Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children's Health

by Adam Ratner

A pediatrician and infectious disease specialist warns of the resurgence of measles, the antivaccine movement, and how we can prepare for the next pandemic

Every single child diagnosed with measles represents a system failure—an inexcusable unforced error. The technology to prevent essentially 100 percent of measles cases has been in our hands since before the moon landing. But this serious airborne disease, once seemingly defeated, is resurgent around the globe. Why, at a time when biomedical science is so advanced, do parents turn away from vaccination, endangering their own children and the health of the wider population?
    Using a combination of patient narrative, historical analysis, and scientific research, Dr. Adam Ratner, pediatrician and infectious disease specialist, argues that the reawakening of measles and the subsequent coronavirus pandemic are bellwethers of forgotten knowledge—indicators of decaying trust in science and an underfunded public health infrastructure. Our collective amnesia is starkly revealed in the growth of the antivaccine movement and the missteps in our responses to the beginning of the coronavirus outbreak, leading to preventable tragedies in both cases.
    Trust in medicine and public health is at a nadir. Declining vaccine confidence threatens a global reemergence of other vaccine-preventable diseases in the coming years. Ratner details how solving these problems requires the use of literal and figurative “booster shots” to gather new knowledge and retain the crucial lessons of the past. Learning—and remembering—these lessons is our best hope for preparing for the next pandemic. With attention and care and the tools we already have, we can make the world much safer for children tomorrow than it is today.

Genres: Nonfiction, Science, Medical, Audiobook, Health, History, American

288 pages, Hardcover

First published February 11, 2025

About the author

Adam Ratner, MD, MPH is a pediatric infectious diseases physician based in New York City. In addition to practicing medicine, Dr. Ratner directs an active research group and teaches students, residents, and other trainees. His work has appeared in The New England Journal of Medicine, PNAS, Pediatrics, and other venues. Currently, Dr. Ratner is a member of the Committee on Infectious Diseases of the American Academy of Pediatrics, edits a major textbook of pediatric infectious diseases, and serves on numerous advisory and editorial boards. He speaks widely in both academic settings and news outlets on topics relevant to vaccination and infections in childhood and is the author of the book Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health.

Reviews

[CatReader · Rating 5 out of 5]

Dr. Adam Ratner is a pediatric infectious disease physician at NYU. His 2025 book Booster Shots explores how current US measles outbreaks due to waning vaccination rates are a sentinel of worse things to come - not necessarily in terms of emerging pathogens (as those will come regardless), but in how equipped our society will be to handle them.

Measles is one of the most infectious known pathogens to humans, causing symptomatic and occasionally life-threatening disease in children, and the measles vaccination (the first M in the measles, mumps, rubella, or MMR, triple vaccine) is highly effective in preventing it when dosed correctly (first dose at 12-15 months of age, second dose at 4-6 years of age, as currently recommended by the Centers for Disease Control and American Academy of Pediatrics). Unfortunately, due to a variety of factors, like the thoroughly-debunked theory that the MMR vaccine is linked to autism, and certain vocal but misinformed influencers, vaccine hesitancy has become a real issue in recent decades. Dr. Ratner discusses his professional and non-judgmental approach when discussing vaccination with parents of kids hospitalized with preventable infections (a very difficult yet important skill for healthcare providers to have), what's led to the current vaccine-hesitant era, and a lot of interesting historical insights into measles (thought to have originated from a bovine virus around the time humans and cows started interacting) and measles epidemiology.

Further reading:
Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure by Paul Offit, MD - for much more about the autism-MMR story
Bad Advice: Or Why Celebrities, Politicians, and Activists Aren't Your Best Source of Health Information by Paul Offit, MD
Lifelines: A Doctor's Journey in the Fight for Public Health by Leana Wen, MD
What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City by Mona Hanna-Attisha, MD
Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live by Nicholas Christakis

My statistics:
Book 192 for 2025
Book 2118 cumulatively

[Debbie Mitchell · Rating 5 out of 5]

My top 2025 nonfiction release so far. So timely. So well-written.

