I helped declare the U.S. measles-free in 2000. I’m dismayed by where we are now
I started my medical career in the early 1990s as a vaccine nihilist. The immunization seminar during my residency was dry and uninspiring. I offered vaccines to my patients and was adherent to the routine schedules, but certainly did not go out of my way to encourage or cajole. I neglected to have my first child vaccinated against chickenpox; the scars are still present.
Twenty-five years ago this week, however, I attended the [2000 CDC Measles Elimination Meeting in Atlanta](https://www.federalregister.gov/documents/2000/02/24/00-4334/elimination-of-endemic-measles-from-the-united-states-meeting). I had been asked to represent the American Academy of Family Physicians at this event, arriving with my relative youth and little to offer, other than an understanding of primary care practice. In 2000 alone, [1 million children](https://www.who.int/news-room/fact-sheets/detail/measles) from across the globe died of measles.
On March 16 and 17, 2000, I received a crash course in measles biology, molecular epidemiology, immunology, and vaccine science. I was blown away by the ability of a simple and safe intervention to change the world. From a relative high of nearly 28,000 cases in 1990, only [85 cases were recorded in 2000](https://www.statista.com/statistics/186678/new-cases-of-measles-in-the-us-since-1950/), all of which were imported. We concluded that measles had been eliminated in the United States, a mere 36 years after the introduction of the measles vaccine. The three-ring binder from the meeting, full of dated reprints, still sits on the bookshelf behind my desk.
I review the roster of participants; some of the 22 attendees became my good friends and colleagues in the ensuring years. Now, nearly half are retired or deceased. Three of us went on, joined by two other experts, to recertify measles elimination in 2012. In the meantime, I participated in rubella and congenital rubella elimination certification in 2004, and — extending over 12 years — became a liaison to the U.S. Advisory Committee on Immunization Practices (ACIP). In time, I was appointed as a voting member, became the vice chair, and then served as chair of the world’s preeminent vaccine advisory committee. I also chaired work groups on MMRV vaccine safety, evidence-based vaccine recommendations, and the revision of the MMR vaccine recommendation.
My intimate involvement with ACIP taught me that each recommendation is the composite of thousands of hours of time volunteered by subject matter experts and professional society liaisons, bolstered by the dedicated CDC staff. Any safety concern is exhaustively and longitudinally evaluated and reported in transparency. Unfortunately, much of this work occurs in the background, making it difficult for the public to fully appreciate and understand.

After stringently avoiding conflicts of interest during my entire tenure on ACIP, I made the intentional decision to consult for a time so as to learn of the other side of the vaccine enterprise. I didn’t do much and stopped after a couple of years. Like many of my contemporaries, money was not much of a motivator. Perhaps that makes us unfamiliar and perplexing to pundits and politicians. Rather, I look at my ACIP colleagues and find resolute servant leaders in science, public health, and infectious diseases.
I now scan the reports of measles re-emerging in Texas and New Mexico with a bit of sadness and disbelief. A simple vaccine bought us 25 years of freedom from a highly contagious and medically significant disease. Over the same 25 years, we witnessed a [90% reduction](https://www.who.int/news-room/fact-sheets/detail/measles) in global childhood deaths due to measles. And yet, we seem to be willing to abandon such success for “a pocketful of mumbles such are promises,” as [Simon and Garfunkel](https://genius.com/Simon-and-garfunkel-the-boxer-live-lyrics) put it.
Other great hopes have dimmed as well. For a time, the entire Western Hemisphere had attained measles elimination, only to be shattered as [Venezuela descended into political chaos](https://apnews.com/article/covid-health-venezuela-public-caribbean-93dced67f765654da6d616b534377566). I am not naïve enough to presuppose that measles will come back as an overwhelming pandemic; it may return as a not too uncommon infection, with occasionally devastating results. When easily prevented, measles is still a tragedy.
My career as a family physician, educator, and researcher has been intimately intertwined with measles and immunization policy. I write on this anniversary to bear witness to the recent but potentially fleeting miracle of elimination. Speaking for my many past and current vaccine colleagues, living and dead, our desire has always been for the health and safety of the least of us — or in the words of naturalist [Loren Eiseley](https://www.harpercollins.com/products/the-unexpected-universe-loren-eiseley): “a child or… a grownup past hope.”
_Jonathan L. Temte is a professor of family medicine and community health and the associate dean for public health and community engagement at the University of Wisconsin School of Medicine and Public Health._
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