++What philosophy has to say about midlife crises. +
++Whatâs the point of philosophy? +
++Itâs an old question, maybe one of the oldest in the history of philosophy, and there has never been a consensus answer. Some people think the point of philosophy is to make the world make sense, to show how everything hangs together. For others, philosophy is a practical tool that ought to tell us how to live. +
++If youâre in the latter camp, then itâs fair to say that you think of philosophy as a form of self-help. Itâs a tradition of thought that â in theory, at least â can guide you to a better life, or something like that. And I donât think thatâs too much to ask of philosophy. What good is all that ruminating if it canât offer you something useful when youâre anxious or depressed or mired in one of those dreaded midlife crises? +
++Kieran Setiya is a philosopher at MIT and the author of several books, most recently Life Is Hard: How Philosophy Can Help Us Find Our Way and Midlife: A Philosophical Guide. Setiyaâs work is uncommonly accessible and a great example of philosophy that really tries to wrestle with the concrete problems of everyday life. +
++I recently invited Setiya on The Gray Area to talk about the perils of middle age and how philosophy has helped pull us out of the dark. Below is an excerpt of our conversation, edited for length and clarity. As always, thereâs much more in the full podcast, so listen to and follow The Gray Area on Apple Podcasts, Spotify, Stitcher, or wherever you find podcasts. New episodes drop every Monday. +
++
+Sean Illing +
++You wrote a book called Life Is Hard. Not that your philosophy of life can be summed up in three words, but if you had to sum it up in three words, is that it? +
++Kieran Setiya +
++I think it is. Ancient philosophers like Plato and Aristotle thought about the ideal life and they tried to provide a blueprint for â and a map toward â it. And that can be both unrealistic and in a certain way self-punitive. Often the right way to approach the ideal life is to think, âThatâs not available. I shouldnât beat myself up about the fact that thatâs not available.â Really living well, or living as well as you can, is about dealing with the ways in which life is hard. +
++Sean Illing +
++How do you define a midlife crisis? +
++Kieran Setiya +
++The midlife crisis is one of those funny cultural phenomena that has a particular date of origin. In 1965, this Canadian psychoanalyst Elliott Jaques writes a paper, âDeath and the Midlife Crisis,â and thatâs the origin of the phrase. Jacques was looking at patients and the lives of artists who experienced midlife creative crises. These were mostly people in their 30s and it doesnât really fit the stereotype of the midlife crisis today. +
++Thereâs been a shift in the way people think about the midlife crisis. The idea now is that peopleâs life satisfaction takes the form of a gentle U-shape, that basically, even if itâs not a crisis, people tend to be at their lowest ebb in their 40s. This is true for men and women, and itâs true around the world to differing degrees, but itâs pretty pervasive. +
++So when people like me talk about the midlife crisis, what they really have in mind is more like a midlife malaise. It may not reach the crisis level, but there seems to be something distinctively challenging about finding meaning and orientation in this midlife period. +
++Sean Illing +
++What is it about this period that generates all this anxiety? +
++Kieran Setiya +
++There are many midlife crises; itâs not just one thing. I think some of them are looking to the past. Thereâs regret. Thereâs the sense that your options have narrowed. Whatever possibilities mightâve seemed open to you earlier, whatever choices youâve made, youâre at a point where there are many kinds of lives that might have been really attractive to you, and now itâs clear in a vivid, material way that you canât live them. +
++Thereâs also regret that things have gone wrong in your life, youâve made mistakes, bad things have happened, and now the project is, âHow do I live the rest of my life in this imperfect circumstance?â The dream life is off the table for most of us. +
++People also have a sense that most of life is occupied by this daily grind. Rather than things that make life seem positively valuable, itâs just one thing after another. And then death starts to look like itâs at a distance that you can measure in terms you really palpably understand. You have a sense of what a decade is like, and thereâs only three or four left at best. +
++Sean Illing +
++Iâm 42 and I can feel all of that. When youâre young, the future is pure potential. Ahead is nothing but freedom and choices. But as you get older, life shrinks, responsibilities pile up, and you get trapped in the consequences of the decisions youâve made. Thatâs a hard thing to wrestle with. +
++Kieran Setiya +
++I think thatâs exactly right. Part of whatâs philosophically puzzling about this is that itâs not news. Whatever your sense of options was when you were 20, you knew you werenât going to get to do all of those things. What this suggests is that thereâs a profound difference between knowing that things might go a certain way, well or badly, and knowing in concrete detail how they went well or badly. +
