Nicholas Florko recently launched a new beat at STAT as its “Trust-in-Science Reporter.” On October 6, 2026, he emailed me for comment on the idea that “current measles messaging” had led to “accusations of fearmongering,” and that maybe public health people should more openly acknowledge “the somewhat benign nature of measles.” I wrote back that same day, emphasizing the ways measles fearmongering can backfire: “If public health is okay exaggerating the risk of measles, maybe it’s also exaggerating the safety of the measles vaccine. Maybe it’s misleading me about other illnesses and other vaccines too.” I went on to apprise Florko of two false measles risk exaggerations often deployed in public health messaging: the claim that measles kills 1 – 3 out of every thousand people infected and the claim that measles infects 90% of susceptible people who come into contact with someone with the disease.
Florko’s October 21 article quoted me briefly, accurately, and prominently. He focused on the safer part of my argument, that public health fearmongering is counterproductive. He largely sidestepped the tougher part, that public health officials sometimes make misleading claims about the evidence, giving people good reason to mistrust them.
Even more dishearteningly, he uncritically reiterated one of the false exaggerations I had warned him about, uncritically reiterating CDC’s claim that measles kills 1–3 of every thousand infected people. That’s a pretty decent guesstimate of the number of measles deaths per thousand reported cases. But back when there was no vaccine and nearly every child caught measles, most cases never got reported. With an estimated 3–4 million annual infections and roughly 400–500 deaths, the infection fatality rate was about an order of magnitude lower than the number routinely claimed today.
I hated to see a measles fearmongering falsehood in an article about how measles fearmongering could undermine trust. Even so, Florko’s article is more critical of mainstream public health communication strategies than is customary for STAT. I worried at first that Florko’s trust-in-science beat would be all about how the mainstream deserves our trust and its critics deserve our condemnation. He’s doing a lot better than that.
Dear Nick—
Lovely to hear from you – and about a topic dear to my heart. (In fact your entire beat is dear to my heart!)
The short answer is yes, I think public health agencies and experts should say forthrightly that for most healthy children measles is an unpleasant, self-limited illness from which they recover completely. And saying this just once low down in an article probably won’t suffice. It has to be said repeatedly and emphatically: “That’s why for some parents measles vaccination is a tough sell. They know their grandparents all had measles as a child, and they rightly wonder why we in public health are making such a big deal out of it.”
That acknowledgment earns the right for public health to explain why measles isn’t trivial. Some children become seriously ill, sometimes needing hospitalization. A much smaller number suffer permanent harm or die.
The temptation to suppress the first half because officials fear it will weaken the second half is exactly the wrong risk communication strategy. Lots of parents already know that measles is usually pretty minor. Others find out from relatives, friends, or the internet. They don’t merely revise downward their estimate of measles risk. They revise downward their estimate of the communicator’s trustworthiness. If public health is okay exaggerating the risk of measles, maybe it’s also exaggerating the safety of the measles vaccine. Maybe it’s misleading me about other illnesses and other vaccines too.
Mistrust of public health claims about COVID generalized to illnesses like measles. Mistrust of public health claims about measles will generalize beyond measles.
What’s core here is the distinction between “measles is usually mild” and “measles is harmless.” Public health people are sometimes reluctant to concede the first because antivaxxers will use their concession to insinuate the second. But here’s the choice.
Acknowledge that measles is usually mild, and antivaxxers will say “Even public health admits….” Or don’t acknowledge it, and antivaxxers will say “What public health doesn’t want you to know….” Every politician and every propagandist knows the latter is a much stronger argument. The better strategy is to force your critics to talk about what you admit, not what you’re trying to hide.
A related point: I suspect public health would be wise to put less emphasis on the awful but rare outcomes of measles, and more emphasis on less awful but much more common downsides. A miserable week in bed isn’t nothing, especially with everybody else warned to keep away. A week at home taking care of your sick kid while trying not to get sick yourself isn’t nothing either. And there’s a kicker: Measles can reduce people’s resistance to other infections for months and possibly several years after recovery, the phenomenon sometimes called “immune amnesia.” I think the relevant audience – e.g. parents trying to decide whether to vaccinate their kids – will relate better to these everyday downsides than to the remote risk of severe illness or death. And emphasizing them won’t feel like fearmongering.
As I imagine you know already, measles fearmongering is broader than just public health’s reluctance to dwell on how kids usually recover fully from measles. You might want to look into the veracity of some of the factual claims public health people often make about measles. Two in particular:
- The claim that measles kills 1–3 out of every thousand people infected. CDC itself makes this claim. But its own historical data suggest that this is closer to a case fatality rate among reported cases than an infection fatality rate. Before vaccination, CDC estimates 3–4 million Americans were infected annually, while roughly 500,000 cases and 500 deaths were reported. That works out to roughly 1 death per 1,000 reported cases, but only around 1–2 deaths per 10,000 estimated infections.
- The claim that measles infects 90% of susceptible people who come into contact with someone with the disease. CDC’s more technical formulation appropriately limits this to susceptible people in “close-contact settings.” But public-facing versions often lose that crucial qualification. Ninety percent is not an attack rate for susceptible “contacts” generally. In outbreak after outbreak, agencies monitor susceptible contacts and most don’t become infected.
These are the sorts of claims that build earned mistrust of public health officials and experts.
Bottom line: Back when there was no measles vaccine and everybody caught it, it wasn’t high on anybody’s list of most feared diseases (as the wonderful 1962 article you cited points out). What follows from that: If the measles vaccine were dangerous, even a little dangerous, measles would be something we just lived with. Vaccine safety should be the issue that dominates measles risk communication. Parents who hesitate to give their kids MMRs aren’t usually insufficiently worried about measles. They’re excessively worried about the MMR. So that’s the question public health should be asking these parents to consider: Is the MMR as dangerous as the antivaxxers say it is, or are they just fearmongering?
That’s another article for you, another time: How can public health talk with scrupulous honesty about vaccine safety?
All the best.
—Peter
P.S. If you want to talk any of this through further, I’m around.
Copyright © 2026 by Peter M. Sandman
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