As measles outbreak grows, primary care physicians can promote vaccines by building trust with patients

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As the nation watches effects of a measles outbreak and questions the safety of vaccines, a trusting relationship is key for primary care physicians to overcome vaccine hesitancy among patients, said experts from Johns Hopkins Bloomberg School of Public Health (JHBSPH).

On March 19, JHBSPH professors William John Moss, MD, MPH, and Anna P. Durbin, MD, met online with news media to discuss “Vaccines: Purpose, Effectiveness, and Safety.” They talked about the latest developments about communicable diseases, and slowing them — possibly eliminating them — through inoculations against those illnesses.

Their fields of expertise include international health and molecular microbiology, touching on diseases such as COVID-19, dengue, West Nile virus, Zika, malaria and more. Vaccines are also relevant in family medicine examination rooms across America, though it may take more than one discussion for primary care doctors to overcome patients’ reluctance about getting the jabs for themselves or their children.

Anna P. Durbin, MD
_{© Johns Hopkins Bloomberg School of Public Health}

“I think what we have seen time and time again, it's building trust,” Durbin said. “It may not be a decision that can be made in one office visit, but it's really, what we found time and time again, is that people go to sources that they trust for advice and for information, and so really building up that trust with the patient, having discussions, asking the patient what their concerns are, and really listening to what those concerns are, and having that discussion and building on it with each subsequent visit.

“As I said, you may not change minds in one visit, but it's really important to have a discussion, to be willing to listen to hear people's concerns, and try to do it to address those concerns as honestly as you can and in a way that the person can understand,” Durbin said.

Latest on measles

The measles outbreak is growing, Moss said, citing data from the U.S. Centers for Disease Control and Prevention (CDC).

William John Moss, MD, MPH
_{© Johns Hopkins Bloomberg School of Public Health}

As of March 14, there were 301 confirmed cases of measles across 15 jurisdictions. “But we know the true number is higher,” he added, with 279 cases in Texas and 38 in New Mexico, as of March 18, based on state figures.

Among those cases, approximately one-third are in patients younger than 5 years of age, but 42% are in patients aged 5 to 19 years, said Moss, who is executive director of the school's International Vaccine Access Center. Among the confirmed cases, 95% are in patients either unvaccinated or with unknown measles vaccination status, he said.

The vaccine protects up to 95% of people after one dose and up to 98% of people following the second dose, which is meant to immunize people who are not protected by the first shot. The CDC has logged a 17% hospitalization rate, with the largest proportion in children aged 5 years or younger, Moss said.

The 2025 tally already has surpassed 285 confirmed cases in 2024 and 59 cases in 2023. Measles surged globally in 2019, with 1,274 cases in the United States, largely due to outbreaks in an orthodox Jewish community in New York and an Amish community in Ohio, Moss said.

He used an analogy to describe the current spread.

“There are two conditions for measles outbreaks,” Moss said. “You have a susceptible community, a group of susceptible people, and you have an infectious person enter that. I like to think of this as like a forest fire with sparks spreading out, and if those sparks land in a community with low vaccine coverage, we're going to see a larger measles outbreak. If it lands in a community with a high vaccine coverage, we may only see one or a few cases.”

Size of an outbreak

Modeling the spread of measles can be rather straightforward, depending on three factors, Moss said:

• The proportion of a population unvaccinated.
• The frequency of contact they have with each other.
• The probability of an infectious person entering that community.

“And this is what we're seeing in West Texas, in the Mennonite community there, with low vaccination coverage, down in the low 80s, 80%, a tight-knit community, people coming into contact with each other, and then an infectious person entered and sparked this large outbreak,” he said.

Vaccine success

It’s true that patients in 2025 may not be familiar with certain diseases because vaccines have been effective in controlling them and preventing children from becoming ill and dying, Durbin said. “I like to say that vaccines really are a victim of their own success,” she said.

Smallpox, a devastating disease with a death rate of almost 30%, has been eradicated due to vaccination. In the past 50 years, vaccines have saved the lives of more than 150 million children. Incidence of diphtheria, measles, mumps and polio are all down more than 99% in the United States, Durbin said.

She recounted stories from her mother, who described effects of polio in the United States. In her own travels, Durbin said in other countries she has seen evidence of past polio infection, such as people with one leg smaller than the other, the “withered limb” of polio. Durbin also cited the author Roald Dahl, known for “Charlie and the Chocolate Factory” and other volumes, who later wrote about the death of his eldest daughter, Olivia, 7, when her measles turned into measles encephalitis.

“Nobody wants to see these diseases come back, and that's why vaccination is so important,” she said.