++Part of the sense of missing out has to do with what philosophers call âincommensurable values.â The idea that if youâre choosing between $50 and $100, you take the $100 and you donât have a momentâs regret. But if youâre choosing between going to a concert or staying home and spending time with your kid, either way youâre going to miss out on something that is irreplaceable. One of the things we experience in midlife is all the kinds of lives we donât get to live that are different from our life, and thereâs no real compensation for that, and that can be very painful. +
++On the other hand, I think itâs useful to see the flip side. The only way you could avoid that kind of missing out is if the world was suddenly totally impoverished of variety. Or you were so monomaniacal, you just didnât care about anything but money, for instance. And you donât really want that. +
++Thereâs a way in which the sense that thereâs so much in the world weâll never be able to experience is a manifestation of something we really shouldnât regret, and in fact should cherish, namely the evaluative richness of the world, the diversity of good things. And thereâs a consolation in that. +
++Sean Illing +
++One of the arguments you make is how easily we can delude ourselves when we start pining for the roads not traveled. âWhat if I really went for it? What if I tried to become a novelist, or a musician, or what if I joined that commune?â Or whatever life fantasy you had when you were younger. +
++But if you take that seriously and consider what it really means, you might not like it, because the things you might value the most in your life now, like your children, they donât exist if you had zigged instead of zagging 15 or 20 years ago. Thatâs what it means to have lived that alternative life. +
++Kieran Setiya +
++Philosophy can lead us toward this kind of unhelpful abstraction, but it can also tell us whatâs going wrong with it. The thought, âI could have had a better life, things could have gone better for meâ: Itâs almost always tempting and true, but when you think through what it would mean in concrete terms â what would have happened if your failed marriage had not happened? +
++Often the answer is that you would never have had your kid, or wouldnât have met these people. And you might think, âYeah, but I would have had some other unspecifiable friends who would have been great, and some other unspecifiable kid who would have been great.â But I think we rightly donât evaluate our lives just in terms of those kinds of abstract possibilities, but in terms of attachments to particulars. +
++So if you just ask yourself, âCould my life have been better?â youâre throwing away one of the basic sources of consolation, a rational consolation, which is attachment to the particularity of the good things in your own life, even if you acknowledge that theyâre not perfect and that there are other things that could have been better. +
++Sean Illing +
++I will say, though, that when real pain strikes, itâs not always easy to find relief in abstract arguments. Two of the hardest moments of my adult life were the sudden loss of my mother a few years ago and the unexpected loss of a baby last year. +
++Like a lot of people, I did that thing where I felt victimized, like the worldâs conspiring against me. But then you go through the anger of all that and realize that youâre not uniquely unlucky, that this happens to people every day. Pain and loss are part of life, as central to life as anything else, and good philosophy, whether itâs in academic books or novels or films, can help remind us of that, and I guess it helped me in that way. +
++Kieran Setiya +
++Iâm sorry to hear about both of those losses. I think what philosophy has to do is what human beings have to do when faced with those kinds of difficulties, which is not switch too rapidly into what I call assurance advice mode, which is saying, âItâs all going to be fine. Or hereâs what you do.â Those are things we do in personal interaction, but theyâre also versions of philosophical approaches to the difficulties of life. +
++Thereâs the kind of theodicy where philosophers argue that all is for the best. Theyâve got some proof that although this seems bad, itâs going to work out well. Or they have some theory where they say, âMy philosophical principle is this, Iâll just apply it to your situation.â And those are rarely good philosophical tactics for dealing with the kind of difficulties youâre describing, for reasons that are not unrelated to the fact that theyâre rarely good interpersonal ways of approaching difficulty. +
++The starting point is sitting with difficulty, acknowledging it, trying to take in whatâs really happening, really describing the particularity of it. Itâs connected with a kind of philosophical methodology that I have come to embrace. And itâs a shift from thinking, âWell, philosophy is going to be about coming up with really cool arguments to prove you should think this or that,â to thinking, âThereâs a real continuity between the literary and human description of phenomena like grief and philosophical reflection.â +
