My apologies to William Shakespeare. The quote above was actually “out, damned spot, out, I say!” and uttered by Lady Macbeth in his play, Macbeth. Lady Macbeth was sleepwalking with perceived blood on her hands and was apparently guilt-ridden from murders in the play. She could not get the spot to go away. This quote is repeated often, usually in jest, as people joke about things that won’t go away. The “spot” either returns or lingers and is either annoying or a downright nuisance.
I am purposefully using this quote to dramatize a “spot” that has returned and won’t go away. While the analogy might be a bit farfetched, it provides a dramatic comparison to a current problem that is unfortunately centered in my now home state, South Carolina. Measles is the spot that is annoying and a downright nuisance with potentially serious consequences.
One of the features of measles is Koplik spots. They are described as bright red spots with a white center that may resemble grains of sand. Typically occurring on the inside of the cheeks before the generalized measles rash, they are pathognomonic (doctor talk for a hallmark feature). Avoiding the potentially serious consequences (pneumonia, ear infections, hearing loss, encephalitis and even death) should be a concern for all.
From Infectious Diseases in Children, 7th ed. Krugman and Katz
What’s my point? I want us to get rid of Koplik spots and therefore measles. The current outbreak of measles in SC was predictable. The previous outbreak in Texas occurred in an area where vaccination rates were lower than needed for control and eventually resolved with aggressive public health measures and increased vaccinations. The same is true about SC – an area where falling vaccination rates due to an increase in religious non-medical exemptions was noted several years ago and pediatricians and public health officials worried about the possibility of an outbreak. Well, it happened, and the numbers continue to grow.
I am particularly distressed with the current state of affairs. My esteemed mentor and Chair of Pediatrics during my pediatric residency in the late 1970s was a pioneer in developing the measles vaccine in the laboratory of Dr. Enders in the 1950-1960s. Dr. Sam Katz – researcher, scientist, pediatrician, infectious disease specialist, administrator, and humanitarian – spent his entire life protecting children and families.1 He would be very disappointed with the loss of protection for all children and the deterioration in the confidence of public health measures.
I share in his perceived disappointment. The measles outbreak in SC (and other places in the country) is preventable. It is due to multiple factors that can and should be overcome.
- Misinformation/disinformation – Misinformation (the unfortunate spread of inaccurate information) and disinformation (the purposeful spread of inaccurate information) have been disseminated all too frequently recently, especially since the COVID pandemic. These two types of bad information go unabated when fear and lack of trust are rampant. Trust in our system of public health, its personnel and its information is totally dependent on truth.2
- Deterioration in public health – the current administration (Department of Health and Human Services) has replaced or eliminated experts on immunization, public health and research to the detriment of our public health and medical research. When this occurs, their replacements are less competent and less trustworthy.
- Lack of understanding about science – science is not static. It is constantly evolving and strictly adheres to the scientific method.3 When the COVID pandemic hit, many people expected specific advice that would fix everything. Science doesn’t work that way. It analyzes data, interprets the results and suggests policies based on that process. In a newly emerging situation, science is our best chance, but it is imperfect. The chemotherapy of today is vastly different from the chemotherapy of decades ago and for good reason. Data was analyzed, results were interpreted, and changes were recommended. Yet some science stays static but only because continued data confirms its safety. Vaccines fall in this latter category. Vaccines continue to be safe but are always evaluated and reviewed.
- Distrust of experts – public health officials have extensive training in the multiple aspects of disease. Their education is exhaustive, their ongoing certification process is rigorous, their commitment to continuing education is well-known, and their dedication to their fellow citizens is unmatched. To dismiss the advice of these devoted individuals is a disservice to them and to our entire system of health and medical care and erodes decades of progress.
- Lack of understanding about social responsibility – We all have a responsibility to assure the safety of others. We obey traffic rules. We don’t smoke in public places anymore. We require seat belts to minimize any severe injuries or deaths. Vaccinating for preventable diseases that can protect our children and adults is one of our responsibilities as citizens. And vaccination rates need to be exceedingly high to be effective for all children.
- Leaders do not lead – When public health problems bubble over, it is insufficient to have our leaders leave the problem to just the public health officials when there is so much more to do. When an ice storm or hurricane is headed our way, our governor heads right to the microphone. He should be doing the same for the measles outbreak, encouraging the populace to step forward and take the right steps to curb the spread.
We know the right way to rid our state of Koplik spots and the concomitant rash. Public health measures (identification, quarantine) and robust rates of safe and effective vaccinations can do it. Eliminating misinformation/disinformation, restoring public health systems, enhancing the understanding of science, eliminating distrust, taking social responsibility and having leaders lead can all help us achieve “out, damned Koplik spot, out, I say!” We know how to do this. We just need the resolve.