Are adults immune?

When a child gets a shot against a disease, some vaccines, such as the measles vaccine, appear to offer protection for life. Even if antibodies wane, the body can have a memory immune response that develops rapidly to protect against measles, Moss said.

With other vaccines, some, such as those against tetanus and diphtheria, have waning immunity over time. Some, such as influenza and COVID-19, work against viruses that change year to year, Moss said. While it is possible to check antibody levels, Moss said he does not foresee a future in measuring antibody levels across different pathogens.

Alternative therapies

It is true the World Health Organization (WHO) recommends vitamin A supplementation for children with measles and with a nutritional or vitamin A deficiency, Moss said. But that is a controlled dose, he added.

Taking cod liver oil or other types of vitamin A in excess amounts can cause toxicity. Any promoted alternative therapies don’t prevent infection — vaccines do, Moss said.

Measles un-eliminated?

Measles was declared eliminated in the United States in 2000, Moss said. If a country has achieved elimination by reducing outbreaks to less than 12 months, then has an outbreak longer than 12 months, it will lose that elimination status. The United States could lose its status, though there is a ways to go based on the current outbreak, he said.

Additional threats

Along with domestic cases that originate in the United States, measles remains a disease that travelers bring back from other countries, Moss said. So are many others, and U.S. policy on disease research, and conditions in other countries, all can have effects on patient health and public health.

When asked about concerns about a potential resurgence of tuberculosis, Moss noted that illness “is a very different beast than measles” — and one with no effective inoculation.

“It's a complex infection,” he said. “People can be infected and asymptomatic and go undetected, and we don't have a good vaccine against tuberculosis. There is concern that with decreasing funding from the U.S. government for global public health programs, including programs that combat tuberculosis, that we're going to see more tuberculosis globally, and again, we're at risk for more cases here in the United States.”

When asked about solutions for poor families in regions where medicines are costly, Durbin said more manufacturers would help, especially to increase production in areas of Africa and Asia.

“I want to emphasize that vaccines are one of the most cost-effective public health tools that we have,” she said. But being relatively inexpensive can create difficulty for companies to get involved because vaccines don’t make them a lot of money, Durbin said.

Aftermath of COVID-19

In the five-year anniversary of the start of the COVID-19 pandemic, it’s helpful to look back four years at health communications, Durbin said.

When the COVID-19 vaccine first came out, people were fighting to find access to it. Probably less than nine months later, vaccine hesitancy and resistance grew in the public, she said.

“I think part of it was our messaging was just not very good,” Durbin said. The early vaccines had greater than 95% efficacy against symptomatic COVID-19. Then people thought it would last forever — mistakenly, she said.

“We did a very poor job of really talking about what vaccines do, how they work, and what to expect,” Durbin said. “Vaccines are designed to prevent hospitalization and to prevent death. That's their high-level goal. We may not necessarily be able to, as I said, prevent infection or prevent, for instance, somebody getting a cough, a runny nose, a headache, even a low-grade fever from COVID. But we know that these vaccines prevent hospitalization and they prevent death, and that's really the important goal. And I think as public health practitioners, we just did not do a good job.”

Future of mRNA vaccines

The physicians did not specifically cite the administration of President Donald J. Trump or Robert F. Kennedy Jr., his secretary of the U.S. Department of Health and Human Services, who has publicly questioned the safety and effectiveness for vaccines, especially relating to children’s health. But they answered press questions relating to the current atmosphere around politics and medicine in Washington, D.C.

There is great potential in development of mRNA vaccines, but there is concern the administration could slow down or halt that research, Durbin said.

Vaccine policy also is a concern, Moss said, citing the Texas measles outbreak and “more muddied messaging from the federal government.”

“I am concerned that we're going to see an undercutting of what has been a highly successful immunization program here in the United States,” Moss said. “And so the combination of undermining confidence in vaccines that will lead to decreased vaccine coverage here in the United States, and a withdrawal from the World Health Organization and other global organizations that are combating vaccine preventable diseases overseas, we are setting ourselves up for larger and more frequent outbreaks of these vaccine preventable diseases that will be really tragic.”

To learn more

The physicians offered links to a number of additional resources for JHBSPH, CDC and WHO:

JHBSPH: International Vaccine Access Center

Center for Immunization Research

The Science of Vaccine Safety in the United States

Vaccines 101: The Basics of Vaccines and Vaccination

CDC: Measles Cases and Outbreaks

Vaccine Schedules for You and Your Family

WHO: Global immunization efforts have saved at least 154 million lives over the past 50 years