Kennedy, Shapiro Feud Over Pa. Measles Deaths

A public feud between U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Pennsylvania Gov. Josh Shapiro over two measles-associated deaths in Lancaster County has laid bare deep tensions between federal and state health authorities amid the nation’s worst measles outbreak in more than three decades.

The dispute erupted after the Pennsylvania Department of Health announced on Aug. 25 that two unvaccinated residents had died after being infected with measles — the first measles-related deaths in the state in 35 years and the first such deaths in the U.S. in 2026, according to AP News.

The Outbreak

Pennsylvania has recorded 460 measles cases as of Aug. 28, with nearly half — 197 — concentrated in Lancaster County, home to large Amish and Mennonite communities. The state is experiencing its largest outbreak since 1992, while nationally the U.S. has tallied 2,777 cases this year, the highest total since 1991, AP News reported.

Both individuals who died were unvaccinated, and none of the more than 390 measles patients in Pennsylvania this year have been fully vaccinated. Vaccination rates in Lancaster County have fallen below the 95% herd immunity threshold, with just under 88% of kindergarteners vaccinated against measles in the 2025-2026 school year.

The Coroner’s Account

One of the deaths was a newborn baby boy who died Aug. 14 at a birthing center in Strasburg Township. The infant tested positive for measles via PCR blood sample and lung tissue testing, but Lancaster County Coroner Dr. Stephen Diamantoni said the immediate cause of death was a lacerated spleen, not measles, as TribLive reported.

Forensic pathologist Dr. Wayne Ross determined measles was not a contributing factor to the infant’s death, Diamantoni said. However, measles was listed under Part II of the death certificate as an “other contributing condition.” The cause of the spleen rupture remains under investigation.

Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, told the Philadelphia Inquirer that measles infection can cause splenic enlargement and thinning of the splenic capsule, making rupture during birth plausible. “Given that congenital measles infection can cause splenic enlargement and thinning of the splenic capsule, it is likely that the child ruptured the spleen during birth,” Offit said.

No information has been released about the second death. The Lancaster County coroner has said he doesn’t know who the second person is, while the Pennsylvania Department of Health noted that not all deaths need to be referred to a coroner under state law.

Kennedy’s Claims

On Aug. 26, Kennedy posted on X that the deaths “may even have been altogether fabricated by one of the Governor’s hopeful staffers,” citing the coroner’s statement that there was “no record of any measles deaths.” At a press conference in Tampa, Florida, the same day, Kennedy said: “We’re trying to figure out, you know, who those deaths were and whether they actually happened, and we can’t figure that out yet.”

Pennsylvania Health Secretary Dr. Debra Bogen pushed back forcefully. “As a pediatrician with more than 30 years of caring for children, I have thoroughly reviewed the case investigation information and sadly can confirm that there were two recent measles-associated deaths in Lancaster County,” she wrote on X.

Shapiro’s Response

At a press conference announcing the deaths, Shapiro blamed declining vaccination rates and criticized Kennedy’s anti-vaccine rhetoric. “I was very, very blunt with him,” Shapiro said. “I made very clear that his actions and the rhetoric that’s coming from this administration are having a negative impact on communities across America, particularly right here in Pennsylvania.”

Shapiro added: “There’s real-life consequences to scaring people and not relying on actual doctors and actual medical professionals to provide unbiased information to parents so that we can make reasonable decisions for our kids.” The governor declined Kennedy’s offer of federal assistance, saying the state health department could handle the situation, as ABC News reported.

The ‘Measles-Associated’ Definition

Much of the confusion stems from different definitions and processes used by state epidemiologists and coroners. The Pennsylvania Department of Health defines “measles-associated” as when “laboratory or epidemiologic evidence of measles is present, but the disease may not be assessed by the medical certifier or coroner to be the immediate cause of death.”

Dr. Amesh Adalja, an infectious disease specialist at Johns Hopkins Center for Health Security, said the two accounts are not necessarily in conflict. “The coroner’s account and the state’s account are not necessarily in conflict — they are two offices answering two different questions — but nobody in Harrisburg explained that, so the public was left to choose between fraud and incompetence,” he told FactCheck.org.

Adalja noted that measles would rarely be listed as the immediate cause of death even when it is the underlying cause — the immediate cause would typically be a complication like pneumonia or encephalitis. He criticized both sides for politicizing the issue: “Now it’s turned political. It’s no longer about getting answers and figuring this out.”

CDC Involvement Questioned

The Centers for Disease Control and Prevention said Pennsylvania has declined offers of federal assistance and has not provided the agency with information about the outbreak. The Pennsylvania Health Department disputed this, saying it is in regular contact with CDC staff and reports weekly cases, as CBS News Philadelphia reported.

National Context

The U.S. eliminated local measles spread in 2000 through high vaccination rates, but those rates have fallen below the 95% coverage needed to prevent outbreaks. The nation has now seen five measles-associated deaths in the last two years — more than the combined total of reported deaths over the previous three decades. In November, international health officials will determine whether the U.S. and Mexico have lost their measles-free status.

Kennedy has a lengthy history of questioning vaccine safety, including a 2021 appearance in Lancaster County where he spoke to the Amish community and downplayed measles risks. However, amid mounting pressure, he has recently said the MMR vaccine is the best way to prevent measles. “Our advice is that people should get the measles vaccination,” he said at the Tampa press conference.

Dr. Paul Offit warned that the outbreak may be far larger than official numbers suggest. “This outbreak is much worse than they’re saying. It’s probably closer to 2,000 cases. And it’s August” — not even measles season, which typically peaks in winter and spring, he told Ars Technica.

What’s Next

As Pennsylvania’s outbreak continues to spread — with cases now in 28 counties — the feud between federal and state health officials threatens to further undermine public confidence in vaccination efforts. Health experts say the focus should be on getting accurate information to parents and increasing vaccination rates, particularly in communities where coverage has fallen below protective thresholds.

“Pennsylvania created its own information vacuum and then seemed surprised when someone else filled it,” Adalja said. “In an outbreak, institutional credibility is a consumable resource — and Pennsylvania spent a great deal of it.”

The state has been promoting measles vaccinations as cases have risen, with about 35,000 people vaccinated — up from the usual pace of about 25,000 per month. Whether the political firestorm will help or hinder those efforts remains an open question as the outbreak enters the fall school season.