CW: medical content, children getting sick from vaccine preventable diseases. Discussion of kids dying (not described in detail).

"While measles is often first, it is a harbinger of problems to come."

"Measles is a master at infiltrating and revealing the cracks in our human systems."

"A fundamental issue in how we think about measles is memory. In the same way that measles virus kills the cells that are the keepers of immune memories.. ... when we forget, measles thrives--both within the body of an individual and in a society making decisions about whether to prioritize vaccination. Both kinds of amnesia leave us vulnerable to a host of conditions beyond measles."

Did you know that measles attacks memory B cells in your immune system so you loose your immune system's memory when you get the measles???

So when kids were finally getting vaccinated for measles, yes they saw measles cases go down but kids also became much healthier since a measles infection was not wiping out their immune memory!!!

Ratner gives an in-depth explanation of the measles virus (like how it destroys the memory of your immune system), the history of the vaccine, & why hesitancy persists.

Something I really appreciated about this book was the honesty around the effects of colonization and unequal access to healthcare on the spread of infectious disease. Diseases are actually not the great equalizer.

Ratner's personal experience treating children that are sick with vaccine-preventable diseases really strengthened this book.

Ratner writes with an empathetic and authentic voice as a pediatrician and expert in public health. This book is seriously a gift and should be required reading.

[Tiffany · Rating 4 out of 5]

"Samoa did not even have enough child sized coffins." This is what happened after RFK jr. brought his anti-vaccine message to Samoa. The author is very kind to vaccine hesitant parents which is why it is good he is the one with the job to educate them, not me. If it was me I would just shake them until I was arrested for assault.

[keara · Rating 5 out of 5]

“when we forget, measles thrives” - dr adam ratner

this book is needed more than ever. got a briefing at my work on an measles case in my state while listening to this book

[Sanjana Sankaran · Rating 5 out of 5]

I can't tell you how important reading this book is for burgeoning young doctors and scientists like myself, and especially those in infectious disease. It was a phenomenal public health book that educated me so much on the development of the MMR vaccine but also the intricate systemic problems in our healthcare system that leads to misinformation and vaccine hesitancy! I plead people from all sides to read this book and educate yourself !! Overall as my first nonfiction book of the year I loved it !

[Amanda · Rating 5 out of 5]

When a science heavy nonfiction book has me telling everyone about all the fascinating things I've learned is when I count it as a major win. Sorry to everyone if it sounded like I was your professor for the last couple of days

[Andrew · Rating 5 out of 5]

Great read.
It is a great look at not just measles, but using it as a mirror on medicine overall, it’s growths, as well as it struggles.
I would highly recommend reading it to anyone, especially anyone who has any questions or concerns about vaccines.

[Shellie Stufflebeam · Rating 5 out of 5]

Educational. he shares that quote about how vaccines alone will not prevent disease, vaccinations prevent disease. as in, we actually have to receive the vaccinations for them to work. he also shares how it's important to make vaccinations fit into busy peoples' lives. he gives some examples of vaccine-hesitant groups and some unfortunate deaths that could have been prevented.

Measles has been eliminated from the US in the past; however, we keep having outbreaks. Dr. Ratner acknowledges the social disparities of health in his book, noting the difficulties in accessing the vaccine in other countries and other barriers. wouldn't it be cool one day if measles were eradicated like smallpox? this doctor says that for every $1 spent in preventative efforts to eradicate measles, we would save like $50 down the line in health care costs.

