How two deaths in a Pennsylvania measles outbreak led to a clash between Gov. Josh Shapiro and RFK Jr.

Gov. Josh Shapiro came to the Philadelphia suburbs on Friday morning to announce a new investment in a local police department. But the first question he fielded at a news conference concerned the growing confusion and political intrigue surrounding his administration’s response to two deaths associated with the state’s spiraling measles outbreak.

For the last three days, Shapiro, a Democrat, and Robert F. Kennedy Jr., the Republican heading the federal Department of Health and Human Services, have clashed over what the state has disclosed about the deaths and the consequences of Kennedy’s longtime anti-vaccination activism.

By Friday, Shapiro wanted to bring the focus back to an outbreak that has grown to more than 400 cases so far this year, saying “getting into a back-and-forth with people online who are spewing irresponsible conspiracy theories” does not “serve the public interest.”

But public health and communications experts say that the state’s initial refusal to share more information on the deaths created an environment in which anti-vaccination skeptics could spread their own narrative.

State officials announced the deaths of two unvaccinated Lancaster County residents at a news conference Tuesday, calling the deaths “measles-associated.” Their ages, causes of death, or their medical histories were not disclosed by the governor or his health secretary.

Within hours, other voices started filling the information vacuum. Lancaster County’s coroner told reporters that he had handled just one of the deaths. Coroner Stephen Diamantoni, a Republican elected official who is also a physician, said his office had examined a newborn who had tested positive for measles, but said the baby had not died from measles.

Soon misinformation and innuendo were spreading online out of the seemingly contradictory and limited details being disclosed by state officials, the local coroner’s office, and federal health leaders — all with their own political affiliations at a time when the safety of the measles vaccine increasingly divides Democrats and Republicans.

In response to the coroner’s statements, state health officials said they define a “measles-associated death” as one in which measles was present, even if measles is not identified as the immediate cause of death. Shapiro’s administration confirmed the newborn’s case was one of the two announced deaths, but offered no information on the second death.

President Donald Trump’s health secretary, Kennedy, pounced on the missing details the next day to spread misinformation. He wrote on X that the deaths may have been “fabricated” by the Shapiro administration and said in a television interview that “they cannot find any measles deaths in Lancaster County.”

Shapiro’s administration has called this inaccurate. Still, his administration has not revealed details of its medical review, beyond saying the state Department of Health’s epidemiology team had “thoroughly investigated.”

By late week, the Centers for Disease Control and Prevention, which operates under HHS, posted on X that state health officials were not sharing “information relevant to the outbreak” as it worked “to clarify conflicting information from Pennsylvania officials about whether the two reported deaths were caused by measles.”

State officials, including Shapiro, have repeatedly said the state is cooperating with the CDC.

But Pennsylvania health officials could have shared information on the patients’ ages, causes of deaths, and reasons for being unvaccinated, said Paul Offit, a physician at the Children’s Hospital of Philadelphia who heads the hospital’s Vaccine Education Center and is a vocal critic of Kennedy.

“It created fertile ground for conspiracy theories to thrive,” he said.

In a statement, a Shapiro spokesperson said the governor understands the “desire for as much information as possible to be made public.”

“However, when an individual dies, it is our legal responsibility to protect their right to privacy by maintaining patient confidentiality,” the statement said, noting this is critical to maintaining trust among communities statewide.

In a highly politicized environment in which measles cases are rising — and vaccination rates dropping — public health experts say it’s imperative for health officials to communicate accurately and transparently.

“You have to be transparent, be very clear about what you know, what you don’t know, what you’re trying to find out, and what questions are outstanding,” said Amesh Adalja, an infectious disease physician at the University of Pittsburgh Medical Center and a senior scholar at the Johns Hopkins Center for Health Security.

A lack of information from the state, he said, “created an information vacuum with people very adept at using information vacuums to spread their message.”

Diamantoni said Friday that the baby died shortly after birth at a Lancaster County birthing center on Aug. 14.

Postmortem testing of the baby’s lung tissue showed that the baby had an active measles infection acquired before birth, he said.

He has not talked to the baby’s mother or the midwife who delivered the baby, and has not fully reviewed records from the birthing center where she gave birth, he said in interviews.

He told the Pittsburgh Tribune-Review that measles was listed on the baby’s death certificate, in a section of the certificate that reports other ”conditions contributing to death but not resulting in the underlying cause.”

He told the outlet that measles was included on the death certificate “to offer a broader view of the general health of the child.”

Babies can become infected with measles in utero if the mother is infected with measles and develops a rash within 10 days of giving birth, Offit said.

Diamantoni said a forensic pathologist in his office concluded the baby died of a ruptured spleen and cited trauma to the baby’s torso. He said he was unsure what had caused the trauma, and added that the baby’s spleen did not appear enlarged or infected.

Offit said that measles can cause an enlarged spleen that is then more likely to rupture — including during birth — and that it’s often difficult to tell whether a spleen has become enlarged once it ruptures.

A spleen also doesn’t have to become “massively” enlarged to rupture, he said: Measles can cause the spleen to become fragile, which also heightens the risk of rupture.

In conversations with state health officials, Offit said he learned that the patients who died in Pennsylvania would not have died were they not infected with measles.

He said the coroner should explain why the spleen ruptured, if it was not damaged from measles. Diamantoni said the office is still investigating the cause.

The state has released no additional information on the second death, and Diamantoni said his office was not handling it. He said his chief deputy spoke to the department prior to Shapiro’s news conference Tuesday.

“At no point was the Pennsylvania Department of Health told that this was not a measles-associated death,” a state spokesperson said on Friday. “The Shapiro Administration stands firmly by their comments on Tuesday.”

Pennsylvania’s health department has cited a state law prohibiting public access to death records, saying they cannot release more information on the deaths. Another state law requires the state to keep records of diseases confidential, except when it’s necessary to inform the public of the risk of communicable disease, a department spokesperson said in a statement.

The department “works hard to build and maintain trust in communities all over the Commonwealth — which includes doing everything possible to keep people’s identities confidential,” the statement read.

The department didn’t share information that could be used to “personally identify individuals or their grieving families” because “the circumstances of these individuals’ deaths do not change the Commonwealth’s response: Measles is a serious, highly contagious and preventable disease, and our focus remains on protecting Pennsylvanians, getting people vaccinated, and stopping the spread of this outbreak,” the spokesperson said.

But the state could have been more transparent about how they characterize deaths in a measles outbreak, said Kathleen Hall Jamieson, director emerita of the Annenberg Public Policy Center at the University of Pennsylvania.

People who are not trained in medicine may not understand the term “measles-associated,” for example, or how it differs from a cause of death, and state officials should have taken time at the news conference to explain what they meant by that term.

“You have an obligation to make sure that people don’t mishear on something as fraught as this topic,” she said.

Jamieson added that the political clashes around the deaths could overshadow a crucial point: A highly contagious disease is spreading in an under-vaccinated community, exposing children — including newborns unable to be vaccinated — to a serious illness.

“If we miss that moment, then the public health community has failed,” she said.