By Katrine L. Wallace, The Conversation via Reuters Connect<\/p>\n
If you\u2019ve been following the dispute between Gov. Josh Shapiro<\/a> and Health and Human Services Secretary Robert F. Kennedy Jr., you probably know that it centers on the deaths of two infants in Lancaster County<\/a>\u00a0in late August 2026.<\/p>\n And you may be aware that despite the\u00a0county coroner\u2019s confirmation<\/a>\u00a0that one infant died due to measles, while the other\u2019s death was \u201cmeasles-associated,\u201d the\u00a0measles dashboard<\/a> on the Centers for Disease Control and Prevention website counts neither death as of Sept. 11.<\/p>\n A third Pennsylvania resident has died from “complications associated with measles” on Saturday, Sept. 12, Jefferson County Coroner Greg Furlong confirmed<\/a>. Officials said the 40-year-old woman was a Jefferson County resident\u00a0but did not release her name.\u00a0<\/p>\n It\u2019s easy to dismiss the squabble as political posturing between public officials. But as an\u00a0epidemiologist<\/a>\u00a0who studies\u00a0vaccine-preventable illnesses and health communication<\/a>, I worry that for people seeking accurate information about how to keep their families safe \u2014 in this case, families in Lancaster County \u2014 there\u2019s an enormous cost when health authorities no longer speak in one voice.<\/p>\n In the confusion that such rifts create, the public has no way of knowing which disagreements are about evidence and which are driven by ideology and narrative control.<\/p>\n Deaths in dispute<\/p>\n The U.S. government issues a certificate for every death, confirming its\u00a0underlying cause<\/a>\u00a0following a physician\u2019s examination. The death certificate poses a narrow question: What single condition set in motion the chain of events that ended in this person\u2019s death? This is recorded as the cause of death.<\/p>\n Because measles is what the CDC calls a\u00a0notifiable condition, or a reportable disease<\/a>, measles deaths get added to a national count. Contributing conditions go on a separate line in the document and are not counted.<\/p>\n Nobody disputes that both infants had measles when they died. The argument is which line on the death certificate \u201cmeasles\u201d belongs on. The Pennsylvania Department of Health\u00a0has called both deaths measles-associated<\/a>. This term is used when there\u2019s evidence the person had measles, but there\u2019s no settled official cause of death yet. It\u2019s a holding category, not a verdict.<\/p>\n The job of determining the official cause \u2014 that is, certifying a death \u2014 falls to the county coroner. Lancaster County Coroner Stephen Diamantoni concluded that for one of the infants, a newborn boy who died in mid-August, the cause was a ruptured spleen\u00a0unrelated to the measles infection. For a 6-week-old girl who died Aug. 18,\u00a0he found that measles was the cause<\/a>.<\/p>\n These are not competing conclusions. They come from two different systems asking two different questions. County coroners\u2019 decisions on cause of death are legal finding, made one case at a time, that feed\u00a0national vital statistics<\/a>.<\/p>\n State health departments, on the other hand, run disease surveillance. They track who got sick and who died during an outbreak so they can contain it. Surveillance moves in days because it has to; death certification moves in weeks because it should. The two rarely line up in real time.<\/p>\n A moving target<\/p>\n While the apparent divergence between county and state data was basically a technicality, the exchange between Shapiro and Kennedy was more of a brawl.<\/p>\n Shapiro\u00a0announced the infants\u2019 deaths on Aug. 25<\/a>\u00a0and blamed anti-vaccine rhetoric for falling vaccination rates and increasing cases. The CDC\u00a0posted condolences on the social media platform X<\/a>, using Pennsylvania\u2019s language calling the deaths measles-associated.<\/p>\n But in response, Kennedy suggested the\u00a0deaths might have been fabricated\u00a0by a member of the governor\u2019s staff. Two days after Shapiro\u2019s announcement, the CDC\u00a0walked back its post<\/a>, expressing appreciation for Kennedy\u2019s efforts to clarify conflicting information from Pennsylvania officials about whether the two reported deaths were caused by measles.<\/p>\n Then, in an unusual move, on\u00a0Aug. 30, the CDC changed the death count on its measles dashboard from 2 to an asterisk, with a footnote stating that the National Center for Health Statistics currently has no death records from 2026 that indicate measles is the underlying cause.