++Because often what philosophical reflection provides is less a proof that you should live this way and more concepts with which to articulate your experience and then structure and guide how you relate to reality. And seen that way, we can understand how philosophy can operate as self-help. +
++To hear the rest of the conversation, click here, and be sure to follow The Gray Area on Apple Podcasts, Spotify, Pandora, or wherever you listen to podcasts. +
++What the debate over âwhite rural rageâ misses. +
++White rural Americans are a âracist, xenophobic, anti-immigrant, anti-gayâ authoritarian fifth column that poses an existential threat to our republic. +
++Unless they are actually a downtrodden people who rightly resent the condescension of liberal elites and wish for little more than âto preserve a sense of agency over their future and a continuity of their communityâs values and social structures.â +
++These are the twin poles of blue Americaâs current debate over why rural white folks vote the way they do. +
++This argument is as old as the urban-rural divide itself. But the latest round was triggered by White Rural Rage: The Threat to American Democracy, a bestselling book from the political scientist Tom Schaller and journalist Paul Waldman. +
++Schaller and Waldman argue that rural white voters are exceptionally reactionary, racist, and anti-democratic. In their telling, these retrograde impulses turn this group into easy prey for a Republican Party that shutters rural hospitals, denies workersâ health insurance, erodes labor rights â and then says, in so many words, let them eat hate. +
++Many commentators and political scientists have taken exception to this argument. The Atlanticâs Tyler Austin Harper argues that White Rural Rage âillustrates how willing many members of the U.S. media and the public are to believe, and ultimately launder, abusive accusations against an economically disadvantaged group of people that would provoke sympathy if its members had different skin color and voting habits.â +
++In his account, the real threat to American democracy âis not white rural rage, but white urban and suburban rageâ â a fact that would be plain to Waldman and Schaller, Harper says, if theyâd only paid more careful attention to the studies their book cites. +
++Colby College political scientist Nicholas Jacobs, meanwhile, insists that White Rural Rageâs âsimplisticâ and inaccurate thesis amounts to little more than âan outpouring of frustration with rural America that might feel cathartic for liberals, but will only serve to further marginalize and demonize a segment of the American population that already feels forgotten and dismissed by the experts and elites.â +
++In my view, this debate has gotten a bit muddled, with each side dancing around inconvenient facts. The argument between White Rural Rageâs champions and its critics would generate more light (and perhaps less heat) if all involved grappled with five important truths: +
+
+
+- Rural white people are more supportive of right-wing authoritarianism than are urban or suburban ones
+
++Harperâs central claim â that rural white people actually pose less of a threat to American democracy than urban and suburban ones â rests on faulty reasoning. +
++His case can be boiled down into three points: +
+-
+
- +A 2021 paper in Journal of Democracy found that âpolitical violenceâ in the US âhas been greatest in suburbs where Asian American and Hispanic American immigration has been growing fastest.â + +
- +Several high-profile right-wing extremists, including the âpizzagateâ gunman, came from areas that arenât rural, at least by certain definitions of that term. + +
- +The vast majority of Americans who believe that the 2020 election was stolen â and that Trump would therefore be justified in reclaiming the presidency by force â live in urban areas. + +
+These facts establish that white rural Americans are not uniquely right-wing or authoritarian; supporters of Trump and the January 6 Capitol riot can be found in nearly every category of municipality. Harper is right to object to the singling out of white rural voters writ large, when the problem is illiberal reactionaries in every part of the country. +
++Nonetheless, his evidence doesnât contradict the premise that rural white people are unusually supportive of Donald Trump and January 6. +
++This is a fatal problem for his argument, since Trump is the fundamental threat to American democracy today. All political violence is lamentable, but individual militants cannot undermine the independence of federal law enforcement, the integrity of the electoral process, or the peaceful transfer of power; an insurrectionary president plausibly can. +
++And there is no question that white voters from low-density areas support Trump by much larger margins than their counterparts in high-density places. +
++In the 2020 election, rural white voters backed Trump over Biden by 42 points, while suburban white voters favored him by just 7, according to the Democratic data firm Catalist. Urban white voters, meanwhile, supported Biden over Trump by a 32-point margin. +
