CDC, Pennsylvania’s growing feud over measles: 4 things to know

Pennsylvania health officials last week announced two unvaccinated people died from measles-associated conditions, including an infant.

But the announcement was just the beginning of a growing political controversy that’s pitting the Centers for Disease Control and Prevention (CDC) against the state’s health department.

The agency is publicly questioning Pennsylvania’s findings and has not yet counted the two in its national tally of measles deaths.

Here are four things to know about the clash.

Last week, the Pennsylvania Department of Health recorded the first measles deaths in 35 years.

Both people were unvaccinated, they lived in Lancaster County and the state described the deaths as “measles-associated.” But that was all the information shared initially.

When pressed for more details at a press conference, including for the ages of the victims, Gov. Josh Shapiro (D) and the state’s secretary of health Dr. Debra Bogen declined to elaborate, citing patient confidentiality. All they would say is the deaths were “measles-associated.”

Shapiro, who is widely expected to run for president in 2028, said he had spoken to Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and “made very clear that his actions and the rhetoric coming from this administration are having a negative impact on communities across America, particularly right here in Pennsylvania.”

The governor’s remarks set off a war of words between federal, state and local officials, including Kennedy, Shapiro, the Lancaster County coroner and county commissioners.

Anti-vaccine activists and Trump administration officials questioned whether the people had died from measles, or whether they happened to have measles but died from something else.

Some suggested health officials were using the phrase “measles-associated” to obfuscate the fact that the virus did not play a role in the reported deaths.

“They cannot find any measles deaths in Lancaster County,” Kennedy said the next day during an event in Florida. “The press is all covering this as if those measles deaths actually happened, but nobody is doing a little bit of critical inquiry to find out. We’re trying to figure out who those deaths were and whether they actually happened.”

According to the Pennsylvania Department of Health, the phrase is used when measles is present, but the disease may not be assessed by the medical certifier or coroner to be the immediate cause of death.

But none of that was discussed during Shapiro’s press conference, or in the initial statement from the state Health Department.

The CDC even released a statement applauding Kennedy’s “efforts to clarify conflicting information from Pennsylvania officials about whether the two reported deaths were caused by measles.”

Poor communication let misinformation flourish

The lack of initial details, seemingly contradictory statements from different officials and a vague phrase like “measles-associated” created an information vacuum that Kennedy and others quickly filled with misinformation.

Before any information was released, Ginger Taylor, who was recently appointed to serve on a federal autism research panel and has suggested there is a link between vaccines and autism, posted an image of a fake news headline claiming that the two patients were men in their 80s.

Public health experts said Pennsylvania officials also gave a masterclass in how not to communicate.

Amesh Adalja, an infectious disease physician at Johns Hopkins University Center for Health Security, said Shapiro shouldn’t have been the one giving a press conference.

“Since the very announcement of these deaths, this has been run like a political operation rather than a public health operation, and these are the results you get,” Adalja said.

Instead of defining the terms being used and emphasizing that there are open questions and an ongoing investigation into the cases, Shapiro attacked Kennedy.

“They operated it like a political operation, and they got burned,” Adalja said. “They hid behind statutes and refused to release information, and that created an information vacuum. They didn’t explain definitions, and it left them completely open for RFK Jr. to swoop in, and he did. And now there’s no way to really reverse all of this.”

After Shapiro’s press conference, details of the cases eventually began emerging, including that one of the deceased was an infant.

Then, the county coroner said the infant died due to a lacerated spleen and bleeding, not measles. He also said initially that his office had been notified of only one death, though Pennsylvania clarified that not all deaths must be reported to a coroner’s office.

He later changed his finding, saying measles was a “contributing factor” that was listed on the death certificate.

Kennedy revives ‘died from’ vs. ‘died with’ claims

Experts said when tracking an outbreak, there isn’t much of a distinction between whether someone died from measles or died with measles.

Having a measles infection when you die counts as a “measles-associated death” in Pennsylvania.

But the discourse is a common tactic among anti-vaccine activists. It was deployed during the COVID-19 pandemic to downplay the virus.

“They’re trying to play a word game to try to minimize the importance of measles,” said Demetre Daskalakis, the former director of the CDC National Center for Immunization and Respiratory Diseases.

“Kennedy and others are trying to take advantage of semantics, I think to try to create doubt around the importance of measles as a vaccine preventable disease,” Daskalakis said.

An example, Daskalakis explained, is if somebody who had underlying diabetes died of a heart attack. The heart attack was the immediate cause of death, but diabetes was the underlying reason for the heart disease and contributed to the death.

Critics say new CDC director failed her first major test

Dr. Erica Schwartz took charge of the agency last month amid a pledge to operate independently from Kennedy.

But in her first agency-wide meeting , Schwartz told agency staff that while she wouldn’t hesitate to disagree with Kennedy if necessary, she would not do so publicly.

During her confirmation hearing, several senators raised concerns that Schwartz would not stand up to the Health secretary.

Former officials and public health experts say those concerns have been validated, since the agency is now openly questioning Pennsylvania’s reporting of measles deaths.

Daskalakis said he is disappointed but not surprised.

“At the end of the day, I think that Dr. Schwartz has some really airtight credentials. Really sounds like a brilliant public health person. But I think being the CDC director role is not about appeasing your secretary; it’s about serving the people,” he said.

Adalja said the latest development is just more evidence that public health is being politicized, and the CDC can’t be trusted.

“I didn’t really have any high hopes for [Schwartz], and this just proves it,” Adalja said. “The CDC is a compromised organization. Its best people quit, or retired, or were fired. I think the CDC has been irreparably damaged by design by RFK Jr.”