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

by Adam Ratner MD MPH

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

286 pages, Kindle Edition

First published February 11, 2025

Reviews

[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.

[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

[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.

[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.

[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.

[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.

[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

[Jerry Smith · Rating 5 out of 5]

I've read quite a number of books penned by physicians and this is one of the best. Ratner is an excellent author and in this book, he takes us through the history of the measles vaccine, the disease of measles itself and fits that into the wider context of the unforgivable rise in vaccine denialism and conspiracy thinking that is putting lives at risk daily, not only via measles but also COVID and other diseases reappearing (polio for example) or likely to become the next pandemic.

I should go on the record as stating that I consider vaccines, along with advances in antiseptics and antibiotics to be the most important medical achievements of humanity. They have prevented countless millions of deaths and distress from, now preventable, disease. However, the human memory is short and, let's face it, too many people are not critical thinkers and are susceptible to conspiracy theories and bad science. The idea that there is some monstrous cabal intent on depopulating the world, or injecting us all with microchips, or somehow wants to make us all sick so pharma companies can "cure" us would be laughable if it weren't so dangerous.

And, as I write this, now we have RFK jr in charge of health in the US and an administration that is as venal and corrupt as it is ignorant. I suspect we will see an undermining of vaccination from the top, the spreading of doubt as to their efficacy and, doubtless, renewed assertions that vaccines cause autism. So we are at something of a crossroads and again, as I write, in the throes on a measles outbreak in the US. How unsurprising.

Measles is an interesting case study in how vaccines work, how the disease impacts vulnerable communities and how we can protect ourselves, and frequently don't. In essence we are a stupid race more prone to hysterical thinking and making decisions based on emotional and frightened responses rather than on logical thinking based on scientific evidence. Ratner remains more optimistic than I do, opining that the eradication of measles a la smallpox is possible and a goal toward which we should be striving. I don't think the political will is there and the political will is everything. We are just too stupid and so people will continue to get sick and die from preventable diseases.

This is very well written and easy to read and AR is very good at making potentially complex issues very understandable. The history of developing the vaccine was very interesting and not something I had heard about before. He weaves together this advance with a more general examination of vaccines and the acknowledgement that the science is one thing, but getting shots into arms is the most important aspect of disease prevention, and the inequity of societies (poor communities almost always bear the brunt of disease and have the lowest access to medication of all types) means we are unlikely ever to solve so many of these problems. Humanity is stupid and innocent people will suffer. As I say, I lack Ratner's optimism but I sincerely hope he is right and I'm wrong.

[Tutankhamun18 · Rating 4 out of 5]

This was brilliant and such beautiful descriptive writing about the body while also balancing an understanding of human psychology and the long shadow of colonialism in medicine and infectious disease.

Booster Shots by Dr. Adam Ratner is a powerful exploration of the global resurgence of measles and what it reveals about the fragility of our public health systems. Ratner, a pediatric infectious disease expert, uses measles as a warning sign—showing how declining vaccination rates, misinformation, and public distrust in science can quickly undo decades of progress. He revisits historical outbreaks, explains the science behind vaccine-preventable diseases, and draws urgent parallels to the COVID-19 pandemic. The book is both a medical history and a call to action—urging society to reinvest in science, rebuild trust, and take proactive steps to protect children’s health before the next major crisis strikes.

Alongside this the writing style he uses to explain the body is beautiful:

“This arrangement, with branching tubes inside of us containing the air that we inspire, implies that there are locations where inside and outside meet. There must be a luminal border, a place where the last point made of human cells abuts the first point of the outside world.
That border prevents some things from crossing into the tissues beneath—the protected, sterile parts of our lungs-and allows other things through. We don't move air in and out all day every day for no reason. In the lungs, oxygen crosses the border into our blood, destined to be bound by the hemoglobin packed in our red blood cells and delivered throughout the body; carbon dioxide travels the opposite path, across the border and back into the airways, ready to be exhaled.
It is a system set up for constant, regulated exchange.
We have cells maintaining that important boundary between inside and outside. The epithelial cells that form the border crowd together tightly, making it difficult for anything that is not supposed to get through to do so. And other cells act as defenders of that barrier as well. Macrophages reside in the air spaces, where they ingest and destroy debris or microbes, or alternatively process what they have found and present it to other immune cells, which gather in nearby lymph nodes. Dendritic cells live in the tissues below the border, but they extend tiny projections into the lumen-fingers in a grab bag-sampling its contents, evaluating potential threats.”

[Natalie · Rating 4 out of 5]

Not my usual fare, but no less important! I'm probably the furthest away from the target audience for this book, but I still found it fascinating and impactful. I particularly enjoyed the fun fact about how "measly" derives from "measles." What will stick with me are all the case studies from throughout history that continue to show us the warning signs of how disease can ravage our populations and affect more than our physical health, and yet how we'll seemingly forget these effects and have to go through the cycle again and again. When reading books like this, I'm honestly reminded of how lucky I am to be alive (and how close I could have been to a career in medicine/science, had things shaken out a bit differently when I was in middle school).

[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.

[Matt Beaty · Rating 5 out of 5]

This was a very engaging read. It covered the virology of measles, the history of the disease, and the current causes of its resurgence.
One of the most interesting things about measles to me, it causes immunity to other diseases to go away, something called "immune amnesia". This is why vaccination against measles reduces overall mortality, and not just mortality due to measles.
Ratner is clear that education and communication with a focus on empathy and understanding is needed to get vaccination rates up.
While Ratner is optimistic, I am less so for the next years with RFK Jr leading HHS.
The history of the development of the vaccine was detailed in the book, and these things are a miracle brought about by hard work and determination, testing, and all that.

[Kathleen Bernick · Rating 5 out of 5]

This morning’s news reported the death of a second child in Texas from measles, an highly spreadable, yet easily preventable disease that was close to being eliminated in the US not so long ago. Disinformation about vaccines has caused vaccination rates to drop in some areas of the country, especially under the current administration, leading to the recent unnecessary deaths in Texas.
Just over three months into the year, the number of cases is more than double the rate for all of last year.

[MB · Rating 5 out of 5]

Quick and informative read about history of measles, vaccine hesitancy today and why it’s important to vaccinate and educate populations at the same time. Touches on Wakefield’s disastrous contributions to vaccine hesitancy among reasons for less robust measles vaccinations compared to polio campaign. Read it to learn about “immunity amnesia” and “measles shadow” to understand importance of vaccinations you might not be aware of concerning measles.

[Sam · Rating 5 out of 5]

Listened to Dr Ratner read this book in two days. It was a fantastic amble through geography and time to learn about measles.

I found it really comforting to know we’ve beaten this before and it’s just something we have to stay on top of. Can’t wait to take what I learned here and awkwardly slip it into conversation with people I know lol.

[Sam Baldazo · Rating 5 out of 5]

Remarkable look into the history of vaccines, both into science and policy. Using the focus of measles, the author is able to demonstrate how we got to where we are today with regard to both the technology and the public sentiment. Would recommend this book to anyone with questions about vaccines or anyone talking to people with questions about vaccines.

[Sherree Bennett · Rating 5 out of 5]

“In ‘Booster Shots’ by Adam Ratner, the author presents scientific facts in an excellent and succinct manner without berating bad science. His deep knowledge and engaging narration make this a compelling and quite educational read.” 

[Cheyenne · Rating 5 out of 5]

Extremely relevant as an RN Infection Preventionist and with the current administration, vaccine misinformation and hesitancy and the emerging and spreading outbreak in Texas.