++If rural white Americans voted the same way that suburban white Americans do, then Trump would never have been elected president and his brand of authoritarianism would not be competitive in national elections. If all white Americans voted like those who live in cities, meanwhile, then Trumpâs party would have negligible influence over the federal government. +
++Whatâs more, Harper acknowledges that rural white Americans are âoverrepresentedâ among those who support restoring Trump to power by force. +
++Given these facts, itâs silly to argue that urban and suburban white people are doing more to imperil American democracy than their rural counterparts. Harperâs only real counter is that more supporters of January 6 live in cities than in rural areas. But this is a trivial point: Roughly 80 percent of Americans live in non-rural areas. Name any ideological group under the sun and youâre almost certain to find that a majority of that group lives in high-population municipalities, rather than in places that, by definition, have few people. +
+
+
+- Millions of rural white Americans support the Democratic Party
+
++All this said, rural white voters are not a monolith. In fact, such voters were an indispensable part of Bidenâs 2020 coalition. +
++Yes, the president won only 28 percent of that voting bloc, but that adds up to more than 9 million votes. In 2020, Biden won nationally by roughly 7 million ballots and took many swing states by tiny margins. Subtract all rural white Democrats from Bidenâs column and Trump almost certainly would have won reelection. +
++Waldman and Schallerâs rhetoric does a disservice to this small but significant segment of the public, which has held the line against Trumpism in places where doing so entails significant social penalties and risks. +
++More importantly â as Harper and Jacobs emphasize â demonizing white rural voters is a luxury that urban liberals can scarcely afford. Yes, the median white voter in rural America is never going to support Biden. But rural white swing voters exist. And in a close election, even a small reduction or increase in Bidenâs share of that bloc could prove decisive. +
+
+
+- Rural white Republicans are not New Deal Democrats who got confused
+
++Liberals and leftists have long debated the root causes of rural Americaâs support for the Republican Party. Some point to the fact that rural white Americans supported the New Deal and conclude that many in the demographic would back Democrats again today if only the party offered more ambitious economic reforms. Others argue that rural white people are simply too racist to support a minimally progressive political party. +
++By my lights, it is unwise to base your theory of American political behavior in 2024 on voting patterns in 1932. A lot has happened in the last 92 years. When FDR was first elected, +
+-
+
- +43 percent of Americans lived in rural areas + +
- +the entire South was controlled by a white supremacist faction that was briefly, improbably tethered to a coalition with northern liberals + +
- +the unemployment rate was stuck above 20 percent + +
- +personal income per capita in the US was roughly one-seventh as high as it is today + +
- +the sexual revolution had not yet occurred + +
- +conservative mass media barely existed, and + +
- +there was, more or less, no federal welfare state. + +
+There is no reason in principle to assume that rural votersâ political priorities and inclinations have not changed along with their country. +
++As Schaller and Waldman demonstrate, the argument that many rural white people are motivated by racial resentments is significantly more robust. +
++But, as Nicholas Jacobs suggests, it is almost certainly true that not all white rural Republicans are motivated by racism. Yet Jacobsâs essay for Politico dances around the other primary explanation for rural white support for Trump: They simply have many conservative beliefs and policy preferences. +
++After all, rural voters are more conservative than urban ones in virtually every developed country, including those where race plays a smaller role in politics than it does in America. +
++You donât need to be racist to believe a fetus is a person. And rural Americans are disproportionately supportive of abortion restrictions, which likely influences their partisan preferences. Many rural areas also depend on extractive, carbon-intensive industries for economic growth. Likely as a result, rural Americans are less supportive of climate action than urban or suburban ones, even when controlling for partisanship and demographics. +
++Jacobs suggests that rural Americansâ opposition to liberal immigration policies is rooted less in racism than a desire to preserve their sense of âplace.â This premise is debatable, at best. Yet Jacobs doesnât merely wish to argue that rural Americansâ desire for community preservation has little to do with racism but also that it has little to do with conservatism: +
