When measles made its way to Dallas County in April, it set into motion a well-rehearsed but rarely used protocol that quickly contained the disease. But the effort was not without significant costs. Several preventable outbreaks have trickled into North Texas over the past couple of years, imposing a hefty financial burden on the healthcare system, taxpayers, and the business community.
Earlier this year, a Tarrant County resident traveled abroad and contracted measles and brought the disease back to their employer before realizing they were infected. When a Dallas County resident tested positive, Dallas County Health and Human Services sent a team to the employer to figure out how many people were exposed and assess the risks of further spread.
Working in collaboration with the employer, DCHHS staff interviewed dozens of employees who had been in contact with the individual; several were asked to sequester themselves in their homes until it was clear that they hadn’t contracted the highly contagious disease. Fortunately, those who had come into contact with the infected individual were fully vaccinated and, this time at least, the disease was contained.
But it all came at a cost. The employer lost productivity for dozens of workers while they were interviewed, and also paid for blood tests for those who had been exposed. Some of the employees had to miss three weeks of work while they were sequestered.
The county epidemiologists and DCHHS staff, funded by taxpayers, had to be dispatched to find out where those who had been exposed had traveled while they might have been contagious. Because measles is so contagious and travels through the air, authorities can’t be too careful. “It starts this whole cascade of trying to contain it,” says Dr. Philip Huang, Dallas County’s health director.
A Growing Problem
By 2000, the United States had eliminated endemic measles through high vaccine rates, surveillance, and rigorous responses to outbreaks. Still, there have been hundreds of measles cases across the country in the last several years, often resulting from unvaccinated individuals traveling abroad and returning to a communities where there are lower vaccination rates.
A 2019 Journal of the American Medical Association article says that the cost of responding to a single measles case costs $142,000, depending on how many people were exposed and how many have to be quarantined. Post-exposure vaccination, laboratory testing, quarantining patients and those who have come in contact with them, and compensating healthcare providers and other staff make this disease especially costly.
“Vaccines are one of the greatest modern miracles. Propaganda against vaccines is really just that.”Michelle Kravitz Partner, Forest Lane Pediatrics
In April, the CDC released data that found 2019 to be the worst measles year since 2000, with 880 measles cases in 24 states across the country. CDC data shows that if a person is hospitalized with measles, the bill can run between $4,032 and $46,060. A University of North Carolina study funded by Merck, a vaccine producer, said vaccine-preventable diseases among adults cost the economy nearly $9 billion in 2015; about 80 percent of the costs were due to unvaccinated individuals.
Prior to the measles vaccine, two to three million people died globally every year, with the U.S. experiencing as many as four million cases and 500 deaths per year. Thanks to quick-acting healthcare providers, the cases in North Texas have been contained thus far, but as vaccination rates go down, the healthcare system could be at risk of significant and avoidable costs.
Local lawmakers are contributing to the conflict over vaccines, with fringe groups claiming (without scientific evidence) that vaccines cause damage to those who take them. Jonathan Stickland, a Republican representative from Bedford, brought up witchcraft in a recent Twitter argument with a vaccination advocate. “Make the case for your sorcery to consumers on your own dime,” he tweeted. “Like every other business. Quit using the heavy hand of government to make your business profitable through mandates and immunity. It’s disgusting.”
Stickland’s rhetoric coincides with an increase in vaccination exemptions in the state. The Texas Department of Health Services reported that for the 2018-2019 school year, the number of children exempted from vaccinations for non-medical reasons went up 14 percent. The number has grown since 2003, when the state began to allow parents to decline immunizations for reasons of conscience. There were 3,000 in 2003, and just under 57,000 last year. Although the overall percentages are still small, the report says that the rate is more than 40 percent at some schools. For a highly contagious disease like the measles, at least 90 percent of individuals need to be immunized in order to achieve herd immunity, which protects those who cannot be vaccinated for medical reasons.
Texas is one of 17 states that allows parents to opt out of vaccination, and no legislation in the latest session found success in trying to curtail the issue. A bill to publish vaccination rates by school and another by childcare facility (it is only available by district now) has not made it out of committee. The Texas DHS report noted that the North Texas region has among the lowest vaccination compliance rates in the state, with 14 counties in the area reporting between 1.6 percent and 3 percent of students claiming exemptions.
Preparing for the Worst
Although local health systems haven’t had to deal with many measles hospitalizations, the possibility means they have to be ready for a case to walk into the emergency room. Dr. Miguel Benet, chief medical officer at Medical City Children’s Hospital, says a facility that encounters a possible measles case must take precautions in order to keep patients and staff safe. “We basically assume measles are present until proven otherwise,” he says.
Patients with suspected measles are put in an isolation room with negative air pressure to make sure the highly contagious airborne disease isn’t spread through air conditioning systems. The hospital will then contact local health departments to ensure everyone is aware of the situation. Results from a throat swab or blood test can take around a day to come back, and isolation must be maintained until measles is ruled out.
Benet says that because the disease is so contagious, hospitals prefer to not admit patients unless they absolutely have to. The hospitals are likely to have immune-compromised individuals, such as infants who have not yet been vaccinated, and they have to take into account all of the ill patients.
At the clinic level, vaccinations have become a contentious issue, with many pediatric clinics saying no to families who refuse to vaccinate their children. Dr. Michelle Kravitz, a partner at Forest Lane Pediatrics with privileges at Medical City, says pushing for vaccinations is the moral thing to do for the patients at the clinic. “Vaccines are one of the greatest modern miracles,” she says. “Propaganda against vaccines is really just that.”
The clinic does not accept patients who are not vaccinated. It’s not just because of the risk; dealing with anti-vaccination families has proven to be a time suck, Kravitz says. She used to spend 30 minutes at every visit trying to convince parents that vaccines were safe for their child and best for society. “But they are ideologues and evidence doesn’t make a difference for them,” she says.
The health and financial costs of measles are frustrating for physicians because the disease is so preventable. As anti-vaccination rates go up, more time and money are spent dealing with measles cases, causing resources to be taken away from other crucial areas. Huang says the impact of vaccinations has, ironically, been a contributing factor. “We are a victim of our own success,” he says. “People have never seen the burden of these diseases.”