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Morbilli, more commonly known as “measles,” is caused by Rubeola virus that results in a highly contagious disease that infects the respiratory system, immune system, and skin. Initial symptoms are a high fever, runny nose, bloodshot eyes, and white spots on the inside of the mouth. It then develops into a rash that spreads downwards (Naim, 2018). Logically, because this is such a contagious disease, anyone who comes into contact with someone who has measles will most likely contract the disease, and this is why the problem exists; additionally, in my opinion, the symptoms do not seem to be quite drastic until later, so the individual might not recognize that they have measles and continue to interact with others, resulting in a higher risk of infections. Measles happens when the virus is transmitted through either direct contact, airborne exposure, or droplet exposure; coughing, sneezing, or even just talking to someone with measles will increase exposure. Measles can occur anywhere, but an individual will mostly likely become more infected if they live in a place with low vaccine coverage. An example would be the Netherlands in 1999, where there was a study conducted in which they found out that elementary students who were vaccinated showed no symptoms of measles compared to those who were not (Van Den Hoff, et. al, 2001). Moreover, because of the disease’s contagious nature, places with high vaccine coverage can have outbreaks through international travel; this is how outbreaks can occur anywhere.
Thinking on social justice terms, measles causes problems in society because it can cause many people to develop diarrhea, pneumonia, or complications in pregnancy; people should have the right to good health if the disease is preventable. On a cost-benefit analysis level, I believe that measles is a problem in society because it can spread so easily that more people will have to be hospitalized at an exponential rate; there will be overcrowding in hospitals where the disease can spread to other people; additionally, the hospital would run out of resources to treat people.
According to the Centers for Disease Control and Prevention (2019), there have been the most cases of measles in the U.S. in 2019 since 1992; the CDC lists the main cause of the outbreaks as international travel. Although I do believe that this is a factor, I think that another main reason is that there is a lot of anti-vaccination movements in which people believe that vaccines can be harmful to the body; this creates misunderstanding and uncertainty in a preventative measure, which leads to higher risk of infection among the population. According to Azhar Hussain (2018), the measles vaccination (MMR) is one of the most controversial, and the anti-vaccination movement affects society because it is a regression in modern medicine, which is why it has recurred in the U.S, even though we believed it to be eliminated in 2000.
There are misconceptions that measles mostly occurs in children, but it can actually affect everybody; humans are also the only host capable of getting the Rubeola virus (White, et. al., 2019). I believe that its highly contagious nature allows for everybody, regardless of age, sex, and race, to be infected. However, people are more susceptible to measles when they come from places without routine immunizations, especially underdeveloped countries, which also spreads when they travel (White, et. al. 2019). According to John T. Watson (2007), from the World Health Organization, another etiological factor is natural disasters; for measles specifically, natural disasters can cause overcrowding in clinics, which spreads the disease; natural disasters can also interrupt immunization routines (Watson et. al., 2007).
In my opinion, the risk of more measles outbreaks in the future could be increased if we do not try to have more urgent and preventative actions, which will be discussed in the next section.
Ways to solve the public health problem
According to the World Health Organization (2019), there is no specific treatment to combat the Rubeola virus. However, we can still try to prevent measles with two strategies: vaccinations and better enforcement of basic hygiene.
The CDC states that the measles vaccination, called the MMR vaccine, protects individuals from mumps, measles, and rubella. People are recommended to get two doses of the vaccine, one at 12-15 months and one at 4-6 years. It has been shown that one dose is 93% effective and two is 97% effective (Centers for Disease Control and Prevention, 2019). In my opinion, the MMR vaccine is probably one of the strongest ways that we can combat measles. As previously stated, we can simply see that it is statistically effective. Additionally, if many people are vaccinated, it would protect those who cannot be vaccinated, which is herd immunity. The fact that this is a possibility means that vaccinations are effective. We can also raise awareness of vaccinations through campaigns, such as the one in Uganda in October 2019, in which 18 million children were vaccinated, 43% of the population (Kampala, 2019). Because this is an underdeveloped country, many people did not have the vaccination and there was a higher risk of measles outbreaks. With a campaign, they can prevent many people from getting measles and also make people aware that there is something that can prevent measles.
An overlooked strategy to prevent measles would be having basic hygiene, such as washing your hands, not touching your face often, and sneezing into a tissue. I think that many people skip out or are relaxed about these strategies because it happens so often, so they automatically assume that nothing will happen, but because a means of transmission for measles is direct contact, we should be more cautious about hygiene. At the very least, though, we should be more hyper-active about hygiene when there is an outbreak occurring.
Another almost compounding factor that I would like to add is combating climate change. As previously stated, natural disasters can cause measles outbreaks, and climate change can make natural disasters worse. If we can work together to decrease our influence on climate change such as reducing waste and carbon emissions, then they would not be as severe and we could better handle an outbreak of measles if it ever occurred during a natural disaster. This would be primary prevention.
A historical example of taking preventative measures to reduce measles outbreaks is changing the vaccination from one dose to two doses. This was proposed by the Immunization Practices Advisory Committee (ACIP) in the 1980s.
A cultural example of preventative action is when the Measles-Rubella Initiative worked with the Philippines Red Cross (PRC) in February 2019. There was an outbreak of measles and more than 12,000 cases were reported. During this ordeal, the hospitals were overcrowded; similar to natural disasters, overcrowding can easily spread the disease because more people are in contact with each other; in this case, people had to share beds with one another. The PRC intervened by setting up Measles Care Units, in which they provided beds and emergency rooms for suspected peoples; the PRC also gave vaccinations and informed people on measles (Measles-Rubella Initiative, 2019). I think that this is important that we inform people of how one can contract measles, so that an outbreak like this does not happen again.
Public health in the future
Research suggests that the most effective method of measles prevention is the MMR vaccine. According to the Morbid and Mortality Weekly Report (1989), 400,000 cases were reported every year in the United States before the vaccine; afterwards, the numbers decreased. However, they decreased even further with the introduction of the recommendation to get two doses of the MMR vaccine, instead of one. As previously stated, one dose is 93% effective and two is 97% effective. Because we cannot directly combat the virus, the best we can do is to make sure the vaccines are potent. The FBR Administration suggests that we can ensure this by keeping them in optimal conditions: there are certain temperatures, lights, and places that we should store the vaccine in the refrigerator (FBR Admin, 2018).
I personally believe that we should push for world-wide vaccinations, except for those who cannot, such as people undergoing chemotherapy or newborn babies, but in that case, we will have herd immunity. However, I do acknowledge that it would be a hard and lengthy process to achieve this because of the vaccine’s controversial nature: there are many people who are anti-vaccine. These people are firm on their beliefs that vaccines are harmful, but the best we can do with them is to try to inform them with undeniable statistics or show them to actual people who have converted because they are more likely to believe someone similar; they might not believe plain statistics, but they will believe more local sources. We should also completely enforce mandatory immunization routines, such as the ones in place at UCI or to enter kindergarten. Ultimately, in order to completely eradicate measles, we would need a large intervention with vaccinations.
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