++++Taken as a whole, rural voters are not merely reacting against change â be it demographic or economic. They are actively seeking to preserve a sense of agency over their future and a continuity of their communityâs values and social structures. Some might call this conservatism, but I think it is the same thing motivating fears of gentrification in urban areas, or the desire to âkeep Portland weird.â +
+
+It is true that rural Americans arenât the only ones who try to protect their communities from outsiders and cultural change. Urban and suburban liberals do this through housing policies that make their municipalities less affordable for newcomers, while rural conservatives do it by supporting anti-immigration politicians. In both cases, the political impulse driving voter behavior is a conservative one: Prizing stasis over change and insiders over outsiders is, more or less, the antithesis of progressivism, properly understood. +
+
+
+- The economic challenges facing many rural areas are inherently difficult to solve.
+
+Both sides in the White Rural Rage debate agree that Democrats have done more to help rural America materially than Republicans have. In addition to saving many rural hospitals with Medicaid expansion, Democrats have also directed a disproportionate share of federal job creation dollars toward low-density areas. +
++But Jacobs emphasizes that these are inadequate to address rural areasâ problems. Such communities often suffer from limited employment opportunities, fiscal shortfalls, and teacher shortages â all of which are partly a function of falling populations. +
++Yet the causes of rural Americaâs depopulation are structural. High-population areas inherently offer greater opportunities for workers to specialize and complement each otherâs labor. This translates into higher productivity, which generally translates into higher wages. It would take an enormous amount of social engineering to stop ambitious young people born into declining rural areas from migrating to cities and suburbs. Making rural life sufficiently appealing to retain around 20 percent of the US population already requires massive subsidization of inefficient rural infrastructure and health care systems. +
++Given that rural ways of life are also more carbon intensive than high-density living, attempting to engineer an increase in the rural population through social policy seems ill-advised. Meanwhile, many important policy initiatives â such as increasing housing abundance in thriving metro centers â would likely have the side effect of accelerating rural depopulation. +
++One measure that plausibly could arrest the decline of many economically depressed rural communities would be place-based immigration policies, which offer visas to immigrants willing to work in low-density areas. But this is the exact opposite of what rural white voters are demanding from their representatives. +
++There is a lot more that Democrats can do to help working-class people writ large. But the party lacks a great, politically viable answer for reviving shrinking rural communities because there isnât one. +
+
+
+- Most people inherit the politics of their families and communities
+
++Finally, however one interprets the politics of white rural America, I think itâs a mistake to treat ordinary Trump voters with contempt or as bad human beings by definition. (I donât think Waldman and Schaller necessarily do this, but some on their side of the argument do.) +
++In Salon, Amanda Marcotte applauds White Rural Rage for treating its subjects as âfunctioning adults who have agencyâ and not âthe childlike ciphers of Fox News.â This is an understandable sentiment. Marcotte is herself a product of white rural America who rejected the reactionary politics of her parents. Her impatience with apologias for Trump supporters in âthe Heartlandâ â which often attribute their lamentable voting behavior to everything but their own failures of good citizenship â is well-founded. +
++At the same time, Marcotte is an exception from the general rule: Most voters inherit the politics of the families and communities they were born into. According to a 2023 Pew survey, more than 80 percent of American teens support the same political party as their parents. +
++I believe that my politics are more moral than those of a Trump voter, but I donât think that says much about my moral character. I was born to liberal parents in a left-leaning suburb of a blue state. If Iâd grown up in a rural town where everyone I knew and loved believed that Democrats were the Godless servants of corrupt elites and shiftless poor people, then Iâd probably have voted for Trump; the data admits no other conclusion. +
++Awareness of how thoroughly accidents of birth and experience shape our selves and life outcomes should make us more supportive of income redistribution and more opposed to retributive criminal justice policies. But it should also make us a bit more patient with Trump voters. +
++This does not mean that liberals shouldnât harshly criticize reactionary beliefs or candidates. But we should hate the vote, not the voter. Rage is rarely the most politically productive emotion â whether itâs of the âwhite ruralâ or urban liberal variety. +
+ +