<\/p>\n No new evidence arrived in those two days that would explain the CDC\u2019s new position.<\/p>\n HHS now says it is working with a national network of disease tracking experts on a\u00a0standardized case definition<\/a>\u00a0for measles deaths. Standard case definitions exist for measles infections but not for measles deaths, for the simple reason that until recently, dying from measles in the U.S. was an extremely rare occurrence: Between\u00a02001 and 2022<\/a>, the U.S. recorded roughly 4,000 cases and three deaths.<\/p>\n But writing a definition in the middle of a count \u2014 and applying it to a single state\u2019s deaths \u2014 is a departure from protocol. Previously, during outbreaks in Texas<\/a>\u00a0and\u00a0New Mexico<\/a>\u00a0in 2025, the CDC did\u00a0count three measles-associated deaths<\/a>\u00a0while they were still being investigated. Declining to do so now\u00a0is inconsistent and confusing, and breeds mistrust.<\/p>\n Unnamed officials told news outlets that\u00a0CDC Director Erica Schwartz removed the deaths at\u00a0Kennedy\u2019s request<\/a>, after CDC staff had accepted the state\u2019s data. HHS disputes this, and Kennedy said in a post on X that the coroner\u2019s finding \u2014 that the newborn boy\u2019s death was caused by a ruptured spleen \u2014 vindicated federal caution<\/a>.<\/p>\n A parent sifting through all this information has no way to gauge who is right. The usual shortcut \u2014 check the CDC numbers on the measles dashboard \u2014 now yields an asterisk leading to a footnote that contradicts statements from state officials, a county coroner and the agency\u2019s own condolence post from 10 days earlier. There\u2019s no neutral tiebreaker left, which means the decision falls back on which institution you already trusted most.<\/p>\n A broader split in public health guidance<\/p>\n While that argument played out, a second rift was widening on a different track.<\/p>\n On Sept. 2,\u00a0four physician groups<\/a> \u2014 the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Infectious Diseases Society of America \u2014 issued their own vaccine recommendations<\/a>\u00a0for the fall respiratory season.<\/p>\n The pediatricians association had already\u00a0split from the CDC\u2019s childhood immunization schedule<\/a> in 2025, ending a 30-year practice of publishing one agreed-upon set of recommendations for families. What\u2019s new is that three more societies have now joined this public health separatist movement, and that the split has extended to the shots most adults get.<\/p>\n On influenza, the physician groups\u2019 advice matches the CDC\u2019s: Everyone 6 months and older should get a flu vaccine. On COVID-19 they go further, recommending vaccination for children 6 to 23 months, whereas the CDC tells parents to consult a doctor.<\/p>\n For decades, the CDC\u00a0has issued fall vaccine recommendations<\/a>\u00a0each year, offering a unified slate of federal advice for everyone across the U.S. to follow. Now, with the federal advisory\u00a0committee that makes those recommendations sidelined<\/a>\u00a0and\u00a0embroiled in a legal battle<\/a>, the agency has issued no new federal vaccine guidance for this season. The four physician groups stepped forward to fill the gap.<\/p>\n Yet technically, the CDC\u2019s previous seasonal recommendations \u2014 and its revised childhood immunization schedule \u2014 still stand, creating a confusing doubling of critical health guidance.<\/p>\n The cost of fracture<\/p>\n This confusion has a measurable cost.<\/p>\n Measles is among the\u00a0most contagious<\/a>\u00a0diseases known. Roughly\u00a01 to 3 in 1,000<\/a>\u00a0children who catch it die, and in 2025,\u00a011% of cases<\/a>\u00a0required a hospital stay. A 2025 study put the\u00a0average cost at roughly $43,000 per case<\/a>.<\/p>\n The\u00a0national case count reached 3,134<\/a>\u00a0on Sept. 4, the highest since 1991. As of the same date, Pennsylvania\u00a0had recorded 624 cases<\/a> \u2014 91 in the previous week. More than 40% of Pennsylvania\u2019s cases have been in Lancaster County.<\/p>\n Parents must now reconcile a recently revised federal immunization schedule, a set of physician-society recommendations that departs from it, a state count of three deaths and a national count of none.<\/p>\n Each of those positions has an institution behind it. None of them explains how it relates to the others \u2014 and that is what\u2019s most damaging. Public trust doesn\u2019t only collapse when officials lie. It erodes when people are handed different information that can\u2019t be squared, or misleading information, and are left to sort it out alone.<\/p>\n