Eliminated No Longer: Time to Change Course on a Lagging Federal Response to the US Measles Outbreak
The US measles outbreak now exceeds 300 cases. The continued failure of HHS to advocate for and support state health agency efforts to test, trace, inform, and vaccinate will worsen the crisis.
Measles was declared ‘eliminated’ in the US - 25 years ago. Since then, new cases have been attributed primarily to the occasional importation of infections by unvaccinated travelers from abroad and subsequent small and localized outbreaks. Not so now.
Instead, we face a growing measles crisis that requires an effective and urgent federally coordinated response. The failure of HHS Sec. Robert F. Kennedy Jr to communicate the severity of measles infections, the effectiveness and safety of vaccines, and the scope of the ongoing national outbreak is putting Americans at risk.
Do you know how many measles cases there are in the United States? I wouldn’t expect so. And how could you? Even the CDC’s measles outbreak webpage is falling behind. But national case numbers tell a story of a preventable and growing failure.
The math is not hard. On Tuesday March 11th, the Texas Department of State Health Services had confirmed 223 measles cases. In contrast, as of noon Friday March 14th, the CDC’s measles outbreak only reported 222 cases. Moreover, the CDC count did not include 33 more cases already confirmed in New Mexico and additional cases elsewhere. Even with an afternoon Friday March 14th update, the cumulative number of measles cases on the CDC outbreak page continues to lag behind state reports.
As measles spreads, the risk increases in places where Americans might reasonably expect to be safe. The failure to inform the public of a few cases or a few dozen cases matters.
It matters because measles is an incredibly infectious disease. Measles spreads through the air and can linger for multiple hours indoors. As a result, a single infectious person typically infects 15 or more in unvaccinated populations. People with measles can infect others up to 4 days before they have a rash such that one case rapidly becomes many. Because of its long incubation period, people can be infected unwittingly, feel fine, travel, and bring measles with them to new destinations.
It matters because measles is also an incredibly serious disease. As of March 16th, there have been 50 hospitalizations and 1 confirmed fatality and 1 fatality under investigation amongst the 300+ measles cases nationwide. Healthy, unvaccinated children will get sick and many will be hospitalized. Approximately 1 in 4 children infected under the age of 5 have been hospitalized in this outbreak already. The Chief Medical Officer of the Covenant Children’s Hospital in Lubbock confirmed that hospitalizations were for medical treatment and not, as Kennedy claimed, for ‘quarantine purposes’. Measles can increase vulnerability to subsequent infections and cause long-term health problems including progressive neurological disease.
Where should Americans look to understand the scope of the ongoing outbreak? For now, the CDC is reporting case updates once a week. Without increasing reporting frequency and leveraging wastewater detection systems, the American public will remain unable to obtain time-sensitive information on risk. Timely reporting can serve a key role in informing individuals who may be unable to vaccinate to take precautions and as part of awareness campaigns to increase vaccination rates.
Despite what Kennedy says, the scope of the ongoing outbreak is not typical. The current outbreak already has more cases than in 2023 and 2024. The vast majority of measles cases in the current outbreak are due to community spread with new risks occurring daily, including the potential recent exposure of newborns at a children’s hospital in Lubbock, Texas.
The opportunities for measles to spread in the United States reflect decades of misinformation centered on false claims linking vaccines and autism. As a result, more parents have chosen not to vaccinate or to delay vaccinating their children and not to vaccinate themselves. These parents might frame their decision as a personal choice. But that choice doesn’t only affect their personal well-being.
Individuals who choose not to vaccinate themselves and/or their children put other children and families at risk – including those who do not have the opportunity to make a choice because they are too young to be eligible (e.g., are <1 years of age), are immunocompromised, or because they require a medical exemption.
Thus far, 95% of measles cases are in unvaccinated individuals. Declining vaccination rates provide the opportunity for measles to spread locally and then jump into new communities. Our vulnerability to a large-scale national measles outbreak started well before 2025, but this is the year the US should commit to harden its defenses. The failure to advocate and support state-level efforts to test, trace, inform and vaccinate is a choice – the wrong one.
It is time to change course before the US loses its ‘measles eliminated’ status and becomes a country where children are routinely hospitalized and die each year of a preventable disease.
These terrible measles outbreaks bode poorly for potential problems with future outbreaks of dangerous but vaccine-preventable diseases such as chickenpox and cancers caused by human papilloma virus. Unfortunately our new health minister has strongly opposed vaccines in the past, and now frames vaccination as a personal choice when the science has proven the opposite, i.e. that lack of vaccination promotes community spread of disease. RFK Jr. will be incapable of addressing the next pandemic because his views reflect his medical ignorance and his actions have proven that he doesn’t know how to protect the health of the public.