The United States could lose its measles elimination status this week, an event likely to cement Health Secretary Robert F. Kennedy Jr.’s legacy of meddling in vaccine policies amid the worst outbreak of the virus in the United States in 35 years.
If the United States loses its measles-free status, it will join Canada and several European and Asian countries that have eliminated the disease, only to have it return.
“It’s a huge step backwards,” said Dr. Paul Offit, director of the Vaccine Education Center, an attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia and a prominent Kennedy critic.
A panel of eight independent experts will review the epidemiological evidence in Washington DC, part of a group called the Pan American Health Organization (PAHO), a regional arm of the World Health Organization (WHO). The Director of OPS will make the final decision.
“Regardless of what PAHO says, measles is now endemic in the United States. Measles has gained a foothold in the United States,” Offit said. “We’re going to see it this year, we’re going to see it next year,” because the United States “has dramatically reduced the percentage” of people vaccinated.
The United States is in the midst of its worst measles outbreak since 1991, with more than 5,400 cases nationwide, according to tracking by the International Vaccine Access Center at Johns Hopkins University. This year alone, six people died in Pennsylvania, a child died in New York on Election Day, and an infant died days later in Wisconsin. Almost every U.S. state has an active outbreak.
Measles is considered one of the most infectious diseases known to medicine. The overwhelming majority of Americans vaccinate themselves and their children, but the sheer contagiousness of measles means that even small dips in immunity allow it to spread. It kills one to three people in 1,000 and hospitalizes about one in five unvaccinated infected people. Two doses of the measles, mumps, and rubella (MMR) vaccine are 97% effective against the disease.
Although elimination status is a formal public health designation, its loss has real effects on everyday Americans. To cite just one example, Dr. David Margolius, public health director of Cleveland, Ohio, warns people to find proof of their measles vaccination in case they are exposed to a positive measles patient.
“Now is the time to go get that evidence, because this is now a real, everyday thing that could happen to you,” said Margolius, who is also executive director of the Big Cities Health Coalition. Without proof, patients are faced with either an immunological blood test or a 21-day quarantine.
Cleveland health officials have already done a tremendous amount of detective work this year to track down people exposed to measles in hospital waiting rooms and elevators.
“We reach out to people and for the most part, myself included, we have no personal experience with measles,” he said. “They have everything else in their lives, and now they’re getting this call.”
The types of people who get measles have also changed. In 1963, when the vaccine was first approved, measles was considered a childhood illness. Most children contracted the disease before the age of five.
“You’re now seeing an epidemiological shift,” Offit said. Two-thirds of those infected with measles in Pennsylvania are adults, a group about which researchers have little information. Mothers have even given birth to babies with measles. “Now you’re seeing something that we just haven’t seen at all: congenital measles.”
The potential loss of elimination status comes at a tenuous time for the Trump administration. The Republicans have just suffered a historic beating in the midterm elections. Several new Democratic doctors and scientists are expected to run to Congress with promises to hold Kennedy accountable. At the same time, Trump doubled down on his commitment to vaccine antagonism with the appointment of Stephen Miller as chief of staff.
“Next to me, Stephen Miller is Maha’s strongest supporter in the administration,” Kennedy said in a statement about Miller’s nomination. “It’s time to release the Kraken.”
Meanwhile, the response capacity of the Centers for Disease Control and Prevention (CDC) has been significantly hampered by the Trump administration. The agency lost up to a third of its staff, Kennedy interfered in the agency’s reporting of measles deaths, and spread false information about measles vaccines.
However, Margolius does not place all the blame on Kennedy. Vaccine hesitancy was growing before Trump took office, and pandemic-related disruptions were real.
“Part of the narrative has been to blame this on our health secretary, and I certainly think he could do a lot more to improve the situation rather than harm it, but I think case numbers are increasing everywhere,” he said. “This could happen even under a more public health-friendly health administration.” »
The second Trump administration also made broad changes that challenge measles elimination globally. Some of Trump’s first acts in 2024 included withdrawing from the World Health Organization (WHO) and the Global Vaccine Alliance (GAVI). GAVI provides measles vaccines to countries including India and Malawi. There are about 95,000 deaths from measles worldwide, according to the World Health Organization, mostly among unvaccinated children under five.
At home, Republicans also passed the largest-ever federal cut to health insurance, changes expected to cause more than 17 million people to lose insurance by 2034. That has challenged people like Margolius, who struggle to connect people to vaccines when their health insurance coverage is unstable.
“Until we can join the WHO and cooperate with other health agencies around the world… This will continue,” Margolius said.
Gn Health
