As PA measles outbreak intensifies, so does the political polarization around it

Pennsylvania’s first major measles outbreak in 35 years exploded into a political firestorm this week, with social-media controversy over the state’s two recorded measles deaths dividing leaders from the political, health and business communities – largely along party lines.

At the center of the current debate is whether the two official measles victims actually died of the highly contagious virus, which has sickened at least 460 unvaccinated Pennsylvanians since the outbreak began in Lancaster County in April; it has since spread to 30 other counties.

The controversy flared up on Wednesday, just after Gov. Josh Shapiro announced a broadening of the state’s measles response to curb the widening outbreak, when he and U.S. Health & Human Services Secretary Robert F. Kennedy Jr. traded accusations in a heated exchange on the social media site X.

Shapiro slammed the federal health czar – a lawyer with a decades-long record of anti-vaccine activism – for “inaccurate and misleading” statements about measles and the MMR vaccine, which prevents it. For his part, Kennedy accused the governor of “gaslighting” residents and Shapiro’s staff of “fabricating” the two official “measles-associated” deaths, which state Secretary of Health Debra Bogen reported on Tuesday.

Also on Wednesday, Lancaster County Commission Vice-Chair Josh Parsons, a Republican, wrote the first of what have become dozens of X posts pushing back against the assertion that his county’s residents died of measles. “They currently have zero measles deaths in Lancaster County. They have one death of a person who died WITH measles, but not from measles,” he wrote on Aug. 26, calling for “transparency” from the governor’s administration. “So as of right now, we have ZERO information that corroborates the idea that there were two measles deaths in Lancaster County.”

But on Friday, Stephanie Nojiri, a spokesperson for the state Department of Health, affirmed its position that measles caused the two reported deaths. “Every measles case, hospitalization and death is thoroughly reviewed to confirm it meets the CDC’s case definition,” Nojiri told City & State. “PA DOH uses the term ‘measles-associated’ when laboratory or epidemiologic evidence of measles is present, but the disease may not be assessed by the medical certifier or coroner to be the immediate cause of death. “It is vital to note that for communicable diseases, the infection itself is not always listed as the immediate cause of death and may instead be listed as an underlying or contributing factor. For example, if someone tested positive for tuberculosis (TB) and died from complications of TB, like pneumonia, the immediate cause of death will likely be listed as respiratory failure, but TB would be listed as an underlying or contributing factor.”

Neither of the two victims has been publicly identified. Much of the controversy centers around one of them, a newborn male – too young to be vaccinated – who reportedly died from a “lacerated spleen” and tested positive for measles; inflammation of the spleen, which can lead to rupture, is a known potential complication of measles, which is often more severe in young infants.

“As a pediatrician with more than 30 years of caring for children, I have thoroughly reviewed the case investigation information and sadly can confirm that there were two recent measles-associated deaths in Lancaster County, which were reported to the CDC’s measles response team early Tuesday morning,” Dr. Bogen wrote in a Wednesday post on X from the Department of Health account. “DOH’s Epidemiology team thoroughly investigated and verified both individuals tested positive for measles.”

Parsons’ fellow Lancaster commissioner, Democrat and former critical-care nurse Alice Yoder, waded into the debate as well, writing in a Wednesday post on Facebook that “my colleague, Commissioner Parsons, is intentionally sowing misinformation and doubt in a trusted public health agency. This is dangerous.” 

Conservative backlash

Within hours of the Shapiro-Kennedy spat, conservative voices were contesting the state’s report, arguing that a “birth injury,” rather than measles, was likely the cause of the baby’s death. Among the skeptics is Lancaster County’s elected coroner, Dr. Stephen Diamantoni, a Republican and a family physician, who said on Tuesday that “no measles deaths were handled by our office” and that the investigation was ongoing.

But the pushback was hardly confined to either the commonwealth – on X, doctors from across the U.S. weighed in on the controversy – or the medical establishment.

“People who died from other causes tested positive for measles, although the measles did not kill them,” posted the PA Manufacturers’ Association, a pro-business group, on Wednesday in response to the DOH post.

On Thursday afternoon in Lancaster County, conservative activist Scott Presler posted on X: “In response to Governor Shapiro lying about the Measles deaths, I will be at the Green Dragon Farmers Market tomorrow…Leave the Amish alone,” he added, in a reference to the religious communities at the center of the outbreak.

