STACEY VANEK SMITH, HOST:
So, Darius, you and I both live in Brooklyn. And last week, something kind of crazy happened.
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UNIDENTIFIED JOURNALIST: A health emergency declared by New York's mayor for parts of Williamsburg, Brooklyn, ordering mandatory vaccinations against the measles, a highly contagious and potentially deadly disease.
VANEK SMITH: New York City Mayor Bill de Blasio declared a state of emergency in our fair borough, Brooklyn, because of measles.
DARIUS RAFIEYAN, HOST:
Right. And there is a measles outbreak happening across the U.S. right now - 555 cases confirmed as of this morning. That's according to the Centers for Disease Control and Prevention in Atlanta. They release numbers every Monday. And 283 of those cases were in Brooklyn.
VANEK SMITH: Part of the problem with an outbreak like this is that measles is extremely contagious. Dr. Maria Sundaram is a fellow at Emory's Rollins School of Public Health. She specializes in epidemiology and vaccinology.
MARIA SUNDARAM: So measles is an infection that causes this very kind of typical rash that's like - it's kind of spotty, starting at the head and then kind of moving down the body. And there can be really significant long-term effects. Some people unfortunately have brain damage after their body is trying to fight measles because of lack of oxygen. They may lose their hearing. They may lose their eyesight.
VANEK SMITH: And some of the people who get measles don't survive. And that is obviously a cost that can't be calculated. But there are a lot of costs that can - costs to an individual, to a community and to the country. And some of these costs can be really high. Maria and a team of colleagues just published a paper in the Journal Of The American Medical Association exploring some of the different costs of a measles outbreak.
This is THE INDICATOR FROM PLANET MONEY. I'm Stacey Vanek Smith.
RAFIEYAN: And I'm Darius Rafieyan. Today on the show, the cost of a measles outbreak. It can compound quickly.
SUNDARAM: Measles is extremely contagious. It can remain in the air for up to two hours after you've left.
VANEK SMITH: Really?
SUNDARAM: Yeah. So if you are in a room and you leave the room, two hours later, someone can come in and get measles from you. Yeah. It's really contagious.
VANEK SMITH: That's terrifying.
SUNDARAM: It's very scary.
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VANEK SMITH: How do you measure the cost of a disease outbreak? In the case of measles, Dr. Maria Sundaram and her team broke the costs down into three major categories.
SUNDARAM: We looked at kind of like an individual immune system perspective. And then we looked at kind of like a hospital-level perspective and then like a broader community-level perspective to kind of figure out, like, what are the unseen, kind of hidden costs of measles?
RAFIEYAN: And the first cost to consider in a disease outbreak is the individual case. And this includes all kinds of factors - community outreach, tracking down people who might have come in contact with that person.
VANEK SMITH: So indicator No. 1 - how much does one case of measles cost?
SUNDARAM: In general, we think the average cost of a measles case is about a thousand dollars.
VANEK SMITH: But this can vary a lot. Maria and her team found one case of a student who got on an international flight after contracting measles. And tracking down all of the people that he might have infected and setting up all of that outreach cost more than $140,000 just for that one case.
RAFIEYAN: OK. Now for cost factor No. 2 - our second indicator, health care. Maria says about 1 in 4 measles patients will end up in a hospital. So how much does that cost?
SUNDARAM: The average cost of a hospitalization is a little under $10,000.
VANEK SMITH: Indicator No. 2 - about $10,000. That is the average cost of one measles patient in the hospital.
RAFIEYAN: Of course, the biggest cost by far isn't the individual case or one particular hospital stay. It's the community response, the protocol that's put in place to try and contain an outbreak.
VANEK SMITH: Maria and team looked at a bunch of recent measles outbreaks to try to tally up these costs. She says a lot of things get factored in.
SUNDARAM: Anytime there is an outbreak, there has to be a control team that's established. They have to isolate measles cases. They often quarantine people who have been exposed. They'll try their best to vaccinate anyone who isn't vaccinated. We also need to maintain lab proficiency for testing for measles cases. We might need to screen all of the hospital staff on a daily basis to make sure that they're not spreading measles to other patients.
RAFIEYAN: Between all of those things, Maria and her colleagues calculated the cost of a measles outbreak to a community to be between 2.7 and $5.3 million. And that is our third indicator - between 2.7 and $5.3 million.
VANEK SMITH: And when you factor all of these things together, Maria says a worst-case scenario measles outbreak would cost the U.S. nearly $4 billion.
SUNDARAM: And the U.S. spends about $45 million for the measles component of the measles mumps rubella vaccine just to avoid that burden, that cost.
VANEK SMITH: So they're spending $45 million, like, subsidizing vaccines, I guess? Is that...
SUNDARAM: Yeah, to avoid this almost $4 billion annually - potential cost of measles.
VANEK SMITH: Well, that seems like a good return on investment.
SUNDARAM: Yeah, it's one of the best returns on investment.
RAFIEYAN: And that's not even counting all of the other costs that Maria and her team didn't factor in - things like the lost productivity from the people who get sick and from the people who are caring for those people.
VANEK SMITH: Also, the cost to individuals themselves. People who have gotten measles, even if they totally recover, are more susceptible to other illnesses for years. And then there's the strain on the health care system.
SUNDARAM: We were like, oh, yeah, when people are having to respond to these outbreaks and they form an outbreak team, those people aren't just materializing out of nowhere. They had another job in the public health system before that now they have to leave to go do this. We were realizing, like, wow, measles isn't just causing measles. It's also causing these weaker links in the health care infrastructure and the public health infrastructure. And goodness knows what that could be doing kind of for our risk for other diseases down the road.
RAFIEYAN: Maria's colleague, Beryl Guterman, co-authored the paper. She says considering all of these different costs and different kinds of costs is crucial when looking at an outbreak.
BERYL GUTERMAN: I think what surprised me the most is how my perspective changed before writing the paper. So when you're trained as an epidemiologist, you look at case counts when you measure outbreak sizes. I think you need to think about, you know, the overall impact of a disease. Like, it's not a one-and-done deal. It's a long-term problem. And so changing the paradigm from case counts to overall burden on all of these levels is really important because it's preventable. And there's ways to step in and prevent these huge impacts.
VANEK SMITH: Beryl says it's critical to consider all of these costs when looking at a measles outbreak. She says it's a question of community and society, of navigating different beliefs and personal freedoms, and balancing all of that with protecting communities, and all of the different costs that a community, an individual and the health care system will bear when an outbreak occurs and long after.
RAFIEYAN: Yeah. And I think it's very easy for a lot of these costs to seem very abstract to us because...
VANEK SMITH: Yeah.
RAFIEYAN: ...I think a lot of us were born into kind of post-measles world. But before the measles vaccine was developed in 1963, the disease infected around half a million people every year and killed nearly 500 people a year.
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VANEK SMITH: Today's episode of THE INDICATOR was produced by Constanza Gallardo. Our intern and fact-checker is Willa Rubin. Our editor is Paddy Hirsch. And THE INDICATOR is a production of NPR.
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