++Disease surveillance has so far kept the infection at bay in the US, but the CDC has renewed concerns. +
++On April 11, the Centers for Disease Control and Prevention (CDC) published a report containing new information about this yearâs spate of measles cases. As of April 11, 121 measles cases have been identified so far in the US this year across 18 jurisdictions. +
++That number should shock you: In a typical year, the US has only around 5 cases in the first quarter. The total for 2024 so far is more than twice the number of cases the country saw in the entirety of 2023, when 58 cases were reported over the full calendar year. +
++The authors of the latest report credited the United Statesâ effective measles monitoring system as a critical factor in enabling public health officials to catch and contain measles cases when theyâve popped up â at least, so far. +
++According to the report, the increase has been so explosive that it threatens to flip the US from being a country where measles is considered eliminated (no longer spread locally) to being one where measles is considered endemic (something that infects people on a regular basis). +
++Itâs been nearly 25 years since measles was officially eliminated in the US. But the declaration didnât mean measles could never come back: Under certain conditions â lots of cases imported from abroad, not enough people vaccinated against the infection, and not enough tools to fight back â measles could re-entrench itself stateside. +
++Thatâs why public health authorities monitor measles cases and vaccination rates against the infection so closely. And why, when cases rise while vaccination rates drop, they fret. +
++Measles is a viral infection that causes fever, rash, and cough, which can be complicated by severe, life-threatening infections of the ears, lungs, and brain. Itâs particularly likely to cause severe disease in children under 5 years old and in immunocompromised people. To make matters worse, itâs one of the most contagious diseases out there: Infectious particles can hang out in the air or on surfaces for hours, and, on average, each infected person infects another 12 to 18 people. +
++When measles turns up in the US, itâs because it was brought to the country from the outside â more often than not, by US residents returning from travel abroad. Thereâs a lot of measles in the world; in 2022, the infection caused more than 9 million cases and killed more than 136,000 people globally, most of them children. Although countries in Eastern Europe, the Middle East, and South Asia currently top the list of measles cases globally, there have also been multiple outbreaks in Western Europe over the past year. +
++Thereâs a highly effective vaccine to prevent measles â but to protect the youngest babies and immunocompromised people in any population, everyone around them needs to have been vaccinated. In the US, pockets of low measles vaccination are a serious concern: 91 percent of patients infected in the US between 2020 and late March 2024 were unvaccinated or of unknown vaccination status. Key strategies for preventing a measles conflagration here include giving unvaccinated people MMR shots (so called because they protect against measles, mumps, and rubella) before they travel and rapidly investigating suspected measles cases, said the report. +
++For now, people can do something about the current US measles situation if they know how and understand the stakes. +
++Hereâs what you need to know. +
+
+
+- Whoâs at highest risk from a measles infection, and what does an infection look like?
+
++Unvaccinated children and immunocompromised people â especially those receiving certain cancer treatments â face the highest risk when measles is in circulation. +
++âEven an uncomplicated case of measles is really awful,â said Sarah Lim, an infectious disease doctor and medical specialist at the Minnesota Department of Health, during a press conference on March 12. Measles infections are so often severe that about one in five unvaccinated people who get infected are hospitalized, and between one and three of every 1,000 measles infections end in death. +
++In its early stages, measles infection can cause a range of symptoms, including high fevers, cough, runny nose, red eyes, and full-body rash. About one-third of infected kids experience complications, which can include severe diarrhea, ear infections, and pneumonia. Brain infection that can lead to brain damage and epilepsy, called encephalitis, occurs in about one of every 1,000 kids who get infected with measles. +
++Measles can also do something else that few other infections are known to do: It can wipe out kidsâ immune memory, leaving them unprotected from other bacterial and viral pathogens. That effect, and the increased susceptibility to other infections that comes with it, can last for years after infection. +
++Travel to parts of the world where measles circulates widely increases the risk of infection. That makes it important to ensure you and your family are protected from measles â in addition to all the other things â prior to travel. +
+
+
+- How is this yearâs measles outbreak in the US different from past outbreaks?
