BOILING SPRINGS, S.C. — In early November, in the back corner of a local library parking lot, mostly out of sight from the main road, the South Carolina Department of Public Health opened a pop-up clinic offering free measles vaccines to adults and children.
Spartanburg County, located in upstate South Carolina, has been battling a measles outbreak since early October, with more than 50 cases identified. Health officials encouraged people who have not been vaccinated to get vaccinated by visiting a mobile vaccination clinic at any of several stops throughout the county.
But on Monday afternoon, only one person showed up in Boiling Springs.
“This is progress. This progress is slow,” said Linda Bell, a state epidemiologist with the Department of Public Health, during a recent press briefing. “We were hoping to see more adoption than we have seen with our mobile health units.”
As South Carolina struggles to contain a measles outbreak, public health officials across the country are concerned that the highly contagious virus is making a comeback. The Centers for Disease Control and Prevention has calculated more than 1,700 cases of measles and 45 outbreaks in 2025. The largest has begun in Texaswhere hundreds of people were infected and two children died.
For the first time in more than two decades, the United States is poised to defeat measles. exception statusa designation indicating that outbreaks are rare and quickly contained.
The measles outbreak in South Carolina is not yet as large as in other states, such as New Mexico, ArizonaAnd Kansas. But it shows how a confluence of larger national trends, including historically low vaccination rates, skepticism fueled by the pandemic, misinformation and the “health freedom” ideology promoted by conservative politicians, has put some communities at risk of a resurgence of a preventable, potentially deadly virus.
“Everyone talks about how it's the canary in the coal mine because it's the most contagious infectious disease,” said Josh Michaud, associate director of global and public health policy at KFF, a nonprofit health information organization that includes KFF Health News. “The logic is undeniable: we are likely to see more outbreaks.”
Schools and “small fires”
Spartanburg's vaccination rate is one of the lowest among South Carolina's 46 counties. And that was true “even before Covid,” said Chris Lombardozzi, senior vice president of Spartanburg Regional Health System.
Last year, about 6,000 children in Spartanburg County schools — 10% of the total student population — either received an exemption allowing them to opt out of required vaccinations or failed to meet vaccination requirements, according to data released by the state.
Lombardozzi said the county's low vaccination rate is due to misinformation not only posted on social media but also spread by “various non-medical leaders over the years.”
The pandemic has made the situation worse. Michaud said fear and misinformation around coronavirus vaccines have “poured gasoline on the fire of people's skepticism about vaccines.” In some cases, that skepticism has rubbed off on childhood vaccines, which have historically been less controversial, he said.
This has left communities like Spartanburg County, with low vaccination rates, more vulnerable. “That’s why we see constant small pockets of measles outbreaks,” Michaud said.
In Spartanburg, the overall percentage of students with required vaccinations fell from 95.1% to 90% between the 2020-21 and 2024-25 school years. Public health officials say a minimum of 95% is needed to prevent significant spread of measles.
Children who attend public and private schools in South Carolina must show they have received some vaccinations, including the measles, mumps and rubella vaccine, but religious exemptions are relatively easy to obtain. The release form must be notarized, but does not require a doctor's note or any disclosure of the family's religious beliefs.
The number of students in South Carolina who have been granted religious exemptions has increased dramatically over the past decade. This is especially true in the northern part of the state, where religious exemptions have increased sixfold compared to a decade ago. According to data published by The Post and Courier. By fall 2024, that number had grown to more than 13,000.
Some schools are more vulnerable than others. The start of the outbreak in South Carolina was largely attributed to one public charter school, South Carolina Global Academy, where only 17% of the 605 students enrolled in the 2024-25 school year provided documentation showing they had received required vaccinations, according to data released by the Department of Public Health.
No one from Global Academy responded to interview requests.
“Freedom of Health”
In April, after visiting a Texas family whose daughter had died of measles, Secretary of Health and Human Services Robert F. Kennedy Jr. wrote on social media that “the most effective way to prevent the spread of measles is the MMR vaccine.” Later that month, he made a similar statement during an interview with Dr. Phil.
