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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

Updated 11 mins ago - Politics & Policy

Military members will be included in Biden's new COVID guidance

Joe Biden. Photo: Anna Moneymaker/Getty Images

Members of the military will be required to get vaccinations or face regular testing, social distancing, mask mandates and restrictions on travel for work, the the Pentagon said on Thursday evening.

Why it matters: The policy was announced for federal workers and onsite contractors earlier on Thursday, part of several new Biden initiatives to get more Americans vaccinated and slow the spread of the Delta variant.

Trump's Republican critics rake in cash

Reps. Liz Cheney and Adam Kinzinger during the first Jan. 6 hearing. Photo: Andrew Harnik-Pool/Getty Images

Republican critics of Donald Trump have raked in campaign cash this year as their votes to impeach the former president and investigate the Jan. 6 Capitol attack have put them in the crosshairs of Trump and his allies.

Why it matters: The 2022 midterms won't just determine which party controls Congress. They're also shaping up to be a test of Trump's continued hold on the GOP. The few remaining Republican dissenters in Washington need to put up big fundraising numbers if they hope to stave off a purge.

The Republicans' mixed mandate message

Illustration: Annelise Capossela/Axios

Republicans have expressed selective rage amid the rise of the Delta variant: They rail against the return of indoor masking but are far less vocal about vaccine requirements.

Why it matters: Masking may help reduce the spread of the coronavirus, but the real solution to the pandemic is getting more Americans vaccinated. Increased support for that — including the use of heavier-handed methods like mandates — will only increase its chance of succeeding.