Measles outbreaks around the country are already a disaster, but more bad news arrived on Tuesday. Pennsylvania Governor Josh Shapiro announced that two measles-associated deaths had occurred in Lancaster County. “These mark the first deaths related to measles within the Commonwealth in 35 years,” an accompanying statement declared. Both individuals were said to have been unvaccinated, but the state Health Department declined to release any other information about the cases, citing privacy concerns.
By yesterday morning, though, this story was in doubt. Lancaster County Commissioner Josh Parsons posted on X that he had spoken with the county’s coroner, who said that he had not identified any deaths due to measles. One individual, Parsons wrote, “died WITH measles, but not from measles.” That evening, Health and Human Services Secretary Robert F. Kennedy Jr. offered a more conspiratorial angle: Perhaps the entire episode had been “fabricated by one of the Governor’s hopeful staffers.”
Pennsylvania’s Health Department quickly doubled down: “As a pediatrician with more than 30 years of caring for children,” the state’s health secretary wrote, “I have thoroughly reviewed the case investigation information and sadly can confirm that there were two recent measles-associated deaths in Lancaster County.” But the facts that have emerged over the past 48 hours suggest that health officials may indeed have committed a catastrophic communication blunder—by either overstating the evidence or politicizing the deaths of citizens without conveying complete information about what had happened.
Here’s what we know so far: In the one case for which additional information has been released, an infant whose lab tests showed evidence of a measles infection died shortly after birth because of a lacerated spleen. According to an interview with the county coroner conducted by The Philadelphia Inquirer, a forensic pathologist decided that this fatal injury was not related to the infection.
That pathologist’s judgment might be wrong. Viruses (including measles) can cause the spleen to grow abnormally large, making it prone to rupture. A 2024 Polish study, for instance, documented an enlarged spleen in four out of 26 infants who had been hospitalized for measles. But there are certainly other potential explanations. Only a doctor familiar with all of the details of this particular patient’s situation would be equipped to reach a reasonable conclusion. Yet when Shapiro announced the two fatalities, he implied that the link was unambiguous. “Death from measles is completely preventable,” he said.
The baby in Lancaster could not have been vaccinated; newborns are not typically given their first dose of the MMR vaccine until they are 1 year old. According to the coroner, the infected newborn acquired the disease in utero from their mother. (Her vaccination status has not been publicly confirmed.) If some genuine uncertainty remains as to whether a measles infection led directly to the baby’s death, state officials’ announcement was premature. Think of the consequences: A grieving parent would hear her governor announce that the tragedy was in some way her fault. And anti-vaccine activists would have the opportunity to pounce on the mistake to continue downplaying the lethality of infections.
As a pathologist, I am used to fielding questions about how and why people die. Such calls were particularly frequent during the early days of the coronavirus pandemic, when many people doubted COVID-19’s official death toll. Some alleged that anyone who merely happened to die while infected—in a car crash, let’s say, or from cancer—was being counted in official numbers. (In fact, government statistics were underestimating the number of Americans who were dying from COVID.) Admittedly, determining why someone died is in many cases difficult for experts such as myself. The body is a frustratingly complex machine. A mild illness can lead to a cascade of severe bodily dysfunction; disparate diseases may all crop up simultaneously. Seemingly ill people can live for years, while apparently healthy individuals rapidly deteriorate. And measles, in particular, may pose a special challenge for cause-of-death discernment, because the virus tends to interfere with the body’s normal immune responses, making death from any pathogen more likely.
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Doctors have developed a specialized language to convey these nuances. Many people end up having two listed causes of death: an immediate cause and an underlying cause. The immediate cause is the disease process that was most closely related to a fatal malfunction of a patient’s heart, lungs, or brain; the underlying cause is the event that initiated a patient’s decline. The Pennsylvania Health Department has said that it uses the term measles-associated death when measles infection is present but may not be the “immediate cause of death.” To see how this works, consider the deaths of two children from measles in Texas last year. Anti-vaccine activists seized on the fact that these kids had both died after contracting non-measles infections to cast doubt on the conclusion that measles was the cause. In fact, this is the typical way that measles kills: The virus weakens a patient’s body, allowing harmful bacteria or viruses to take hold more easily. Bacterial pneumonia or sepsis may have been the children’s immediate cause of death—but measles was the underlying cause.
The situation does not seem to be as clear-cut in Pennsylvania. A fatal splenic injury caused by a congenital measles infection may be plausible, but it would not be a typical cause of death from the disease. And regardless of whether measles unequivocally led to either of the two deaths in Pennsylvania, officials have already emboldened vaccine skeptics and lent credibility to their doubts. The state Health Department seems to have withheld relevant information from its constituents—that is, that local investigators were not themselves attributing the infant’s death to measles—and then it politicized its announcement of the deaths by having Shapiro, who is currently running for reelection, play a prominent role in the press conference. (In response to questions, Stephanie Nojiri, the deputy press secretary for the health department, directed me to the health secretary’s prior statement. She declined to provide any further details about the cases, again citing patient confidentiality.)
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Public-health experts should have known that the anti-vaccine movement would use any modicum of ambiguity in the evidence to press its case. Kennedy himself has been doing this for years. In 2021, he called the idea that “measles is a deadly disease” propaganda, and visited an Amish fair in Lancaster County to congratulate locals on their wariness toward vaccines (“The Amish are doing it right,” he said), make light of measles’ risks, and tout chicken soup and vitamin A as its cure.
Kennedy has repeatedly denied having any responsibility for measles outbreaks. Indeed, he is neither the underlying nor the immediate cause of the country’s current crisis. Vaccine doubts have been around as long as the shots themselves, and immunization rates had begun to decline, at least a bit, before Kennedy became HHS secretary. But another part of a death certificate is relevant here: a listing of any significant conditions that contributed to a patient’s death. There is no doubt that Kennedy’s years as a prominent anti-vaccine activist and his actions since taking office have misinformed the public about immunizations. Health leaders who reach premature conclusions and unjustly turn a family’s private tragedy into a public morality tale will only make this preexisting condition worse.
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