Pennsylvania is bracing for a surge in measles cases, with some public health officials fearing it is “only a matter of time” before the disease spreads beyond the epicenter of the outbreak.
Last week, the state reported its fifth measles-associated death among 943 confirmed cases in 39 counties. The outbreak comes amid concerns that public health in the United States is being hit by growing skepticism about vaccines, particularly because of the power and influence of controversial Health Secretary Robert F. Kennedy Jr.
Contributing to this challenge is the fact that Pennsylvania is one of the few U.S. states where most counties do not have their own health department, with only seven of 67 counties having theirs.
Lancaster County, which does not have its own health department, had the highest number of cases at 381, likely among the Amish or similar religious groups who have historically low rates of measles, mumps and rubella (MMR) vaccination. County health officials, doctors and other community members are now trying to create their own health department to better combat the outbreak.
Jeanne Franklin, the director of the Chester County Health Department, said her county, which has the third highest number of cases, with 83, is preparing for an influx of cases from neighboring Lancaster.
“We have a very long border with Lancaster County, and these types of diseases don’t care about borders,” Franklin said. “It’s going to continue and find a person who is not vaccinated. We are operating under the assumption that the disease can spread and spread to members of the non-Plain (Amish) community. Our goal is to prevent that, but we assume that it can happen.”
She added that while many Amish have not been vaccinated, it is not because they are anti-vaccine, but rather because “they are either unaware of it or they do not seek health care as often as other residents.”
She added: “But they are willing to have the conversation and make a decision about what is happening today. They are not making decisions based on myths, but because their neighbors are affected.”
Through active surveillance of measles cases, contact tracing and the establishment of community vaccination centers, the county is also working to clear up misinformation some of its residents have regarding the safety of the vaccine.
“We have people in key positions saying it’s not an outbreak, it’s not a problem. We have people coming up to our nurses and telling us they were told the vaccine would make them sterile, or that there’s a microchip inside,” Franklin said.
But for Franklin, the fact that Chester County is one of the few counties with its own health department is a distinct advantage in the race to stop the spread of the disease.
“By having our own health department, it means 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 must) support, it’s impossible to know all the key partners in a geographic area.”
She added, “The state has a limited number of employees, whereas I can take my employees away from their normal jobs and say we need help with this. We live here, we know this, and we work with the communities and organizations that know us. I think every county needs a health department, but we’re just not organized that way in Pennsylvania like other states.”
Dr. Richard Lorraine, medical director of the Montgomery County Public Health Office, said it’s only a “matter of time” before Pennsylvania’s third-most populous county begins recording measles cases.
“We recognize that it’s basically all around us and so the county’s primary focus is on vaccination,” Lorraine said. “This is the best preventative measure and what the county is focusing its efforts on.”
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Working closely with community organizers, Lorraine said the county is ensuring every resident can be vaccinated regardless of their insurance status.
“Because we are a public health agency, our mandate is to provide for those in our population who are mostly underinsured, and there is a very high percentage of people who are uninsured,” Lorraine said. “And through our partnership with pharmacies, we’re able to open these clinics to everyone. So whether you have insurance or not, we can find a solution for someone to administer a vaccine.”
Lora Werner, director of the Delaware County Health Department, said her agency faces several challenges in protecting residents from the virus.
Among them was the collapse of Crozer Health, Delaware County’s largest health system, due to bankruptcy last year.
“They were a huge provider of pediatric care,” Werner said. “And while we have a high vaccination rate throughout Delaware County, there are pockets where they are not as good.”
For Werner, the newly created local health department has been a game-changer in promoting public health initiatives in the county.
“We are the newest health department in the neighborhood and we are very passionate about the fact that we are now here and can serve our residents,” Werner said. “We are deeply integrated into social media.”
She added: “Creating a new department has been very difficult, and we are in a very strange situation in that regard,” Werner said. “If you want to have one, you have to have a referendum to establish one. But it’s not required, so we have a hodgepodge of counties that have taken that step and those that haven’t.”
The Guardian has contacted the Pennsylvania Department of Health for comment.
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