Priscilla Luna holds her daughter Avery Dahl, as she gets the MMR vaccine from Raynard Covarrubio at a vaccine clinic hosted by Lubbock Public Health Department in Texas in 2025.
Photo by Jan Sonnenmair, courtesy Getty Images
“We are taking measures to ensure that we still have the resources to respond, but simply having to deal with fluctuating, difficult-to-predict funding streams is a problem. It disrupts our ability to focus on the problems that really matter.”
— Chad Smelser
The U.S. may soon join a handful of other high-income nations that have officially lost their fight to contain measles, a highly infectious disease that is easily preventable with vaccines.
With more than 4,300 cases and three deaths from the disease since 2025, the U.S. is on track to lose its measles elimination status this fall. The public health designation — bestowed on the U.S. in 2000 by the Pan American Health Organization —does not mean measles no longer occurred in the U.S. Rather, it certified that measles cases were not being spread locally for 12 months or longer. To keep its status, the nation had to maintain that norm.
But the U.S. has fallen behind on four out of seven elimination status indicators, such as having most cases come from abroad rather than internally, and less than one case per 10 million people, research published in May in The Lancet documents. There were 93 cases per 10 million U.S. residents as of early 2026, the study found.
“If we have an honest look at the criteria that have always been used, and we continue to use those, it is extremely unlikely that we are not going to lose elimination status,” study co-author Maimuna Majumder, PhD, MPH, an assistant professor in the computational health informatics program at Boston Children's Hospital and Harvard Medical School, told The Nation's Health.
If the U.S. does lose its elimination status, it will join other high-income nations such as Canada, the United Kingdom, Austria and Spain. Mexico is at risk of losing its elimination status this fall as well.
A decrease in vaccination rates and increase in exemptions for school attendance requirements, particularly in tight-knit religious communities, has fueled much of the increase in locally transmitted cases in the U.S.
Reducing vaccine exemptions for non-medical reasons would go a long way toward preventing disease spread, according to Patricia Stinchfield, RN, MS, CPNP, a pediatric nurse practitioner in infectious disease and immediate past president of the National Foundation for Infectious Diseases. Both religious and personal exemptions have increased.
Residents wait their turn at a vaccination clinic at Benjamin Tasker Middle School in Bowie, Maryland, in August 2025.
Photo by Sarah Voisin, courtesy The Washington Post/Getty Images
Exemption rates for kindergartners reached their highest rate at 3.4% during the 2024-25 school year, but rates of medical exemptions for children who have immune deficiencies and cannot receive live vaccines have not changed at all, according to CDC.
Schools that fall below 95% vaccination rates could become a breeding ground for community outbreaks. In South Carolina, where a six-month outbreak infected nearly 1,000 people through April, vaccination rates were as low as 90% in schools in one city, according to KFF.
“When you look at the states who are not having problems, they do tend to have strong school entry requirements,” Stinchfield told The Nation's Health.
Misinformation about the safety of vaccines is one of the biggest drivers of falling vaccination rates, according to Ronald Nahass, MD, MHCM, FIDSA, president of the Infectious Diseases Society of America.
Decades of anti-vaccine sentiment and faulty science were promoted by celebrities, conservative media outlets and social media. The actions fueled public distrust in the safety of vaccines in general, especially among families weighing vaccinations for their children, including measles.
“The misunderstanding about safety leads to people being concerned,” Nahass told The Nation's Health. “They want to do the right thing by their kids and they choose not to vaccinate, even though that's not what's really safest for them.”
Vaccine hesitancy has been a driver of an outbreak in Utah that began on its southwest border with Arizona and reached nearly 700 cases as of mid-June in 22 of 29 counties, according to Leisha Nolen, MD, PhD, the Utah State Epidemiologist for the Utah Department of Health and Human Services.
In Utah County, some of that hesitancy comes from people who are not comfortable following childhood immunization schedule timelines, said Michael Leman, NP, the nursing director for the Utah County Health Department. But despite science showing that receiving multiple vaccines together is safe, some parents are afraid, risking their child's health.
“They want to do it on their own time,” Leman told The Nation's Health. “We want everybody to know that, yes, measles is here and there is this real possibility that you may get infected, your child may get infected.”
