Opinion: Make infectious disease data boring again

Amid soaring measles cases, the U.S. health secretary and leadership at his CDC have picked a fight with the Commonwealth of Pennsylvania about what counts as a measles death. The last thing public health needs is drama when the focus needs to be on responding to the outbreak itself. States have a standard process for notifying the CDC about notifiable diseases, using established case definitions. Developing those definitions is usually a long, deliberative process involving epidemiologists, scientists, and agency review through the Council of State and Territorial Epidemiologists and the CDC. Right now, that standard process is under threat and will further drive a wedge between states and how they work with the CDC and the administration. Although this methodical process may sound boring to the general public — even to many of us in public health at times — it ensures that data are collected, reported, and counted consistently. By working off a common definition and process, you know what the numbers mean and can trust what is being reported locally and nationally. If the data or definitions are subject to political interpretation, that trust and the nation’s ability to respond effectively are quickly lost. When outbreaks occur, states may call the CDC for additional assistance, including requests for highly specialized laboratory testing, help with contact tracing and data management, consultation on infection-control guidance, and critical countermeasures such as vaccines. Sometimes states request on-the-ground assistance through an “Epi-Aid,” supported by CDC’s well-known Epidemic Intelligence Service, the nation’s disease detectives. We were both at CDC working on the measles response when Texas reported the nation’s first death from measles in a decade, followed quickly by the second. Throughout that period, Texas followed the standard protocol: State officials investigated the cases, made the determinations, and notified CDC, which then included the deaths in its national reporting. CDC also provided the state with financial support, vaccines, and personnel on the ground to assist with counting cases, infection control protocols, and advice on air handling systems. These tragic deaths were certainly cause for alarm, but they were not entirely unexpected given the high number of cases during that outbreak. On average, 1 to 3 in 1,000 children with measles may succumb to the infection and its complications. What was unexpected was the active campaign by groups such as Children’s Health Defense to question whether measles had caused these children’s deaths, laying blame for their deaths on the hospital that treated them rather than the virus that sickened them while exploiting the grieving families. The health secretary also appeared on national television eating french fries cooked in beef tallow while falsely suggesting that the measles, mumps, and rubella vaccine causes more deaths than measles and that the protection from the vaccine wanes. As had become our routine when he shared incorrect information, we worked with our scientists to quickly send accurate scientific analyses through CDC’s political leadership to correct, or debunk, the mis- and disinformation stated by the secretary. An outbreak is precisely the wrong time for the nation’s health leaders to spread misinformation. We offered to brief the secretary on a host of topics, including measles and childhood vaccines, but that briefing never occurred while we were there. He also posted on social media about “healers” who used inhaled steroids and antibiotics to treat children with measles despite no evidence to support such claims, and tried to oversell vitamin A as a miracle cure or a preventative for measles. Again, we sent up written corrections through political leadership. Not naive, we realized that these memos were at best a paper trail of our attempts to correct his misinformation. To this day, it is unclear whether he bothered reading them or if his entourage even alerted him to their existence. Around that time, the Department of Health and Human Services asked us to revise the CDC’s information for clinicians to include use of these unproven and potentially harmful treatments in children with measles. We declined to endorse steroids and antibiotics, which are not recommended as routine treatments for measles and lack “gold-standard” evidence of effectiveness. We also received reports of vitamin A toxicity, underscoring why it should be administered only under medical supervision. Now something similar is playing out in another state. We are no longer at the CDC, having resigned in protest last summer because of political interference and concerns for scientific integrity, and we’re concerned about what we’re seeing. In August, Pennsylvania’s governor announced two deaths related to measles. The state followed the same established process as Texas did in 2025. Yet this time, CDC political leadership questioned the state’s determinations in a politicized social media post and delayed adding the deaths to the national dashboard. It is unclear what was different other than the state being “blue” and its governor’s criticism of the administration. That disparity raises a troubling question: Is CDC now applying different standards to state data depending on who governs the state or what political party won an election? At a time of rising measles cases and falling vaccination rates among kindergartners, the CDC director should be explaining the importance of vaccination as children return to school. Instead, Erica Schwartz, the newly confirmed director, has withheld Pennsylvania’s reported deaths from the national dashboard. The Atlantic reported that the child’s parents themselves believe their child died from measles. It remains unclear what additional evidence the CDC director believes she needs or why she would attempt to adjudicate the cause of death without working collaboratively with the state if she or her staff have questions or concerns. Lost in all of this are the grieving families and the more than 400 people infected in Pennsylvania, including 83 who have been hospitalized. Some children will face serious complications. Measles can cause pneumonia and encephalitis, erase immune memory and leave children more vulnerable to other infections, and, in rare cases, lead years later to a devastating fatal neurological disorder. The more measles we have in the United States, the more common these will become. Chicken noodle soup and vitamin A are not substitutes for vaccination, as the secretary of health claimed in 2022 while standing in Lancaster, Pa., the epicenter of the current outbreak. The best way to protect children is neither complicated nor new: Provide clear information and make it easier for families to get vaccinated. We need CDC to return to what has long made it effective: reporting data consistently, working collaboratively with states, and encouraging vaccination and treatment grounded in evidence. Public health data should not be manipulated for political advantage or treated differently depending on where they come from. They should be reliable, transparent, and, yes, boring. Debra Houry, M.D., M.P.H., is the former CDC chief medical officer. Demetre Daskalakis, M.D., M.P.H., is the former director of the CDC’s National Center for Immunization and Respiratory Diseases.