In a Friday press release, state Treasurer Stacy Garrity – Shapiro’s Republican rival in this fall’s gubernatorial election – denounced what she called Shapiro’s “highly staged partisan press conference” and what conservatives view as a lack of transparency around the reported deaths. “There are still more questions than answers, largely because Josh Shapiro refuses to share the relevant information,” she said in the statement.

Many conservatives raised the specter of unpopular COVID-19-era public health mandates to criticize Shapiro, a Democrat, and tie him to the pandemic-era administration of former President Joe Biden. “Josh Shapiro recently proposed public health mandates that would make draconian COVID-era restrictions blush,” Garrity wrote, referring to the state Health Department’s first-in-decades proposed overhaul of public health protocols.

And Kennedy, in criticizing Shapiro’s “giddy delight in announcing two measles deaths,” called the governor’s Wednesday press conference “a replay of the Democrats' COVID playbook: fearmongering, misinformation, finger-pointing, and the weaponization of infectious disease fears for political gain.”

Fear among the farms

Those fears are an everyday reality for Lancaster’s busy agricultural sector, as was made clear in a Friday Zoom call hosted by PennAg, an agribusiness industry group, together with Bogen and state Agriculture Secretary Russell Redding.

“I’m not going to get caught up in the political craziness … This isn’t blue or red. I just want to figure out how to keep my farmers healthy and safe, and my employees healthy and safe,” Chris Pierce, the co-owner of Heritage Poultry Management Services, told the state officials. 

Agriculture involves a complex supply and delivery chain, making the industry particularly vulnerable to communicable disease. Pierce said that for months now, the specter of measles – which can incubate for up to three weeks – has been a daily challenge as his team regularly comes into close contact with a variety of service providers, including more than 100 poultry farms, feed trucks and egg pickup drivers. “I don’t know what their employees are and the exposure – what risk it would cause to them,” he said. 

In responding, both Redding and Bogen sought to lower the temperature of what has become a high-voltage debate in Lancaster – “being helpful here, not with the drama but with the facts, to make sure that folks understand the seriousness of this,” Redding said, adding that the department plans to raise awareness of measles at January’s annual Pennsylvania Farm Show.

Dr. Jennifer Wallace, the medical director of the state Department of Health’s Bureau of Community Health Systems, reassured farmers that measles is “strictly a human-to-human disease. 

“In agriculture … you worry about not only, obviously, your workers, but you also worry about your product,” she said. “And here’s the good news: Unlike with some other infectious diseases, measles is not going to be spread by the eggs raised by the farmer who has measles. 

But among people, she warned, “measles is one of the most highly contagious diseases known to mankind.” Wallace outlined the commonwealth’s more aggressive response to the outbreak, including home visits for those wishing to be tested or immunized for measles and updated MMR vaccination protocols. 

Going forward, she said, infants can get a first dose of the vaccine at six months of age ­– a half-year earlier than the standard protocol – and the second and final dose of the series at 2 years of age, rather than at ages 4 or 5, the common age for school-compliant immunization.

Wallace said the department is reaching out to newly diagnosed patients to perform contact tracing and, where appropriate, treat contacts prophylactically. Unvaccinated people can be protected by receiving the MMR vaccine within 72 hours of an initial exposure; for people who remain unvaccinated, those at risk of severe disease, including the elderly or infants, can receive a temporary protective treatment known as measles immunoglobulin within six days of exposure.

While the officials declined to address the controversy over Lancaster’s measles-associated deaths, Wallace did provide an overview of the virus’ frightening potential complications – including pneumonia – “we’ve seen a bunch of cases of that here in Pennsylvania” – and encephalitis. “Typically younger children who get measles, they will fully recover. And then five to 10 years later, they suddenly get a headache, end up with encephalitis, and die within 48 hours. Scariest thing ever as a parent,” Wallace said. “It is a rare complication, but it does happen … So go ahead and get those kids vaccinated. 

“And if you get a call from us, please answer our calls. We have a lot of people that don’t because they’re just afraid – ‘it’s the government, you know, why are they barging in on my private stuff?’” she added, nodding to the politicization around public health. “But it is really important because when we call you, it usually is because we know you’ve had an exposure or we’ve heard that you may be sick. And we can help keep your family safe.”