The Centers for Disease Control and Prevention is excluding two deaths reported by Pennsylvania from its weekly updates of a national measles death tally, a decision that came from new CDC director Erica Schwartz, according to three former and current officials familiar with the matter who spoke on the condition of anonymity for fear of retaliation.
The highly unusual decision departs from the agency’s practice of including such data from state health departments, which historically make the determinations. It also reflects how a bitter political dispute over the cause of the deaths in Lancaster County is now playing out inside the nation’s premier public health agency, testing a director who began helming the agency this month.
The deaths were made public Tuesday by the Pennsylvania health department, and Gov. Josh Shapiro (D) later discussed them during a news conference. State health department officials have said they reported the deaths to the CDC measles response team Tuesday morning and met with agency officials Wednesday.
The deaths were not included on the CDC’s website, which is typically updated on Fridays. An asterisk on the CDC’s website says: “This week’s measles outbreaks update will not include the two measles-associated deaths reported by the Pennsylvania Department of Health on August 25 while CDC reviews additional information regarding the circumstances and causes of death. At this time, available information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles. CDC will update the national count as additional information becomes available.”
The case has garnered extraordinary national attention as Shapiro, who is widely expected to run for president, and Health Secretary Robert F. Kennedy Jr. spar over the cause of the deaths.
Shapiro and the state health department say the deaths were “measles-associated,” meaning the virus is present, even if the disease is not identified as the immediate cause of death. However, Lancaster County Coroner Stephen Diamantoni, a Republican family doctor first elected coroner in 2007, has said a pathologist who examined a newborn told him the primary cause of death was a spleen laceration hours after birth on Aug. 14. The coroner said that the child tested positive for measles but that the pathologist did not believe the virus played a role in the baby’s death.
Measles can cause significant inflammation to the spleen, making it more fragile and susceptible to life-threatening rupture, the state health department said Thursday.
The CDC’s delay in updating the data goes against how information about measles is reported to the agency. State health officials are the ones who report measles cases, hospitalizations and measles-associated deaths to the agency.
Grace Davis Jamison, a spokeswoman for the federal Department of Health and Human Services, said in a statement that the two measles-associated deaths announced by Pennsylvania “have not been confirmed based on the information currently available to CDC.” The agency “therefore delayed its weekly update while seeking additional information to ensure its national reporting is accurate.”
She did not address who made the decision to delay the update and whether Kennedy, the founder of a prominent anti-vaccine group, was involved in the decision. Kennedy and his allies have accused Shapiro of using the moment for political gain, and Kennedy has suggested the deaths “may even have been altogether fabricated by one of the Governor’s hopeful staffers.”
Over the weekend, the CDC’s measles dashboard was updated several times. At one point, the two deaths were included in the tally, before the site was changed to show an asterisk and the language stating they were not going to be included. Former and current agency employees said the multiple changes were the result of confusion among staff about what they were supposed to do.
Jamison, the HHS spokeswoman, said that during the process of updating the website, “multiple versions of the language were inadvertently published.” That should not have occurred, she said, adding that HHS and the CDC are “reviewing the circumstances surrounding those postings and the applicable publishing processes.”
Deb Houry was the chief medical officer at the CDC during last year’s West Texas measles outbreak that infected more than 700 people and resulted in the deaths of two unvaccinated school-aged children. The CDC was notified of the deaths by the state health department, the standard process, she said, and the deaths were included in the agency’s measles dashboard. New Mexico reported a third death in an unvaccinated adult to the CDC, and the CDC followed a similar process in counting it in its measles dashboard, Houry said.
“This is a deviation,” she said in a text message, referring to the CDC’s decision not to include the deaths reported from Pennsylvania.
During the West Texas outbreak, “although some outside organizations questioned the tragic death of these children, CDC did not,” Houry said.
Some Kennedy allies argued during the West Texas outbreak that measles may not have killed the children, suggesting that poor medical treatment and other medical conditions might have.
“CDC has historically relied on the expertise of state and local health departments,” said Houry, one of three CDC leaders who resigned a year ago to protest what they described as the politicization of science at the agency under Kennedy.
José Romero, who served as a top health official in Arkansas during the coronavirus pandemic and then at the CDC, called the decision to wait to update the website “prudent.”
“If there is this difference between what the pathologist believes and what has been reported, it merits looking into more closely,” Romero said.
Other public health experts say the decision to exclude Pennsylvania’s information about the deaths raises questions about political interference in the integrity of public health data.
“It’s completely unprecedented and, quite frankly, very worrying,” said Katelyn Jetelina, a California epidemiologist who writes a weekly newsletter about public health and infectious diseases.
She added: “This situation opens a whole can of worms: What is the protocol now? How does adjudicating deaths differ from adjudicating hospitalizations or cases? Does it matter which state it is and what color that state is? Are they going to second-guess those? Who holds the truth?”
Pennsylvania officials said last week that two unvaccinated residents had died after being infected with measles, the first such measles-associated deaths in the state in 35 years, they said, and the first reported in the United States this year. At Tuesday’s news conference, health officials declined to release more information, such as the residents’ ages, citing the privacy of the families.
Some infectious-disease experts, who are typically critical of Kennedy, said they believe Shapiro should have offered more information from the start. Instead, state officials opened the door for others — such as anti-vaccine activists — to fill the void.
Amesh Adalja, an infectious-disease physician in the Pittsburgh area, said he believes there’s probably enough information about the first death to provisionally include it in the tally. But the state health department has released sparse details about the second death, and there has been no additional public reporting about its nature.
“Right now what you have is a very muddled situation, and no one really knows,” he said. “Every day there’s a drip drip drip of new information.”
Schwartz told agency staff in a recent all-hands meeting that her priorities were to preserve trust through radical transparency and scientific rigor, build up the agency’s relationship with state and local partners, and strengthen the CDC’s ability to respond to disease threats. She said she would be able to disagree with Kennedy, but “probably in private, not in front of the media,” according to a recording obtained by The Washington Post.
Alice Yoder, a Democrat who serves on the Lancaster County Board of Commissioners, said she learned about the deaths from the state health department’s news conference, which she said is standard practice because the county doesn’t have its own local health department. She has since had conversations with the county coroner, she said.
“There are two deaths that we’re talking about in our county that [are] somehow associated with measles, and it’s being focused on so much that we are losing the context,” said Yoder, a former nurse and executive at the regional hospital. “What we need to focus on related to how serious measles is and how contagious it is and that vaccines are the best way to prevent the spread.”
On Friday, the CDC awarded $50.2 million in additional one-time funding to help state, local and territorial authorities prepare for and respond to measles and other vaccine-preventable disease outbreaks, an administration official said, speaking on the condition of anonymity because they were not authorized to share the details. The funding is aimed at identifying emerging risks and vaccination gaps in communities with lower vaccination rates and help communities respond more quickly and effectively to outbreaks, the official said.
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