+
++The biggest number of measles cases the US has seen over the past 25 years was in 2019, when nearly 1,300 infections were reported over the course of the year. Nine out of every 10 of these cases occurred among unvaccinated people living in close-knit communities. A single outbreak in an Orthodox Jewish community in New York involved 649 cases; another outbreak involving 71 cases occurred in a Washington state community of recent immigrants from the former Soviet Union. +
++Whatâs different so far about this yearâs US measles cases is that theyâre occurring in âlots of little sparks across the nation,â as epidemiologist Katelyn Jetelina put it in a March edition of her newsletter. âThe more embers, the more likely it is that they find unvaccinated pockets and spread like wildfire,â she wrote. +
++The CDCâs April 11 report noted that over the past four years, the typical US measles case has been younger than in previous years â 3 years old compared to 5 years old in the first four months of 2019, the year of that last big outbreak. The report also noted 63 percent of index cases â that is, cases imported from measles-endemic countries â had occurred in US residents returning from travel abroad. Thatâs fewer than in early 2019, when 77 percent of imported cases were in residents. +
++This yearâs uptick is happening at a time when a relatively large proportion of kids are going unvaccinated against measles. In a November 2023 publication, CDC scientists reported that roughly 7 percent of kindergarteners were vaccinated against measles during the 2022â2023 school year. At the same time, vaccine exemptions reached an all-time high, exceeding 5 percent of kids in 10 states. +
++To make matters worse, according to recent reporting in the LA Times, a lot of parents are choosing to delay measles vaccination in their infants, which increases vulnerability to the most severe effects of measles in a group thatâs already at the highest risk of complications. +
++The World Health Organization (WHO) cautions that the risk of a measles outbreak increases dramatically if more than 5 percent of people in a community arenât vaccinated, which makes these numbers pretty concerning. Whatâs even more alarming is that they are averages: In some states, as many as 22 percent of people are unvaccinated, and that number is likely much higher in some smaller geographic pockets. +
++âThatâs where youâre really talking about throwing a match [into a pile of kindling] and having a large fire,â said Jane Zucker, an infectious disease doctor and epidemiologist who retired in 2023 after 30 years in public health, including more than 20 with the New York City health departmentâs Bureau of Immunization, when I spoke with her in March. âThatâs what youâre really most anxious about.â +
+
+
+- Who should get vaccinated, revaccinated, or tested for immunity?
