it's sending more ships and fighter jets to eastern Europe due to Russia's buildup of troops near Ukraine.

Driving the news: "NATO Allies are putting forces on standby and sending additional ships and fighter jets to NATO deployments in eastern Europe, reinforcing Allied deterrence and defense as Russia continues its military build-up in and around Ukraine," per a NATO statement.

Editor's note: This a breaking news story. Please check back for updates.

Updated 2 hours ago - World

State Department orders evacuation of U.S. diplomats' families from Ukraine

From left, undersecretary for political affairs Victoria Nuland, Secretary of State Antony Blinken and U.S. chargés d'affaires in Ukraine Kristina Kvien during a meeting with Ukrainian Prime Minister Denys Shmyhal in Kyiv. Photo: Yevhen Liubimov/ Ukrinform/Barcroft Media via Getty Images

The State Department will begin evacuating families and nonessential staff from the U.S. Embassy in Kyiv this week, according to a travel advisory published Sunday evening.

The latest: The United Kingdom's Foreign Office announced Monday it was also withdrawing some embassy staff and dependants from Ukraine's capital "in response to the growing threat from Russia," but added the British Embassy would remain open.