Between 500 and 1000 years ago, military soldiers had tasks and responsibilities that included manning the ramparts. This required skill, initiative, experience, training, and the ability to discern when a foreign army might be preparing to attack, or the insight of a sniper capable of spotting enemy actions from a thousand yards away. This assignment was crucial for the inhabitants of a walled city, as their lives and security relied on these well-trained sentries. At the sound or sight of an approaching army or death squad, they would raise the alarm, giving the city’s inhabitants ample warning to defend themselves. Unfortunately, the consequence of dereliction of duty could be an enemy breaching the city walls, leading to death and destruction.
We are now living in 2025, and the fortress we are guarding is the United States of America. As PAs and NPs, we are the frontline guardians whose responsibility is to go beyond the diseases with which we are familiar, but also to follow the Boy Scout motto and be prepared to investigate, research, and become aware of diseases that were once considered almost obsolete. We need to start this task and duty by examining the diseases that we believed were under our control because the new drastic cuts in healthcare providers and research could potentially lead to the demise of many of our citizens due to ignorance and unpreparedness.
Among the diseases that have been nearly eradicated are smallpox, polio, German measles, pertussis, chickenpox, mumps, and diphtheria. In 1978, the CDC set a goal to eliminate measles from the United States. The measles vaccine, introduced in 1963, had a significant impact and was further enhanced in the world of childhood diseases by the development of MMR. In 2000, the CDC reported that measles had been eliminated from the US, as there had been no continuous disease transmission for more than a year. But what have we seen in the past six months? We have seen a resurgence of this disease, first in Texas and now in 19 states. The U.S. has confirmed more than 480 cases across these 19 locations, the highest total since an outbreak in 2019 sickened more than 1200 people. On March 26, Ohio became the fifth State to declare a measles outbreak this year, joining Texas, Oklahoma, Kansas, and New Mexico. There has been at least one case this year in Alaska, California, Florida, Georgia, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, and Rhode Island. The CDC reports that 70 patients have been hospitalized for measles so far this year. One unvaccinated child died from the virus on Feb 26 in Texas, the first recorded measles death in a decade.
Who is most affected by measles? Nearly all confirmed cases -97%- have occurred in unvaccinated patients or those whose vaccination status was unclear. Only 2% of cases have been transmitted to patients who received the MMR (measles, mumps, and rubella) vaccinations. Two doses of the MMR vaccine are 97% effective in preventing this virus, and one dose is 93% effective. Do you think it is necessary to encourage our patients to receive this vaccine, and will you place the order starting Monday?
The most susceptible patients, 75%, are people 19 years old and younger. 1/20 children will go on to develop pneumonia, and 1/1000 pediatric patients develop brain swelling, which can lead to hearing loss, intellectual disability, and death. Why play the numbers when our children trust us to make these decisions based on our love and commitment as parents? However, the US Secretary of Health, RFK Jr., has stopped short of calling on people to be vaccinated. “The decision to be vaccinated is a personal one,” he wrote in a Fox News article on March 2. “Vaccinations not only protect children but also contribute to community immunity, protecting those who are unable due to medical reasons”.
My personal ethical decision is to support the literature, seek out best practices, and diligently follow them, as expected by our patients who trust us with their health and lives. Scientific knowledge that is unbiased yet proven is the standard for all PAs and NPs. What reason would you have for withholding an MMR from your patients besides a belligerent parent with vaccine phobia? What justification could you provide to a prosecuting attorney and a jury for withholding this act of concern for their health? What excuse would you offer to a jury if your patient is in the 1/20 group? How would you personally feel knowing that your failure to take appropriate medical action was responsible for a morbidity case? While you’re at it, what malpractice policy do you have to protect yourself in adverse events? Who will support you in a medical liability case? This spring would be a good time to plant an essential seed in your budget and purchase a medical liability insurance policy that is an occurrence policy and to look for an A.M. Best Superior plan, which will support you in the future and provide the same security that you offer to your patients when ordering an MMR vaccination.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
