Blog/2026-04-21/Childhood Measles

My daughter and me, both in our childhood, with my mother holding us

San Francisco's current state of affairs is pretty amazing

When I was a young child, around 8 months old, my parents were doctors in a village in India. The deal back then was that that government would educate you to be a doctor and, in exchange, you'd go and be a doctor where they told you to. So one way or another they found themselves in rural India in the late 1980s. India's infant mortality rate (the number of children that don't reach 1 year of age per 1000 live births) at the time was about 90 (San Francisco today is about 3 for comparison). The thing about poor places is that the base stratum upon which societies are built is weaker. Many of the things we take for granted are not that common.

As an example, rich societies like the US have specialized areas for medical care and a substantial enough number of medical personnel that these places are always staffed. Medical care of this base sort is one of the first things that most societies target since it ensures a population capable of building more things and my experience of urban and suburban India even by the time I was 5 years old was that this was available there. Rural India in 1988 was not yet so advanced, and when the clinic closed there was no medical care. One such day, my parents were home with me when they heard a desperate knock on the door.

My Measles Illness

I was playing on the floor in the front room of the home when my dad opened the door and a terrified man rushed in with his very sick child who had red spots and a high fever. I was in the room for a few seconds before my mother rushed me away to the back room and my father ushered the man outside to check his child. Measles is an incredibly contagious disease, though, and the next day I began my own illness. I was perhaps a month away from receiving the vaccine and maybe two months from being fully immune. And there I was: deathly ill. In another sense, I was somewhat protected by my age since my mother's antibodies were still available to me. I don't have any knowledge today of what happened to the other child but with the 1-in-10 fatality rate for our age group I rate their chances pretty highly.

I was fortunately not at any nutritional risk, and I had two doctors as parents so my illness was managed well, and I eventually recovered with no lasting damage done. Yhprum's Law came through, and I was part of the vast majority of children that encounters this disease with no real trouble. But the thing with any thing that operates at the 90% is that the survivors outnumber the dead by 9 to 1. If you were to just ask around among parents almost everyone would tell a tale of how it was tough but in the end just fine. That's the wrong lesson to take at the population level, though.

What Could Have Happened

Measles is an insanely contagious disease and you need 95% population coverage of the vaccine to prevent its spread. It is some six times as contagious as COVID-19 and kills and injures children very easily. Besides the various direct ways to die, I also read about something perhaps much worse which made me recall this entire episode of my life: an NYT Op-Ed article about a woman whose child died at the age of 10 years after getting measles. In about 1 in 600 children who got the disease like I did, the measles virus persistently infects the brain and eventually causes an incurable progressive brain inflammation called Subacute sclerosing panencephalitis (SSPE). Despite what will look like an unremarkable recovery from the disease, the child will eventually start losing brain function and finally die.

The Never-ending War

Humanity holds back entropy at great ongoing cost. Nothing is free, and it is only through the constant effort of many people that our present level of civilization is possible. The shifting baseline caused by newer generations born into an era of prosperity unknown to the past means that a safe and illness-free human life is assumed to be standard in the West, effort-free. If things changed drastically and acutely, we would perhaps adapt accordingly. But if the conditions are delayed, then will we be able to adapt? Western doctors of the last twenty years would probably never have encountered SSPE. But the British rates of vaccination are dropping below 85% and the American rates are dropping below 90% and this illness is going to show up as an echo of this action, ten years hence. This woman's child was killed by the immunity status of Britain of 10 years ago. The pre-teens who will die 10 years from now are being born today.

This kind of civilizational amnesia scares me in a deep sense. In a sense it's adaptive. Forgetting allows us to move forward to deal with novel problems and stop carrying cost for solutions to problems that don't exist. It is nature's own regularization regime for us. But when I think about my own daughters falling to this kind of disease, I feel a deep fear. Maybe our role as the older ones is to play the role of memory in the autoregressive model so that we may keep our civilization alive while the younger ones carry the role of exploration. I hope we're collectively up to it.

Appendix

Making a position your political opponents' position has great positive results

What's actually happening in the US is quite interesting. Johns Hopkins published a county-based dataset that is quite detailed so you can check how things have gone from 2017 to 2023. What this reveals is that while the counties around us here in the Bay Area actually adjusted to fix the vaccination issue for MMR-2 the

MMR vaccination rates, San Francisco Bay Area counties (kindergarten, 2-dose)

County	2017–18	2018–19	2019–20	2020–21	2021–22	2022–23	2023–24
Alameda	94.88%	95.08%	98.52%	92.59%	97.19%	97.20%	96.36%
Contra Costa	94.82%	94.59%	97.95%	96.44%	97.47%	97.85%	97.86%
Marin	90.29%	88.21%	96.92%	97.67%	99.09%	98.97%	98.89%
Napa	89.62%	88.00%	98.00%	96.74%	98.80%	98.34%	98.99%
San Francisco	89.91%	92.11%	97.56%	95.13%	96.42%	98.20%	98.37%
San Mateo	93.87%	94.12%	98.12%	98.29%	98.19%	98.04%	98.54%
Santa Clara	94.77%	95.01%	98.16%	97.57%	98.12%	98.75%	98.63%
Solano	96.66%	96.31%	98.06%	96.70%	98.30%	97.90%	98.16%
Sonoma	89.73%	88.61%	94.70%	94.02%	95.03%	95.47%	94.95%

But the fraction of other counties that are at 90% or more:

Share of counties ≥90% MMR — 609 counties reporting in both years

School year	Counties ≥90%	Reporting	Share ≥90%
2017–18	501	609	82.3%
2023–24	401	609	65.8%