I enjoyed the discussion at the beginning of the story with a patient's grandparents who did not agree with their child's decision not to vaccinate their grandchild. The grandparents remembered how horrible the disease was. the parent of the child did not experience how horrible the disease was, so the parent decided not to vaccinate. this was a mistake, causing the grandchild to suffer. the doctor shares that people make decisions based on misinformation and disinformation (when incorrect things are shared with bad intent). he assesses what causes the parent to choose not to vaccinate in a respectful way and tries to help them decide to vaccinate going forward.

this book may anger you to hear about all the negative outcomes that could have easily been prevented as well as how the political climate affects the funding and whatnot surrounding vaccinations. the author discusses mainly measles but also the implications of the COVID-19 pandemic and some other vaccines as well. I read this as a nurse who is pro-vaccine. I doubt anyone who doesn't love vaccines would read this book unfortunately.

[Rebecca · Rating 5 out of 5]

4.5

[Anna Peare · Rating 5 out of 5]

Should be required reading tbh

[Amy · Rating 5 out of 5]

Excellent overview of the worldwide scourge that is measles, and the hope that it can be conquered. (Spoiler alert: Vaccination is the answer)

[Manisha · Rating 3 out of 5]

Listened to the audiobook.

Not bad! But it didn't feel like anything special.

[Jennifer Mangler · Rating 4 out of 5]

FANTASTIC book! I thoroughly enjoyed reading it and I learned so much. Ratner really schooled me. The discussion of what Peter Ludvig Panum learned from the 1846 Faroe Island measles outbreak and the devastating impact of the 1875 Fiji measles outbreak were so interesting and informative, and I was fascinated by the discussion of how phylogenetic trees help us build a history of the virus. It makes me so angry how vaccine misinformation and disinformation seems to slip in so easily, and the work to address it is so much more difficult and time-consuming. The chapters dealing with this topic were more frustrating to read, but no less interesting. Just a really well written, informative book. So glad I heard Dr. Ratner on Fresh Air and learned about this book. Highly recommend.

[Taylor Anderson · Rating 5 out of 5]

Dr. Ratner shares an in-depth explanation of the measles virus and the creation of its vaccine. This is a fascinating look into the efforts of researchers and the indication of the current status of public health. As a pediatric nurse with a measles outbreak on the brink of affecting my community (West Texas), I feel more informed and knowledgeable after reading this book. I would recommend this book to anyone curious to know more. Thank you, Dr. Ratner!

[Mel · Rating 5 out of 5]

Brilliant overview, well written and engaging

[Lorna · Rating 5 out of 5]

Very informative about measles and the need to vaccinate . It's not a harmless childhood disease.

[Sarah Marshall · Rating 5 out of 5]

“Vaccines don’t save lives.
Vaccinations save lives.” - Dr. Walter Orenstein.


Gosh, how I wish this was a dystopian novel and not real life.

[lola Franco · Rating 5 out of 5]

Really enjoyed this work bookclub book. To think were it not for Wakefield, Kennedy and others we could be so much further along in vaccination rates.

[Diego Laboy · Rating 5 out of 5]

An excellent primer on vaccine history and efficacy, especially for those of us who have skeptical family members. I found it especially helpful for understanding the role of the government in vaccine distribution and how vaccination policy is drafted. Dr. Ratner doesn’t shy away from addressing the unfortunate segments of vaccine development history nor does he sugarcoat the social disparities in health outcomes, both of which are important context when appreciating the success of vaccination programs and addressing vaccine hesitancy.

[Elizabeth · Rating 5 out of 5]

Booster Shots contains an amazing amount of information for a book that is a bit more than 200 pages. Dr. Ratner describes his own experience as a researcher and pediatrician specializing in infectious diseases, and personalizes the diseases by describing particular patients. He gives a chapter-long history of how measels was determined to spread from person to person, and covers the history of vaccine development. (To be honest I skimmed those chapters, but readers interested in the history of medicine and clinical research will enjoy them).

As Dr. Ratner gives a timeline of how the number of measels cases in the US waxes and wanes, it is clear that there is a correlation with what political party was in power. However, the author is careful to not make this a political book and instead describes the state of the country at the time, gives the numbers, then lets the reader draw their own conclusion. I think this is a positive thing as hopefully more people will read this book and be receptive to its contents since it is not explicitly partisan.

