One year ago this week, a single case of measles was recorded in Gaines County, Texas. That initial case sparked an outbreak that tragically claimed the lives of two children and sickened at least 760 people, with thousands more contracting the highly contagious disease across the U.S. since then. The United States is now on the verge of losing its measles-free status, a milestone achieved in 2000.
A Nation at Risk: Losing Ground Against Measles
The U.S. may soon lose its measles elimination status, a consequence of declining vaccination rates and a shifting public health landscape.
- The Pan American Health Organization will determine in April whether measles has been continuously circulating in the U.S. for 12 months.
- If continuous transmission is confirmed, the U.S. will officially lose its measles elimination status.
- 2025 saw the highest number of measles cases in the U.S. since the early 1990s, with 2,242 confirmed infections.
- Conflicting messaging and changes to vaccine recommendations from health officials have contributed to declining vaccination rates.
The Pan American Health Organization, an affiliate of the World Health Organization, will review data on April 13 to determine if the same virus strain first identified in West Texas on Jan. 20, 2025, has been circulating uninterrupted for a year. If so, the U.S. will officially relinquish the measles elimination status it earned in 2000.
“Meeting those requirements took several decades of really hard work,” said Dr. John Swartzberg, an infectious disease specialist and emeritus professor at UC Berkeley. “Losing that distinction is an embarrassment for the United States. It’s another nail in the coffin for the credibility of this country.”
In public health terms, “elimination” doesn’t mean a disease is eradicated, but rather that it’s rare enough, and immunity widespread enough, that any new cases quickly fizzle out without sustained local transmission.
Scientists at the U.S. Centers for Disease Control are analyzing virus sequences from across the country to determine if recent cases stem from the original Texas outbreak or represent new introductions from elsewhere. This distinction is crucial in assessing whether the U.S. can retain its elimination status.
Regardless of the international committee’s final decision, one thing is clear: a highly contagious, vaccine-preventable disease, largely contained for a quarter-century, is making a worrying comeback. What is the biggest threat to measles elimination in the U.S.? Declining vaccination rates are the primary driver of the resurgence of this preventable disease.
Between Jan. 1, 2000, and Dec. 31, 2024, the Centers for Disease Control documented 4,485 confirmed measles cases in the U.S. However, 2025 alone saw a dramatic surge, with 2,242 cases – the highest annual total since the early 1990s.
“Measles is incredibly contagious, and it is the thing that comes first when you take your foot off the gas, in terms of trying to keep vaccination levels up,” said Dr. Adam Ratner, a New York-based pediatric infectious disease specialist and author of “Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health.”
“It didn’t have to turn out this way,” Ratner added. “It doesn’t help us that there haven’t been clear messages from the Department of Health and Human Services.”
In March, following the first measles-related child death in the U.S. in over a decade, Health and Human Services Secretary Robert F. Kennedy Jr. released a statement acknowledging the effectiveness of vaccines in preventing measles spread, but stopped short of directly recommending parental vaccination.
A month later, he posted on X: “The most effective way to prevent the spread of measles is the MMR vaccine,” a move that angered many of his anti-vaccine supporters.
Throughout the year, Kennedy and his agencies disrupted the nation’s vaccine delivery system and disseminated misleading information about immunizations.
Kennedy replaced members of a key CDC vaccine advisory committee with appointees, many of whom have publicly questioned vaccines or promoted medical misinformation. He also reshuffled the committee with individuals critical of vaccines.
Late last year, the CDC revised its website on vaccines and autism, including inaccurate claims linking immunizations to the neurodevelopmental disorder. Earlier this month, the CDC reduced the number of diseases it recommends children be vaccinated against from 17 to 11.
While the CDC hasn’t officially altered its MMR vaccine recommendations, experts say the agency’s inconsistent actions and confusing statements have further depressed vaccination rates.
“The messages coming out of the CDC are crazy. It’s hard for pediatricians. It’s hard for parents,” Ratner said. “Nothing has changed about how safe the MMR vaccines are… or how well they work. It’s all the messaging. And I’m very concerned that that is speeding up, not slowing down.”
Vaccination rates in the U.S. were already declining before Kennedy’s appointment. Only 10 states—including California—meet the 95% vaccination threshold needed to prevent measles outbreaks.
Forty-five states reported confirmed measles cases last year, and at least nine states have already reported cases in January alone.
“If you go to cdc.gov, you would expect to see a huge banner saying, ‘Measles outbreak, get your vaccine now,’” said Dr. Jeff Goad, a Chapman University School of Pharmacy professor and president of the National Foundation for Infectious Diseases. “And it’s not there.”
The Pan American Health Organization will review data from the U.S. and Mexico on April 13 to determine if both countries will share the same fate as Canada, which lost its measles elimination status in November.
“Whether or not we officially lose elimination status is an academic exercise at this point,” said Mathew Kiang, an assistant professor of epidemiology and population health at Stanford University. “The reality is that without concentrated efforts to ramp up vaccination, we will continue to have these long, extended outbreaks across the U.S. We’re witnessing the results of a years-long effort to disassemble the vaccine infrastructure in the U.S. that has been accelerated by the current administration.”
