Opinion: RFK Jr.’s use of the National Center for Health Statistics will add confusion to measles deaths count
By mid-September, the Pennsylvania Department of Health had reported four confirmed measles-associated deaths, surpassing the highest annual number of measles-associated deaths in the United States since 1992. Pennsylvania public health professionals are sounding the alarm as statewide measles cases exceed 800, with cases clustering among communities with a history of vaccine hesitancy. But the CDC's measles dashboard page shows just one measles-related death so far this year, with an asterisk.
Amid a tussle between Pennsylvania and the federal government, HHS Secretary Robert F. Kennedy Jr. recently stated that the CDC will only "report measles-caused deaths when the National Center for Health Statistics (NCHS) reports measles as the underlying cause based on death record information submitted by the states." The authors, former senior leaders at NCHS, questioned this approach.
They say the new method deviates from how the CDC historically relied on notifications from state medical officials—including information about symptoms, hospitalizations, and deaths—to immediately publish real-time "associated" death cases that include any deaths with a positive laboratory result for the outbreak condition. During active outbreaks, the CDC has played a key role in making real-time state-level public health surveillance information available for effective and timely responses. Shifting away from the rapid notification approach and relying strictly on mortality statistics generated by NCHS will not provide the surveillance information needed at the beginning of an active outbreak when counts are low.
To see why, the authors explain NCHS's mission and data processing and reporting procedures. As the nation's principal federal statistics agency, NCHS's mission is to produce high-quality, trustworthy statistical information for informing public health policy and actions. Collecting, compiling, and releasing information on death certificates is part of that mission.
Before death counts are released by NCHS, death certificates are first completed by state and local medical officials including physicians, medical examiners, and coroners. Those officials must determine all causes of death—underlying and contributing—listed on the death certificate by adhering to established national guidelines. States' vital registries then submit death certificate information to the NCHS National Vital Statistics System, and the time between death occurrence and data submission to NCHS can vary from state to state.
When the data are received, NCHS verifies and codes the certificates using automated systems, with all causes of death coded with the International Classification of Diseases system. Once coded by NCHS, the data are made available in CDC WONDER, a primary repository for disseminating NCHS mortality data, within one to two weeks.
The excerpt then cuts off as it begins to describe "A small portion o..." The authors' core argument is that this slower, death-certificate-based process will add confusion to the measles deaths count and is poorly suited to providing the real-time surveillance needed during an active outbreak.