A Nursing Approach to the Largest Measles Outbreak in Recent U.S. History

Lessons Learned Battling Homegrown Vaccine Hesitancy

Blima Marcus, DNP, RN, ANP-BC, OCN


Online J Issues Nurs. 2020;25(2) 

In This Article

Abstract and Introduction


Immunization is widely lauded as the greatest achievement in public health. However, vaccination rates have been dropping in developed countries due to vaccine hesitancy. Vaccine hesitancy has been listed by the World Health Organization as one of the top ten threats to global health for 2019. During a recent measles outbreak in New York, a group of nurses became ambassadors for immunization, bringing evidence-based health information to the Orthodox Jewish community in a culturally-sensitive manner that was known as the Engaging in Medical Education with Sensitivity (EMES) Initiative. Using a grassroots community-based approach, healthcare providers countered widely-distributed misinformation using evidence and empathy. This article will provide useful tips to address vaccine hesitancy through effective communication and evidence-based answers to common and uncommon vaccine myths for communities and discuss implications for nurses faced with vaccine hesitancy.


Immunization is widely considered to be the greatest achievement of public health. In 1900, 30.4% of all deaths occurred among children under age 5; in 1997, that percentage was only 1.4% (Association of State and Territorial Health Officials, 2016). This is attributed to overall improved sanitation, immunizations, antibiotics, and access to medical care. The initial, immediate benefit of vaccination is to the individual, who is now protected from the disease he is immunized against. The second, delayed, benefit of vaccination is to the community. Herd immunity occurs when enough people are protected against a disease, which then cannot gain a foothold and circulate.

Different diseases require different vaccination thresholds to keep the disease away; once the threshold dips, outbreaks may occur. A recent analysis of vaccination benefits found that immunizing the 2009 United States (U.S.) birth cohort would result in 42,000 fewer deaths and 20,000,000 fewer cases of vaccine-preventable illnesses, with a net savings of $69 billion in total societal costs (Zhou, 2011).