Pennsylvania is preparing for a surge in measles cases, as public health officials warn that it may be “only a matter of time” before the outbreak spreads beyond its current epicenter.
The state reported its fifth measles-related death last week, bringing the total to 943 confirmed cases across 39 counties. The outbreak comes as US public health officials face growing vaccine skepticism, amplified in part by the influence of controversial health secretary Robert F Kennedy Jr.
Pennsylvania’s response is further complicated by its public health structure. Unlike most states, the majority of its counties do not operate their own health departments; only seven of the state’s 67 counties have one.
Lancaster county, which lacks an independent health department, has recorded the state’s highest number of cases, with 381. Most are believed to involve Amish or similar religious communities, where uptake of the measles, mumps and rubella (MMR) vaccine has historically been low. Health officials, doctors and community members are now working to establish a county health department to strengthen the response.
Jeanne Franklin, director of Chester county’s health department, said her county has recorded the third-highest number of cases, at 83, and is preparing for more infections from neighboring Lancaster.
“We have a very long border with Lancaster county, and these types of disease don’t care about borders,” Franklin said. “It’s going to keep going and find a person who isn’t vaccinated. We’re operating with the assumption that the disease may jump and spread to non-Plain [Amish] community members. Our goal is to prevent that, but we assume that it may happen.”
Franklin said the low vaccination rate among many Amish residents should not automatically be interpreted as vaccine opposition. In many cases, she said, people were “either unaware of it or they don’t seek out healthcare as frequently as other residents”.
“But they’re willing to have the conversation and make a decision on what’s happening today,” she added. “They’re not making decisions based on the myths out there, but because their neighbors are impacted.”
Alongside active case surveillance, contact tracing and the creation of community vaccination clinics, Chester county is working to counter misinformation about vaccine safety.
“We have people in key positions saying it isn’t an outbreak, it isn’t a problem. We have people who approach our nurses and say that they were told the vaccine will make them sterile, or that there’s a microchip within it,” Franklin said.
Franklin believes Chester county’s status as one of the few Pennsylvania counties with its own health department gives it an important advantage in containing the outbreak.
“By having our own health department [it] means that we already have the infrastructure in place, and we prepare for these things all year round,” Franklin said. “With the number of counties [the state has] to provide support to, they can’t possibly know all the key partners in a geographical area.”
She added: “The state has a finite set of employees, while I can pull my employees away from their normal jobs and say we need help with this. We live here, we know it, and we’re working with the communities and the organizations who know us. I think every county needs a health department, but we’re just not set up that way in Pennsylvania while other states are.”
Dr Richard Lorraine, medical director of Montgomery county’s office of public health, said it is a “matter of time” before Pennsylvania’s third most populous county begins reporting measles cases.
“We recognize that essentially it’s all around us, and so a big focus for the county is immunization,” Lorraine said. “It’s the best preventative measure and where the county is focusing its efforts on.”
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Lorraine said Montgomery county was working with community organizers to ensure that every resident could receive a vaccination, regardless of insurance coverage.
“Because we are a public health agency, our mandate is to provide for members of our population for the most part who are underinsured, and there’s a very high percentage who aren’t insured,” Lorraine said. “And through our partnership with pharmacies we’re able to open these clinics for everyone. So whether you have insurance or if you don’t, we can work it out so that someone is able to administer a vaccine.”
Lora Werner, the director of the Delaware county health department, said that her agency is facing several challenges in protecting residents from the virus.
Among them was the collapse of Crozer Health, Delaware county’s largest healthcare system, due to bankruptcy last year.
“They were a huge provider of pediatric care,” Werner said. “And although we do have a high vaccination rate across Delaware county, there are pockets where they aren’t as good.”
For Werner, the newly established local health department has been a gamechanger for promoting public health initiatives in the county.
“We are the newest health department on the block, and we’re so passionate about the fact that we’re now here and can serve our residents,” Werner said. “We’re deeply integrated into the social networks.”
She added: “Creating a new department was very challenging, and we’re a very odd state in this regard,” Werner said. “If you want to have one you need to have a referendum to establish one. But it’s not required, so we have a mishmash of the counties that have taken that step and those that have not.”
The Guardian has approached the Pennsylvania health department for comment.
