New York And Pennsylvania's Split Screen Approach To Measles

Pennsylvania and New York's Democratic governors have taken vastly different approaches to fighting measles outbreaks in their states.

In New York, Gov. Kathy Hochul is calling in the Trump administration to help, while Pennsylvania’s Gov. Josh Shapiro attempted to go it alone for months without federal assistance. Both are up for reelection this year.

New York, which has reported around 100 cases since mid-July, declared a state of emergency Monday, which expanded the categories of medical personnel authorized to give measles vaccines. Hochul’s administration is also preparing a formal request for assistance from the Centers for Disease Control and Prevention, a spokesperson confirmed.

Pennsylvania, which has logged more than 1,000 cases since the outbreak started in April, waited several months to request CDC help. It’s yet to issue an emergency declaration.

The divide underscores the different approaches to containing the disease, which has come roaring back in the U.S. amid falling vaccination rates after decades of containment, as well as how politicized fighting infectious disease has become.

“No state can address this on its own, which is why the Governor will partner with anyone who can support our efforts to protect New Yorkers,” wrote Nicolette Simmonds, a spokesperson for Hochul, in a statement. “She will provide a detailed and specific request for assistance from the federal government, including support from the Department of Health and Human Services and the Centers for Disease Control and Prevention.”

Pennsylvania says it doesn't need to issue an emergency declaration because the state has the money and personnel to bring the outbreak under control.

It’s made strides towards achieving that goal: Since the outbreak started in April, the state’s health department staff have administered nearly 6,000 measles, mumps and rubella vaccinations at almost 200 pop-up clinics in the affected communities, with dozens more pop-ups scheduled for the coming months.

More Pennsylvanians are also seeking out the shot. Health care providers in the state typically administer around 25,000 doses of the MMR vaccine each month. In September, they gave out 56,000 doses.

The state also says issuing an emergency declaration wouldn’t make sense.

“Pennsylvania’s laws are not the same as New York’s,” a spokesperson for the department told POLITICO Friday. “The Department of Health currently has the resources and authority it needs to respond to the ongoing outbreak,” the spokesperson said, adding that licensed health care providers, including physicians, physician assistants, nurses, certified nurse midwives and pharmacists are already authorized to administer vaccines.

“A need does not exist for more parties to be given authority to administer vaccines,” the spokesperson added.

Pennsylvania’s handling of the measles outbreak, the largest the country has seen in decades, has drawn criticism from the very top of the Trump administration.

"They've got a bad governor in Pennsylvania. People just don't know it. He's very, he's close to incompetent,” President Donald Trump said at the Oval Office last month, while discussing the outbreak.

Pennsylvania's outbreak has now sickened at least 1,136 people, though some experts suspect the true case count is higher, because of the higher-than-usual death count. Pennsylvania has reported five. In high-income countries like the U.S., measles usually kills one-to-two people for every 1,000 infections.

The disease is primarily spreading among members of Lancaster County’s Amish community, who have less contact with the traditional health care system than the general population and can be harder for health care workers to reach.

Neil Ruhland, a spokesperson for the Pennsylvania Department of Health, told POLITICO earlier this month that the department only counts measles cases that have been confirmed through testing or linked to other confirmed cases.

“If a person does not seek health care, is not tested, or is not linked to another case as part of our public health investigation, [the health department] does not have a mechanism to capture and count these cases," Ruhland said in a statement.

Inside Pennsylvania's response

The Pennsylvania health department first requested an Epi-Aid — a team of CDC epidemiologists who can provide outbreak-response support — in a September letter. But it conditioned that request, saying the state would only accept federal help if CDC logged the measles deaths the state reported on the agency’s website.

That ask came after Shapiro and Health Secretary Robert F. Kennedy Jr. got into a dispute over the deaths in late August. Kennedy accused Shapiro, without evidence, of using the deaths for political gain and suggested that they could be fabricated. Shapiro accused Kennedy of spreading misinformation about vaccines that contributed to the resurgence of measles.

“The CDC’s choice not to publicly recognize the deaths undermines our response,” Debra L. Bogen, secretary of health at the Pennsylvania health department, wrote to CDC Director Erica Schwartz last month. “For this reason, if CDC is unable to transparently and accurately communicate information about those measles-associated deaths, the Department will respectfully rescind our request for a CDC Epi-Aid.”

Since Bogen wrote to Schwartz, the CDC has quietly added two measles deaths to its website.

An HHS spokesperson told POLITICO last month that the delays in the CDC's measles death reporting were because the agency had asked the Council of State and Territorial Epidemiologists to develop a standardized definition of a measles death.

Pennsylvania is now accepting CDC’s offer of aid, a CDC spokesperson confirmed Thursday, despite the agency only reporting two of the deaths Pennsylvania logged.

“The Shapiro Administration continues to urge the CDC to transparently and accurately report the five measles-associated deaths in PA confirmed by the Department,” a spokesperson for the department said in a statement Friday.

On Wednesday, the department submitted a formal request to CDC asking for help creating one model to estimate the actual burden of the outbreak and another model to help the state better understand the outbreak’s trajectory.

Despite its delayed request for formal assistance, the department says it has been in touch with CDC experts throughout the outbreak.

“We did not initiate the request earlier because we had received the assistance we needed through the ongoing remote support from the CDC measles response team,” the spokesperson said.