The economic cost of measles vaccine refusal

The measles virus is among the most infectious of all know viruses, with an attack rate of well over 90%. That means that over 90% of susceptible people — those who have not been vaccinated or who have not had the disease — will get it if exposed. I’ve seen one case, and that was thirty years ago, although my parents showed me a picture of what I looked like with measles in 1958.

Before the introduction of a vaccine in 1963 measles caused about 4 million cases annually in the USA, leading to 48,000 hospitalizations and 500 deaths. That’s a lot of kids in the hospital and a significant mortality. The measles vaccine has nearly eliminated these things, but not entirely. I recently ran across an interesting article from a couple of years ago that investigated  a measles mini-epidemic that happened in Southern California. One thing that caught my eye, something I had not considered before, was the economic cost of the epidemic.

The outbreak happened when an unvaccinated seven-year-old child returned from Europe after being exposed to measles there, and proceeded to expose other children. Like many viruses, people who are infected shed virus before they know they are sick; think of it as a crafty strategy the virus uses to spread itself.

Although 879 people were exposed, most of these were vaccinated so only 12 secondary cases occurred, all in unvaccinated children. Nine of these children were deliberately unvaccinated, but three of them were too young to have received the vaccine. One three-month-old had to be hospitalized. Forty-eight children too young to be vaccinated had to be quarantined at home for several days.

The authors estimated the economic costs of the entire epidemic, including lost work time for parents, costs of treatment, and time spent by the health department investigating it, at nearly eleven thousand dollars per case. So besides saving lives, measles vaccine reduces healthcare costs significantly.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must FaceHow to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

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  • John C. Key MD

    Interesting information. The unvaccinated cohort seems destined to rise not only due to Southern Border immigration, but increasing numbers of young parents who elect not to vaccinate. My thirtysomething daughter is a member of a “Crunchy Moms” group, and she was astonished to find that many of that group were outspoken in their anti-vaccine sentiments.

    In my weaker moments I have wondered about the importance of MMR and Chicken Pox vaccination, since these were commonplace in my childhood and when in medical school in the 1970′s we routinely recorded “UCHD” in the past medical history to indicate that the patient had, like everybody else, suffered the usual childhood diseases. Yet devastation was not unknown then–in my small circle of friends there was once cases of deafness due to rubella and one death from measles encephalitis.

    Vaccination is a sound medical practice for which all physicians should remain strong advocates.

    • Chris Johnson

      Yes — I remember the “usual childhood diseases” thing in the past medical history as well. I also recall seeing children who had suffered dreadful complications from measles. How soon we forget.

      • May Wright

        One of my uncles was rendered permanently deaf due to mumps. “How soon we forget” indeed. This is not ancient history, these are our parents’ and grandparents’ generations.

  • Chiked

    Doctors view the anti-vaccine crowd as ignorant and dangerous. What they won’t acknowledge is that childhood disorders are truly on the rise and their 15 minute clinic appointments (half spent typing on a computer screen) does very little to reassure us. Are you really surprised that we may finger vaccines as a possible culprit?

    • Chris Johnson

      I’m not sure what your point is here. Doctor’s visits are too short and harried, and therefore parents don’t believe in vaccines? If that is your point than, yes, I am surprised, because it’s incoherent.

      And if you are worried that “childhood disorders are on the rise,” then stopping vaccines makes no sense. If you stop vaccinating, the numbers will really explode — measles, as only one example.

      • guest

        I suspect that poster intended to say “autoimmune disorders,” such as T1 diabetes, lupus and celiac disease, the incidence of which is on the rise, for reasons that are unknown, but suspected to be environmental.

        On an unrelated note, I personally find it offensive to have the potential effects on my productivity as a worker (“lost work time for parents”) factored into the rationalization for why I should go along with an aggressive schedule of vaccines whose long-term safety has not been scientifically proven.

