Amesh Adalja is a Pittsburgh-based infectious disease, critical care and emergency medicine physician.
The task of containing Pennsylvania’s measles outbreak would have been herculean in any circumstance. The fact that health officials in the state also had to confront an adversarial federal government, with Health Secretary Robert F. Kennedy Jr. pushing disinformation about vaccines, made their jobs even harder.
Unfortunately, they failed to manage that conflict in a way that best serves the public. That provides an important lesson for health officials going forward: The vulnerability under this administration is not just disinformation, but also the sloppiness that allows it to flourish.
To be clear, the state deserves credit for its response to the outbreak, the scale of which hasn’t been seen in Pennsylvania for decades. Three dozen counties reported cases. State officials had to confront a significant hospitalization rate, multiple community and hospital exposures and the logistical challenges of managing vaccine pop-up clinics, testing and contact tracing. As a result of these efforts, rates of vaccination for measles are up in the state versus last year, and health care facilities are developing protocols to deal with inevitable new cases.
Nevertheless, I unequivocally believe the state’s communication regarding the deaths of two infants infected with measles in Lancaster County invited Kennedy and his anti-vaccine brigade to disseminate lies and disinformation throughout my state. Purveyors of vaccine disinformation are, in my view, parasitic. They can do nothing on their own accord but require some seam, some slip, some opening to seize.
The state failed to release even basic information about the two deaths. It refused to immediately clarify the terms “measles-related” and “measles-associated”; it did not address conflicting statements made by the Lancaster County coroner; and it conducted a news conference with Pennsylvania Gov. Josh Shapiro (D) that seemed more focused on scoring political points than on the operational aspects of an out-of-control outbreak. That created the aperture for Kennedy to plant doubts about the state’s messaging.
What health officials should have done is been clear on what they did know. They should have been as transparent and forthcoming about the deaths as statutorily possible. Then they should have explained what outstanding questions they had regarding the deaths; what investigations might be pending; when more information would be coming; and why there could be differing views from the coroner. They also should have kept politicians away and handled it solely as a medical and public health issue.
The harder lesson is for every other state health officer watching this. For decades, a state could report a death and expect the Centers for Disease Control and Prevention to accept it, publish it and stand behind it. That’s what happened in 2025 with the measles deaths that occurred in Texas and New Mexico. That’s no longer the case.
Pennsylvania reported two deaths associated with measles, and Erica Schwartz, the newly installed CDC director, pulled them from the national dashboard at Kennedy’s request. Now, the administration is asking the Council of State and Territorial Epidemiologists to develop a new definition for measles deaths. That suggests any future death could result in more bickering.
State officials should be prepared for this: They will now need to build corroboration to support the announcement of a death before any crossfire with the federal government. That means academic laboratories that can independently confirm genotyping, professional societies willing to say publicly that a case definition is sound and peer states willing vouch for their methods.
For two weeks, people on the left have called me a “DINO” and chastised me for criticizing Shapiro. Meanwhile, people on the right have called me a shill. Both charges assume I am playing a game with either side.
In reality, I am neither a Democrat nor a Republican. The discourse only proves how politics has completely polluted my field, but such ideological battles do not help end outbreaks and are wholly irrelevant to the physicians and public health workers working to protect Pennsylvania residents. Measles does not have sides. It will find the unvaccinated in a red county and a blue one with equal efficiency.
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