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The Perils of Vaccine Hesitancy
Why a psychiatrist cares about the resurgence of measles in the U.S.
Posted March 18, 2025 Reviewed by Abigail Fagan
Key points
- Measles vaccination is safe and effective.
- The aftermath of the Covid-19 pandemic has led to increased vaccine hesitancy.
- Measles may cause serious psychiatric complications with few treatments.
Outbreaks of measles in Texas and New Mexico have received national attention as cases have continued to rise. Over 300 measles infections across multiple states have been recorded since the start of this year. In Texas alone, 259 cases have been confirmed with 34 patients hospitalized and one death of an unvaccinated child. Most cases in Texas and New Mexico occurred among unvaccinated individuals, and targeted vaccination efforts may limit further spread. But vaccine hesitancy remains common at both the local and national level.
Parents in Texas are increasingly opting out of recommended vaccines for their children. The percentage of conscientious objections — allowed for a period of two years with an affidavit signed by a parent — for at least one state-recommended vaccine has been steadily increasing in the state. Data from the Texas Department of State Health Services shows that 3.63% of kindergarten parents filed conscientious objections on behalf of their children between 2023-2024 compared to 1.35% between 2015-2016, with a sharp rise after the onset of the Covid-19 pandemic.
Many factors contribute to lower rates of vaccination of preventable communicable diseases. Structural factors like war and civil unrest can disrupt delivery of vaccines to needy children. The ongoing war in Ukraine is one example. Refugee displacement to rural areas with limited health infrastructure as well as disruptions in vaccine supply chains have resulted in outbreaks of both measles and polio among at-risk children in recent years.
Fears of vaccination also contribute to lower immunization rates for measles and other diseases. In 2021, the World Health Organization estimated 9 million cases and 128,000 deaths worldwide from measles due in part to public reticence associated with the development of the Covid-19 vaccine. In the United States, distrust in government sowed by economic anxiety, concerns for election infidelity, and political corruption have fostered wariness among many about public health vaccine recommendations.
When in doubt, some may turn to public health leaders for guidance about vaccine safety. After the incipient vaccine hesitancy sparked by the Covid pandemic, government public health authorities must reclaim public trust for the success of any vaccination campaign. Current messaging from leaders falls far short, however. Secretary of Health and Human Service Robert F. Kennedy, Jr. said in an interview this month that the measles vaccine causes deaths every year and “all the illnesses that measles itself causes.” Such misinformation undermines efforts to limit viral spread and places many at risk.
When in doubt, some turn to social media for guidance about vaccine safety. Online forums are imperfect and suffer from a lack of evidence-based information and often serve as echo chambers that amplify misinformation. Nevertheless, research indicates that vaccine-hesitant parents more often seek out social media for vaccine information rather than physicians or other knowledgeable healthcare professionals. Reliance on social media correlates with greater skepticism of vaccine safety and a personal perception that one’s risk of becoming ill is low.
Measles complications can be dire and include debilitating neuropsychiatric sequelae such as subacute sclerosing panencephalitis (SSPE), a rare condition that can cause confusion, personality changes and psychosis. SSPE has no cure, does not respond to standard antipsychotic drug therapy and is often fatal.
Clinical psychiatry has benefitted from widespread measles vaccination. I have never seen a case of SSPE in the U.S. in 20 twenty years since graduating from medical school and becoming a psychiatrist. In medical textbooks of countless pages from my training, measles received fewer pages than other childhood infections. The incidence of disease was low with limited circulation and high vaccination rates.
Some forego measles vaccination hoping to rely on herd immunity, but this approach is risky. Measles is highly contagious with herd immunity achieved only at vaccination rates of 95% or higher in a community. In Texas, 90.9% of children born in 2020 have received at least one dose of measles vaccine, falling short of this 95% threshold. Unvaccinated populations often cluster due to social determinants that limit vaccine access (eg, lack of transportation to clinics). In such communities, herd immunity cannot be the bulwark against infection that some might claim.
Measles vaccination is a proven, well-tolerated, and potentially life-saving public health intervention. Long-term neuropsychiatric complications of measles have limited treatments, making preventive efforts paramount. As more children fall ill and cases mount, continued misinformation from officials is irresponsible and negligent. The health of the nation requires that leadership come from the top.
