The Minnesota Department of Health Responds to Measles Outbreak: An Interview with Ed Ehlinger

August 24, 2017|4:10 p.m.| ASTHO Staff

Ed Ehlinger, MDMeasles is a highly contagious disease that can be prevented with two major vaccinations: the measles, mumps and rubella (MMR) vaccine and the measles, mumps, rubella and varicella (MMRV) vaccine. The rate of measles in Minnesota began to rise in April 2017. As of July 13, 2017, there have been 79 confirmed cases of Measles in the state of Minnesota, 71 of which linked to unvaccinated populations. In response to this outbreak, The Minnesota Department of Health worked closely with community leaders and state health organizations to increase vaccination rates and awareness.

Ed Ehlinger, MD, commissioner of health at the Minnesota Department of Health (MDH), shares key lessons learned from this outbreak. 

It has been said that one should never let a good crisis, or a major infectious disease outbreak, go to waste. We have tried to use the 2017 measles outbreak to raise the public’s consciousness and understanding about infectious diseases, vaccinations, vaccine hesitancy, inaccurate information, health equity, and overall public health approaches to community challenges. 

Kristen Ehresmann, director of the infectious disease epidemiology, prevention, and control division described very well the complex, varied, and intense efforts needed to address this major outbreak. Having the organizational infrastructure and a dedicated staff with a myriad of skills was essential for the response. 

As the state health official for Minnesota, the most important thing for me to do was to let our agency experts implement their best practices and give them both the public and behind the scenes support for their activities. My bully pulpit allowed me to build public support for their efforts, which in turn helped us expand the conversation about what creates health in our communities as part of our efforts to advance health equity and optimal health for all. 

We learned several lessons from this outbreak:

  • Proactive engagement with the community is essential. This engagement must be wide-ranging to include political, religious, and community leaders, healthcare providers, daycare center and school staff, community agencies, as well as parents and families. This engagement should be ongoing and not just initiated for a single event. Other concerns may arise over the years so an ongoing relationship with the community is beneficial.
  • Let the community lead wherever and whenever it can. Without backing off from our public health mission and responsibilities, it’s often more effective to follow the advice and leadership of community leaders. Similarly, it is important to be sure state and local public health agencies are clear on who is doing what and who is accountable.
  • Having staff in your program who are members of the affected community is essential if the science and public health messages are going to be heard and trusted. This is even more critical when interacting with racial minorities and groups whose first language may not be English.
  • Public health problems do not present themselves in isolation and can’t be effectively addressed independently. The issues of measles, autism, vaccine safety, child care, sick leave, health insurance, access to care, racism, anti-immigrant sentiment, and overall health beliefs were part of many conversations during this outbreak response and had to be collectively and individually addressed in an effective way. 
  • Having a well-designed, flexible and consistently implemented communications plan is essential in making sure messages coming from all staff involved are complementary and have the desired impact with the intended audience. Part of that plan must include how to interact with skeptics, detractors or others who may have alternative views on the nature of the challenges and solutions. 

Thanks to the advent of vaccines, antibiotics, food and water regulation, laboratory testing, and 21st century epidemiology, infectious diseases are not as devastating as they were in the past. However, they are kept at bay only by the continuation of core public health efforts. Inadequate support of the basic public health infrastructure comes with huge risks for all of society. This measles outbreak has been a stark reminder that public health is essential for a community to thrive and be healthy, and it must be supported so that it can be there 24 hours a day, seven days a week for all members of the community.