Potential Loss of Measles Elimination Status Poses Public Health and Operational Risks

Executive Brief

Declining vaccination rates across the US, including Hawaii, threaten the nation's measles elimination status, raising the risk of outbreaks. This necessitates monitoring by healthcare providers and small businesses due to potential impacts on public health and workforce stability.

• Healthcare Providers: Increased patient load, potential for managing outbreaks, need for surge capacity planning.
• Small Business Operators: Risk of staff illness leading to operational disruptions, potential impact on customer confidence.
• Action: Watch community health metrics and vaccination coverage rates. Prepare contingency plans for potential staffing shortages.

The Change

The United States is reportedly on the verge of losing its measles elimination status due to a significant decline in vaccination rates. Experts are warning that the virus may have re-established a foothold, indicating a growing vulnerability to outbreaks. This trend, observed in multiple states including Hawaiʻi, suggests a potential resurgence of a highly contagious disease that was once considered eliminated nationally.

Who's Affected

Healthcare Providers (small-operator, healthcare)

For private practices, clinics, and hospitals, a loss of measles elimination status translates directly into a heightened risk of encountering and managing measles cases and potential outbreaks. This could lead to:

• Increased Patient Load: A measles outbreak would strain emergency rooms and primary care facilities, requiring immediate response and potentially diverting resources from other critical services.
• Public Health Mandates: There may be increased pressure to implement or reinforce vaccination requirements for staff and potentially patients, impacting operational workflows and insurance compliance.
• Resource Strain: Managing infectious disease outbreaks requires specific protocols, isolation measures, and potentially specialized staff training, all of which can tax existing resources and budgets.
• Telehealth Considerations: While telehealth can facilitate remote consultations, managing contagious diseases often requires in-person diagnosis and care, limiting its effectiveness for initial measles assessment.

Small Business Operators (restaurant owner, retail shop, service business, local franchise) (small-operator)

Beyond the direct public health implications, declining vaccination rates and the potential for outbreaks pose indirect but significant risks to small businesses:

• Workforce Disruptions: If measles outbreaks occur, businesses could face staffing shortages due to employee illness or fear of exposure. This is particularly concerning in Hawaii's tight labor market, where finding replacement staff is difficult and costly.
• Reduced Consumer Confidence: Potential outbreaks might lead to decreased foot traffic as consumers become more hesitant to gather in public spaces, impacting businesses reliant on in-person patronage like restaurants and retail stores.
• Operational Costs: Businesses may need to implement enhanced sanitation protocols or health screening measures, adding to operating expenses. Furthermore, increased community illness could lead to higher health insurance costs for employees.

Second-Order Effects

• Decreased Vaccination Rates → Increased Measles Cases → Strain on Healthcare Systems → Reduced Healthcare Workforce Availability → Increased Wait Times for All Medical Services
• **Increased Measles Cases → Public Hesitancy to Gather → Reduced Foot Traffic for Businesses → Lower Consumer Spending → Potential Business Closures
• Heightened Public Health Alert → Potential Border/Travel Restrictions (even localized) → Impact on Tourism Industry → Ripple Effects on Ancillary Services

What to Do

For Healthcare Providers:

Action: Watch vaccination coverage rates and public health alerts. Prepare for potential surges in demand for pediatric and general medicine services. Review internal protocols for infectious disease management and ensure adequate personal protective equipment (PPE) is on hand.

• Monitor: Track Hawaiʻi Department of Health (HDOH) updates on measles incidence and vaccination rates. Monitor CDC guidance on outbreak preparedness.
• Prepare: Develop or update surge capacity plans for potential outbreaks, including staffing contingencies and isolation room availability. Ensure robust internal communication strategies are in place for staff regarding new protocols.
• Educate: Consider proactive patient education campaigns on the importance of childhood immunizations and the risks associated with measles.

For Small Business Operators:

Action: Monitor community health trends and HDOH advisories. Develop or review business continuity plans to account for potential workforce disruptions or decreased customer traffic.

• Monitor: Stay informed via local news and HDOH announcements regarding any increase in measles cases or public health warnings. Be aware of employee health and any potential exposure risks.
• Plan: Review your existing business continuity or disaster recovery plan. Specifically, include scenarios for significant staff absenteeism due to illness or public health advisories. Cross-train staff where possible to maintain essential operations.
• Communicate: Ensure clear communication channels with employees regarding health policies and any necessary operational changes.

Both groups should consider this a medium-term risk. While immediate, widespread disruption is not yet apparent, the trend toward reduced vaccination coverage creates a window of vulnerability. Proactive monitoring and preparedness over the next 90 days will be crucial to mitigate potential impacts.