But these claims contradict other statements from Kennedy that question the safety of vaccines and wrongly link vaccines to autism. The CDC, under his leadership, is now claiming such ties.”were ignored by health authorities“
“What would I do if I could go back in time and not give my children the vaccines I gave them?” he said on a podcast in 2020. “I would do anything for it. I would pay anything to be able to do it.”
During 2025, he completed another misleading or unsubstantiated statements. During congressional hearings in September, Kennedy defended his past statements that he was not anti-vaxxer, but reiterated his stated position that no vaccines are safe or effective.
Emily Hilliard, a spokeswoman for the Department of Health and Human Services, told KFF Health News that Kennedy is “for safety, transparency and accountability.” Hilliard said HHS is working with “state and local partners in South Carolina” and other states to provide support during measles outbreaks.
Meanwhile, Kennedy frequently championed the idea of health freedom or freedom of choice regarding vaccines, a talking point that has taken root among Republicans.
That has had a “chilling effect on state and local legislators,” Michaud said, leaving some leaders hesitant to talk about the threat posed by ongoing measles outbreaks or the effectiveness and safety of the MMR vaccine.
Brandon Charachak, a spokesman for South Carolina Gov. Henry McMaster, said the governor was not available for an interview for this story but referred to McMaster's October comment that measles “is a dangerous disease, but from a disease perspective, it is not a disease that we should panic about.”
In another case that same month, the Republican governor said he did not support vaccine mandates. “We will not have mandates,” he said, “and I think we are responding appropriately.”
While the South Carolina Department of Public Health has repeatedly encouraged measles vaccinations, the initiative has been noticeably quieter than the agency's efforts to distribute the Covid vaccine.
For example, in 2021, the agency partnered with breweries across the state for a campaign called Shot and Hunter, which rewarded people who received the Covid vaccine with a free beer or soda. In contrast, the pop-up measles vaccination clinic at the Boiling Springs Library had no colorful signage, no giveaways, and was not visible from the library's main entrance.
Edward Simmer, interim director of the Department of Public Health, would not speak to KFF Health News about the measles outbreak. During legislative hearings in April, Republican state lawmakers voted against his permanent confirmation due to his past support for coronavirus vaccines and mask wearing. During the hearing, one lawmaker specifically criticized the agency over its Shoot and Chase campaign.
Public health officials in other states have also been stripped of new positions due to their response to the coronavirus. In Missouri, where MMR vaccination rates have declined among kindergarteners since 2020, and measles cases have been reported this year, Republican lawmakers said refused to the director of public health in 2022 after anti-vaxxers protested his appointment.
In South Carolina, Simmer is temporarily leading a public health agency without approval from lawmakers.
South Carolina Sen. Tom Davis of Beaufort was the only Republican on the Senate Medical Affairs Committee to vote to confirm Simmer in April. He told KFF Health News that fellow Republicans have raised valid questions about Simmer's past support for coronavirus vaccines.
But Davis said it would be “extremely unfortunate and unhelpful from a public health perspective” if the GOP simply took an anti-vaccine position “as a matter of policy.”
From October to mid-November, the Department of Public Health administered 44 doses of the MMR vaccine through its mobile health unit. The last mobile vaccination clinic was scheduled for November 24th. But health officials are encouraged that patients are looking elsewhere for vaccines. The agency's tracking system shows vaccine providers in Spartanburg County administered more than twice as many measles vaccines in October as they did a year ago.
As of mid-November, more than 130 people remained in quarantine, most of them students at local primary and secondary schools. Cases have also been linked to a church and Greenville-Spartanburg International Airport.
“We remind people that traveling for the upcoming holidays significantly increases the risk of infection,” said Bell, the state epidemiologist. “Because of this risk, we encourage people to consider getting vaccinated now.”
KFF Health News reporter Amy Maxman contributed to this report.