The book devotes a lot of time to vaccine hesitancy, and shows that concerns (both valid and nonsense) about vaccines have been deliberately introduced to vulnerable and susceptible groups, which of course results in outbreaks within these groups. He does not hesitate to call out those in his own profession such as Andrew Wakefield (though thankfully Wakefield is not in the same profession anymore), celebrities, and leaders of the anti-vax movement for spreading misinformation and disinformation. Quite a bit is said about RFK, Jr. and his courting of Trump during Trump's first presidancy.... well, here we are.

Since COVID-19 vaccines have become an emotionally charged issue for many, with social media fanning the flames. Dr. Ratner gives examples of how to combat vaccine information and increase vaccine uptake both on a personal level (spoiler alert: threatening to report someone to social services for child neglect on Facebook is not constructive, so instead have a series of conversations always coming from a place of empathy and understanding that the parent is doing what they understand to be necessary to keep the child healthy), and through programs run by the state and federal governments and NGOs.

This book is (sadly) very timely, and is written in a way that is accessible to a general audience. Highly recommended.

[Sarah · Rating 3 out of 5]

I strongly support this book and hope it reaches a broad audience.

I found the overall organization of the book to be unclear, which made it a bit more work to read. A section on the biology/medical background of measles and vaccines, one on the history of measles, and then on current events might have helped lay out why this topic matters and how harmful it is that we are losing scientific advances. I found these topics to be jumbled together.

I also appreciate that the anti-vaccine movement is very harmful and full of people with an anti-science agenda, but I wish the author had avoided personal attacks and instead focused on WHY these folks choose to ignore proven scientific information. What is their angle and why do they promote unfounded claims instead?

Important book, but I felt it could be stronger and clearer.

[Marion · Rating 5 out of 5]

Scarily brilliant! More than I or likely most people knew about measles and how deadly and insidious they are. Scientific evidence as to why the vaccine is necessary. A must-read for any parents of young children or anyone who has ever been a child.
My sister and I, ages 6 and 4,had the measles in the early 1950s. We stayed in bed with the shades down to protect our eyes. Our mother read out loud to us from Uncle Wiggly and Thornton Burgess. I had the German measles (aka rubella) in 1964, the year (as I read in this book) there was a national outbreak of rubella.

[Sofia · Rating 4 out of 5]

Great book. It focuses on measles but applies the lessons from measles to other vaccines. I really enjoyed learning about the history of measles vaccine campaigns in the USA. He's a pediatric infectious disease specialist and you can tell he cares deeply about the children he cares for. This made me think and I learned some new things - not much you can ask for from a well written nonfiction book.

[Ruth · Rating 5 out of 5]

*Audiobook*

"...it depends on whose baby gets the measles." - Late Former President Franklin D. Roosevelt, 1937

Adam Ratner, MD, MPH is a powerhouse for writing this book. There was recently (in the last few months) a measles outbreak near my home, and I was curious to know more about the disease, the impact it can have on individuals, communities, and why we're seeing outbreaks pop up after it was deemed eradicated in the early 2000s. Dr. Ratner absolutely delivered!

What is Measles?
Measles is a highly contagious, serious airborne disease caused by a virus that can lead to severe complications and death (World Health Organization, 2024). Interestingly, the measles virus is thought to have evolved from Rinderpest (discussed later), an infectious disease found in hoofed animals, and is closely related to the canine distemper virus.

How is measles transmitted? Because measles is an airborne disease, it is spread through coughs or sneezes, as well as close contact (e.g., kissing, sharing drinks) and contact with contaminated surfaces. If you consider the amount of close contact and bodily fluids expelled in a preschool or college campus, then you can see how easily this disease could flourish and spread if the appropriate precautions are not taken and/or vaccinations are not administered before exposure.

