SPARTANBURG, Feb 13 — About a dozen times each day, medical staff at Parkside Pediatrics in the city of Spartanburg, South Carolina, the United States (US) head to the clinic’s parking lot, reaching inside cars and minivans to check children and their parents for fever, rash and other signs of measles.
Dr Justin Moll started this outdoor triage in December to cope with what has quickly become the largest American measles outbreak in over three decades, federal health data show. He wants to keep the highly contagious virus out of the clinic’s waiting rooms, already packed with infants and other small children.
Many of them are unvaccinated against measles because they are still too young.
Dr Moll and his colleagues have treated about 50 measles patients since the outbreak began in early October, a number never seen before at their South Carolina clinics. They fear that outbreaks like these are becoming the new normal as Americans’ opposition to vaccines deepens, fueled by backlash to the COVID-19 response and misinformation on social media.
Medical experts say US Health Secretary Robert F. Kennedy Jr.’s anti-vaccine policies have further undermined public trust in life-saving immunisations by promoting unproven theories about the dangers of vaccines.
"This is not going to be the last vaccine-preventable disease to hit us," Dr Moll told Reuters at his clinic in Spartanburg, the epicentre of the outbreak.
For this story, Reuters interviewed more than two dozen doctors, nurses, parents, school officials, pharmacists, pastors, lawmakers, and former health officials in the state.
The South Carolina outbreak has surpassed 930 cases, about 20 of which required hospitalisation, according to state health officials. No deaths have been reported so far.
School immunisation rates statewide have dropped by nearly three percentage points since 2020, as local leaders and parents pushed back against COVID-related lockdowns and vaccine mandates, demanding more "medical freedom" to choose what, if any, other routine shots their children receive.
Only 89 per cent of all students from kindergarten through high school are up to date on their shots in Spartanburg County, below the 95 per cent rate that public health experts say is needed to prevent the spread of measles. In some local schools, vaccination rates have dropped below 20 per cent, according to state data.
During previous outbreaks, the federal government led efforts to encourage widespread vaccination and coordinate among states to curb the spread of disease. Kennedy has not made any major statements regarding the measles outbreak in South Carolina.
HHS did not respond to a request for comment.
The measles, mumps, and rubella (MMR) two-shot protocol remains recommended at the federal level, starting at 12 months of age, with a second dose at four to six years of age.
Measles is among the most highly contagious viruses known. Spread through coughing, sneezing, and talking, it can linger in the air for up to two hours and move quickly through communities with low vaccination coverage.
'Some folks have overreacted' in avoiding all vaccines
Some South Carolina Republicans now have second thoughts about discrediting routine immunisation, but find they hold little sway.
"I now believe that some folks have overreacted in the other direction and oppose any and all vaccines, even ones that have been tried-and-true for decades," wrote Republican state senator Josh Kimbrell, who is running for governor, to a Spartanburg County school board last month.
He asked school officials to review their policies on student vaccine exemptions, but was pilloried on social media after he posted the letter online. Kimbrell did not respond to requests for comment.
Dr Leigh Bragg, a paediatrician near Spartanburg, said local hospitals, churches, and schools are reluctant to speak up about the most proven way to curb the outbreak.
“People are trying to stay in the middle and not pick a side on vaccinations,” she said.
Even South Carolina Governor Henry McMaster, a Republican, has championed personal choice as the preventable disease spreads through the state.
"Our approach is to be sure people have the information and that the vaccine is available for them, give them all the information so they can make up their mind on what they want to do," he told the media at a state tourism conference this week.
The outbreak struck as South Carolina’s Public Health Department grappled with reductions in federal funding and overall staffing in recent years, two former department employees told Reuters.
Last month, the Trump administration said it had sent South Carolina US$1.4 million (RM5.47 million) to support its measles response. State officials said the federal government has also provided assistance with testing, clinical advice, and free vaccines.
"The number of cases we are seeing now is unprecedented. We have a great deal more work to do to stop this outbreak," said South Carolina’s state epidemiologist Dr Linda Bell this week.
Despite Dr Bell's pleas for people to get fully vaccinated, some remain reluctant to heed those calls. At state-run vaccine clinics at Spartanburg churches, only a handful of people have shown up in recent weeks.
Spartanburg barista Talina Podrez, 21, said measles had swept through her local church in January, leaving services about half empty. While she stayed away because she had only one of the two recommended MMR doses, Podrez said she is not interested in getting another.
"My mom was against most of the vaccines, so we just got whatever was needed for the bare minimum," she said.
'Many parents have lost respect and fear for this disease'
Nurse practitioner and Spartanburg County-based Parkside Pediatrics medical director Nathan Heffington believes that many more infections are not being counted. He has seen multiple unvaccinated families show up with telltale signs of measles, but then refuse to get tested.
The clinic still reports them to the state as suspected cases and advises them to quarantine.
“The actual numbers are much, much higher than the reported numbers, which is just all the more nerve-wracking. Many parents have lost respect and fear for this disease," he said.
While political leaders shy away from a strong endorsement of vaccines, it is left to medical providers like Dr Moll and Heffington to persuade reluctant parents of their value.
"They are not anti-anything. They are just trying to do the best thing for their family and figure out who to trust," said Dr Moll.
Kathleen Black’s two oldest children, ages eight and four, got all their routine immunisations. But she wanted to wait until her youngest, Katie, was born about a year ago.
From social media and friends, Black heard childhood vaccines may cause autism or developmental delays, claims not supported by medical research. Like many in South Carolina, she voted for Trump and supports Kennedy’s demands for more vaccine safety studies.
“I like to go down those rabbit holes, and it opens up millions of questions, like ‘What is in the vaccines? Why are we giving all these vaccines?’” she told Reuters during a visit to the Parkside clinic.
Heffington explained to her the risks posed by vaccine-preventable diseases. He then discussed the immediate threat her baby faced from measles, and the protection provided by an early MMR shot.
Heffington answered all of her questions about possible side effects. Finally, Black pressed him: “Would you do it?”
“Absolutely,” the father of five replied. Black agreed to the first dose that day, and her daughter received a second dose last month.
“I would not trust every doctor, but I definitely trust Nathan," she said.