Some people downplay how serious measles can get, resulting in a sobering wakeup call for some families who had infected children, Nolen said.
A decrease in vaccination rates and increase in exemptions for school attendance requirements has fueled much of the rise in locally transmitted cases of measles in the U.S. in recent years.
Photo by Sorapop, courtesy iStockphoto
“People were getting fevers up to 107, which is, as a doctor, just unbelievable to me,” Nolen told The Nation's Health. “Teenagers were just horribly sick. They couldn't keep food down.”
Education about severity is an important tool for healthcare providers. Because most parents today were vaccinated against measles, they may not know the disease symptoms can be more than a rash, said Anne Bischops, MD, a pediatrician and co-author of The Lancet study. The disease can attack multiple organs, resulting in liver and kidney failure, encephalitis and long-term neurological issues, she said.
“It can also have a huge impact on the immune system,” Bischops told The Nation's Health. “It has not only the effect of the virus itself, but it can also make the person much more vulnerable to all of the other diseases.”
While the Centers for Disease Control and Prevention has long been a trusted voice and source of science-based education, its role has eroded under the Trump administration, leaving a leadership vacuum. Deep programmatic cuts across CDC also means states have fewer federal dollars to help with surveillance and vaccine programs to help curb the spread.
In New Mexico, nearly 100 cases of measles occurred in 2025 in a spillover from a large outbreak in West Texas. The state relies heavily on federal funding for infectious disease surveillance, epidemiology and response, said Chad Smelser, MD, medical epidemiologist for the New Mexico Department of Health.
“Decreasing funding from the federal government could lead to barriers in our state,” Smelser told The Nation's Health. “We are taking measures to ensure that we still have the resources to respond, but simply having to deal with fluctuating, difficult-to-predict funding streams is a problem. It disrupts our ability to focus on the problems that really matter.”
Afra Brown, a regional school health specialist, takes a sign down at the end of a vaccine clinic held at Benjamin Tasker Middle School in Bowie, Maryland, last year. Vaccination against measles is 97% at providing lifelong immunity.
Photo by Sarah Voisin, courtesy The Washington Post/Getty Images
Transparency and gaining trust with residents in local communities via trusted messengers is key to stopping local measles transmission.
One of the strategies that ultimately helped bring an end to the 2025 outbreak in Texas — which numbered nearly 1,000 cases — was relying on people in the religious community at the center of the outbreak to talk with families about the importance of vaccination, Nahass said. The local personal touch made a difference.
“If you get somebody that lives in the community — whether it be a physician, a nurse practitioner, a pharmacist, maybe the county health officer...or someone from your church or your synagogue — that's how you deal with this,” Nahass said.
New Mexico was praised for its rapid response. After setting up a small incident command structure to identify vaccine inventory and send shots where they were needed most, the New Mexico Department of Health created a centralized website with a vaccine dashboard tracking doses given and vaccine coverage percentage.
The state department also spread messages through local media and staffed a call center previously used during the COVID-19 pandemic. Residents could talk directly to a nurse for guidance, ask for vaccination locations or look up their records. By the end of the outbreak, the department provided 57,000 measles vaccine doses — 22,000 of them for adults.
“Being transparent with the community really helped us in the response of vaccine uptake overall,” Andrea Romero, the New Mexico Department of Health's immunization program manager, told The Nation's Health. “The same message was being said even from local radio, local meetings, directing everyone so that would keep the worry down.”
Clinical practices are also important to turning the tide on measles infections in the U.S., Stinchfield said.
Listening to patients instead of engaging in debate is key to getting everyone on the same page about vaccines. But diligence is crucial, meaning every visit to the doctor should be treated like a vaccine visit. A child coming in for a broken thumb is an opportunity to see if that child is also up to date on their vaccines, she said.
“Does your clinic have a reminder recall text message system?” Stinchfield said. “Do you know who in your practice is behind on their vaccines? Do you call them? Do you remind them of their appointment? Do you keep them up to date? Clinics really need to take an active role in this and not just passive.”
For more information on measles vaccination recommendations, visit bit.ly/aapmeasles.
- Copyright The Nation’s Health, American Public Health Association