Measles: A History
Dr. Ratner brilliantly describes how measles unequally impacts certain populations and how the disease not only serves as a warning sign of diseases to come, but also the socio-political landscape that allows these diseases to thrive in the first place. As someone who is actively trying to increase my awareness of the inequities in the healthcare system, I really appreciated the extra detail the author added to the book.

Measles preys on the weak, the crowded, and the malnourished. Where have we seen or see these types of conditions? One specific example would be Civil War camps, where Blacks died at nearly 2x the rate of Whites, not because of intrinsic susceptibility, but because of malnutrition and inhumane living conditions. Other examples could be mental health facilities due to the overcrowding and possible unsanitary conditions, refugee camps, orphanages, houseless camps, and homeless shelters. These examples overwhelmingly impact systemically disadvantaged and marginalized communities. The answer is not as simple as achieving a 100% vaccination rate in the US, because that is not entirely feasible for every individual. However, addressing the roadblocks can still help stop or lower the spread of transmission.

Takeways
Why should we care? Measles is a highly preventable disease, so why do we need to write a whole book about it? As you've probably gathered from the previous paragraphs, we should care, and we should care a lot. Social determinants of health (i.e., non-medical factors that influence an individual's health and well-being) determine who gets sick and who stays healthy. While I can easily pop over to the nearest pharmacy to get a measles, mumps, and rubella (MMR) vaccine, that pharmacy might be out of reach for individuals without access to public transportation or insurance.

Measles was eradicated in the US in 2000, but unfortunately, it has made a resurgence. This is vital information to know! Measles is an early warning sign for diseases to come, as we saw with the 2019 Measles outbreak and then the 2020 COVID-19 pandemic. Measles serves as an early warning because it indicates that people are not being vaccinated, which can then lead to the spread of additional infectious diseases and mutations.

This lack of vaccination is due to multiple reasons, but one touched on by the author was the Anti-Vaccination (Anti-Vax) movement. This movement, which requires a whole video essay of its own, not only impacts people by their choosing not to vaccinate themselves or their children, but can also put their pets at risk. A rising number of owners are refusing to vaccinate their dogs. I have issues with not vaccinating your pets for a myriad of reasons, but the sheer fact that some diseases, historically have been or are zoonotic (transmissible between animals and humans), including Rinderpest, seems like another epidemic waiting to happen.

Measles thrives when we collectively forget. While the disease was eradicated in 2000, it reared its ugly head because we forgot why it was important to still vaccinate for a disease we didn't see anymore. History will repeat itself, as it always does, if we don't pay attention. Also, the answer isn't to berate your nearest anti-vaxxer, no matter how tempting. For the most part, everyone is collectively doing what they think is best, even if that isn't the case. We need to actively listen and calmly communicate to address any misinformation they have heard or understand their fear of vaccination.

The most effective way to prevent disease is to build systems to prevent and efficiently diagnose, teach people about the disease, and then regularly boost or remind people that the disease still exists as well as regularly receive booster shots as recommended.

"Build, teach, boost." - Adam Ratner, MD, MPH, 2025

[Megan · Rating 5 out of 5]

Audio. Preaching to the choir. Today a child in Texas died from measles. We actually have the tools to eliminate measles entirely. It’s heartbreaking.

[Meagan]

Anti-vaxxers are some of the biggest idiots on the planet lol (if this offends you you should probably read this book)

[Ray · Rating 5 out of 5]

relevant to dr. dad

and matches my medical reading kick

[brianna maphis · Rating 3 out of 5]

some of this book was too historyish for me but the other parts i had a better time focusing on were crazyyyyyy

[Virginia · Rating 5 out of 5]

I listened to while traveling. Very well written and researched, curiously entertaining given the subject, and “must read” IMO. Available on my library app (Libby) as audio or e-book.

[Sarah · Rating 5 out of 5]

An excellent and nuanced account of how we got where we are today. But given all that’s happened in the last six months, maybe we need a sequel already.