      • Chiked

        My point is that if doctors keep cramming more patients into every hour, it should not come as a surprise that people are turning to other sources for medical advice.

        No I don’t believe vaccines are responsible for rising illnesses in children but you will need more than 15 mins to convince parents that do.

    • James Tyrrell

      Actually it’s organic foods that are the culprit. Correlation does not equal causation.

      • May Wright


  • ninguem

    Am I the only one who finds it intriguing that the index measles case…….meaning the first patient what started this outbreak……..contracted measles in Switzerland, and brought the disease back to California.

  • SBornfeld

    Yes, but–everything’s subject to cost/benefit analysis these days (pace USPSTF), and so while I understand your objection everything else is dollars and cents–and if an economic analysis can help support the fight against the “antis”, I’m all for it.

    • guest

      All that accomplishes is to make those of us who are somewhat skeptical of the vaccine industry, even more skeptical. To be told that a vaccine like varicella is “critical” because it “saves lives,” even though one unintended effect is to create a cohort of non-immune adults for whom varicella poses an even more serious threat, and then find out that one of the main reasons the vaccine is being promoted is to make sure that parents don’t have to call in sick to work to care for a child with chickenpox, is profoundly offensive and does nothing to improve the level of trust that some people have in the system.

      • SBornfeld

        You write:
        “To be told that a vaccine like varicella is “critical” because it
        “saves lives,” even though one unintended effect is to create a cohort
        of non-immune adults for whom varicella poses an even more serious
        Kindly explain the above, and if you would, please cite your source.

        You know what I find offensive? People dying from preventable diseases due to misinformation.

  • Chris Johnson

    But why? Lost productivity is a legitimate economic cost, it seems to me.

    • rtpinfla

      It is a legitimate economic cost but in my opinion it dilutes the main argument for vaccination- improved health outcomes. I never tell a parent they should vaccinate their children against polio because they may have to stay home from work a few days. I recommend it to prevent the devastating neurological complications associated with the disease.
      That is not to say that economics shouldn’t be considered in the equation. It absolutely needs to be when talking about population health and how to best spend public health dollars. But “you may miss work if you don’t immunize your child” is a terrible argument for any medical intervention.

  • C.L.J. Murphy

    We use the impact of economic activity including loss of productivity and loss of work time when discussing smoking and alcohol abuse, is this offensive as well? If this article had been titled “The Economic Cost of Smoking” or “The Economic Cost of Alcohol Abuse” or “The Economic Cost of the Obesity Crisis”, would people have found it offensive?

    • rtpinfla

      See my comment below. When I talk to patients about smoking, obesity, and alcohol I discuss what impact has on their personal health rather than the health of their children. In the case of these issues I might mention to them that they will not be able to work/earn to their full potential in an effort to change lifestyle. However, that is a bit different than the argument about vaccination-since the children being vaccinated generally are not earning a living and the children are not “choosing” a non vaccinated lifestyle (the parent that may have to stay home from work is).
      Bottom line, to potential for personal missed work days should not be an argument for vaccinating your children.

  • DrJA

    I had an immigrant child that I referred to her pediatrician for vaccines. She was from Germany and was documented up to date for vaccines according to German standards. I just thought she needed a tetanus up date. She came back to me having been given nine vaccinations at one time. She was so vaccinated she swollen over both arms and hips (more than two vaccines per limb in a very petite child). The doctor said- “I have no idea if those foreign vaccines are as good as ours so I gave her everything again.” Great work. I now have an anti-vaccine family and a child who hates doctors among my patients and they were NOT that way before this episode.
    I do not advocate the anti-vaccine agenda but when I see things like this happen, it convinces me that our own profession is very actively creating some of these responses. We need to scrutinize the ways our own behaviors are contributing to the problem too.


    Well, guess I’m not taking a trip to Seattle to visit the inlaws when my kid is 4 months old as planned. Helpful info, will not go to that petri dish until fully vaccinated and better immune system. Thanks.

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