+
++Thereâs no medicine to treat measles infection once itâs taken hold, which makes prevention the main strategy for avoiding the virusâ worst effects. +
++The best news about measles â and the reason most of us have no idea what it looks like â is that the MMR vaccine that prevents it is extremely effective and safe. +
++That vaccine is what experts call a âlive-attenuatedâ vaccine. That means itâs made using a weakened version of the measles virus that canât actually cause the disease. Because they so closely replicate the actual virus, these kinds of vaccines induce the strongest and longest-lasting response of any type of vaccine â including Covid-19 vaccines. MMR vaccines are 97 percent effective at preventing symptomatic measles infections. +
++These vaccines can even protect people after theyâre exposed to measles if theyâre given within 72 hours of exposure, and theyâre extraordinarily safe. +
++Who should get vaccinated against measles? Babies (lifelong immunity comes after two shots, the first at 12 months old and the second at 4 to 6 years of age) and almost everyone else who doesnât have proof that theyâve been vaccinated before should get vaccinated, according to the CDC. +
++Thatâs especially true if those people without vaccination proof work in health care or are about to travel to places where thereâs lots of measles in circulation â which these days includes Europe, Zucker said. Babies 6 to 12 months should also get an MMR shot if theyâre going to be traveling; because their immune systems arenât mature enough at that age for the vaccine to âtake,â theyâll still need another two-shot series after their first birthday. +
++Many adults whoâve already been vaccinated wonât ever need another measles vaccine. Thatâs because all the versions of measles vaccines in use since 1968 have been strong enough to give lifelong protection against infection. So long as youâre certain youâve had two vaccines in the years since then â that is, itâs documented somewhere in your medical record that you got them â you donât need a repeat. The exception is for adults who only got vaccinated between 1963 and 1967: Because the version used during those years was too weak to give lifelong immunity, theyâre not considered protected unless theyâve gotten at least one dose of a newer version of the vaccine. +
++Another group that doesnât need to worry about vaccination is most adults over 65. Measles was so common before the vaccine was available that experts assume people born in those years were exposed and are immune. So if you were born before 1957, you donât need a vaccine unless youâre in a high-risk situation â for example, you work in health care or youâre about to travel to a place where thereâs a lot of measles in circulation. +
++There are some people who should wait to get an MMR vaccine if theyâre unvaccinated or if their vaccine history isnât clear. Live vaccines like this one are typically not recommended for people with weakened immune systems, which include pregnant folks and some immunocompromised people. Some other conditions make it sensible to hold off on vaccination â have a look at the answers to âWho Should Not Get MMR Vaccine?â on the CDC website and talk to a health care provider if youâre not sure what to do. +
++A blood test called a measles serology can measure the level of measles antibodies in a personâs blood. If the level is high, itâs safe to assume that person is immune to measles, as a result of either vaccination or past infection. But low scores on these tests may not be very meaningful, said Zucker: Many people with low levels of measles antibodies actually have measles protection due to prior vaccination, making it a bad test for determining whether immunizations documented a long time ago are still providing protection. For that reason, the CDC says a history of vaccination supersedes a serology result when it comes to determining whether a person is protected from measles. +
++Health experts sometimes administer these tests in outbreak settings and during pregnancy, but the results are typically used in ways specific to those scenarios. So you donât need a serology to prove youâre vaccinated if the shots are documented in your medical record â and in any case, itâs harmless to get a repeat vaccination even if youâve been vaccinated before. âIf you donât know if youâre immune,â said Zucker, âitâs easier to just get yourself vaccinated.â +
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+- How bad is this outbreak likely to get?
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++Where US measles cases go is really up to us. +
++Thereâs hope for controlling measlesâ damage in the US if more parents opt to vaccinate their babies as soon as theyâre eligible, if they keep unvaccinated kids home from school, and if they vaccinate their unvaccinated children as soon as they hear about a potential exposure. +
++Itâll also help if public health authorities have adequate support and staffing to educate the public about measles, provide and document vaccination â as with immunization registries â and intervene when outbreaks happen. +
++However, last yearâs national debt ceiling deal resulted in cuts to statesâ child vaccination programs. Furthermore, the wild nonsense on vaccines that pervades social media â and, occasionally, official messaging, as in the case of Floridaâs surgeon general â makes it challenging for many parents to disentangle the common-sense guidance from the crap. +
++Joshua Barocas, an infectious disease doctor at the University of Colorado, said during the March 12 press conference that pushing back against measles is a team effort and that removing shame from the equation is key. âParents are flooded with tons of information, some of that [being] misinformation â and so if you are a parent whoâs been on the fence, now is the time to catch up on your kidsâ delayed vaccines,â he said. +
++âI would also encourage health care workers to welcome people with open, nonjudgmental arms,â Barocas said. +
++Correction, March 15, 11:35 am ET: A previous version of this story incorrectly stated the number of years Jane Zucker worked for the New York City health departmentâs Bureau of Immunization. +
++Update, April 12, 1:40 pm ET: This story was originally published on March 13 and has been updated multiple times, most recently to include information from a new CDC report. +