The United States could lose its measles-free status next year. If this happens, the country will enter an era where outbreaks will again become commonplace.
More children will be hospitalized due to this preventable disease. Some will lose their hearing. Some will die. Measles is also expensive. A new research Estimates not yet published in a scientific journal estimate that public health responses to outbreaks with just a couple of cases cost about $244,000. When a patient requires inpatient treatment, it costs an average of $58,600 per case. The study estimates an outbreak the size of the one in West Texas earlier this year, with 762 cases and 99 hospitalizations, would cost about $12.6 million.
America's status depends on whether the country's major outbreaks this year have been driven by the large outbreak in West Texas that officially began on Jan. 20. If these outbreaks are linked and continue until January 20 next year, the US will no longer be among the countries that have banished the disease.
“A lot of people have worked very long and hard to achieve elimination—years of figuring out how to make vaccines available, get good vaccine coverage, and respond quickly to outbreaks to limit their spread,” said Paul Rota, a microbiologist who recently retired from a nearly 40-year career at the Centers for Disease Control and Prevention.
Instead of acting quickly to prevent measles from returning, Robert F. Kennedy Jr., a lawyer who founded an anti-vaccine organization before leading the Department of Health and Human Services, undermined the ability of public health officials to prevent and contain outbreaks by undermining confidence in vaccines. The measles vaccine is safe and effective: only 4% of more than 1800 Confirmed cases of measles in the U.S. this year have been in people who received two doses.
Kennedy has dismissed experts on a vaccine advisory committee to the Centers for Disease Control and Prevention (CDC) and without any evidence stated that vaccines can cause autism, brain swelling and death. On November 19, scientific information on the CDC webpage about vaccines and autism was replaced with false statements. Kennedy told The New York Times that he ordered a replacement.
“Do we want to go back to the pre-vaccination era, when 500 children die from measles every year?” asked Demetre Daskalakis, the former director of the CDC's National Immunization Center who resigned in protest of Kennedy's actions in August. He and other scientists said the Trump administration seemed more concerned with downplaying the measles resurgence than with containing the disease.
HHS spokesman Andrew Nixon said in a statement that vaccination remains the most effective tool for preventing measles and that “CDC and state and local health agencies continue to work together to assess patterns of transmission and ensure an effective public health response.”
Looking for links
CDC scientists do track measles, along with researchers from health departments and universities. To find out if the outbreaks are related, they study the genomes of the measles viruses, which contain all their genetic information. Genomic analysis can help reveal the origins of outbreaks and their true size, and alert officials to undetected spread.
Scientists have been conducting genomic analyzes of HIV, flu and Covid for years, but this is new for measles because the virus hasn't been a big problem in the U.S. for decades, says Samuel Scarpino, a public health specialist at Northeastern University in Boston. “It’s important to build a surveillance network so we can expand quickly if and when we need to,” he said.
“We are working with the CDC and other states to determine whether what we are seeing is one large outbreak with continued spread from state to state,” said Kelly Oakson, a genomics researcher with the Utah Department of Health and Human Services.
At first glance, the ongoing outbreak in Utah And Arizona258 cases as of December 1 appear to be linked to the Texas case because they are caused by the same measles strain, D8-9171. But the strain is also spreading across Canada and Mexico, meaning outbreaks may have emerged separately from people infected abroad. If that happens, the formality could save the U.S. from losing its status, Rota said. The absence of measles means that the virus does not circulate continuously throughout the country year-round.
Canada lost its measles elimination status in November because authorities could not prove that various outbreaks caused by the D8-9171 strain were unrelated, said Daniel Salas, executive manager of the Pan American Health Organization's comprehensive immunization program. The group, which works with the World Health Organization, includes health officials from North, South and Central America and the Caribbean. He calls for the elimination of measles based on reports from scientists from the countries he represents.
Early next year, PAHO will hear from American scientists. If their analysis shows that measles is continuously spreading in the United States throughout the year, the organization's director can revoke the country's measles-free status.
“We expect countries to be transparent about the information they have,” Salas said. “We'll ask questions like, 'How did you determine your findings and did you consider other perspectives?'”
Pending PAHO's assessment, Oxon and other researchers are studying how closely the D8-9171 strains in Utah match the others. Instead of looking at just a short snippet of genes that mark a strain, they analyze the entire genome of the measles virus, about 16,000 genetic letters long. Genetic mutations occur naturally over time, and the accumulation of small changes can act like a clock, showing how much time has passed between outbreaks. “This tells us about the evolutionary history of the specimens,” Oxon said.
For example, if one child directly infects another, the children will share the same measles viruses. But the measles viruses that infect people at the start of a major outbreak will be slightly different from those that infect people months later.
Although the outbreaks in Texas and Utah are caused by the same strain, Oakson said, “the more detailed details lead us to think that they are not very closely related.” To find out how different they are from each other, scientists compare them with measles virus genomes from other states and countries.
Ideally, scientists would combine genetic research with research into the causes of each outbreak. However, many investigations remained inconclusive because the first infected people did not seek help or contact health departments. As in West Texas, the outbreak in Utah and Arizona is concentrated in close-knit, under-vaccinated communities that are suspicious of government agencies and mainstream medicine.
Researchers are also trying to find out how many cases of measles have gone undetected. “Confirmed cases require testing, and in some communities, traveling to the hospital to get tested comes at a cost: a tank of gas, finding a babysitter, missing a job,” said Andrew Pavia, an infectious disease physician at the University of Utah. “If your child has a rash from measles but is not very sick, why should you worry?”
Subtle observation
Pavia is part of a national outbreak surveillance network led by the CDC. The easiest way to find out how big an outbreak is is through surveys, but that's difficult when communities don't trust public health workers.
“As part of the collaboration, we could fill out questionnaires asking if anyone in the family has had the rash and other symptoms of measles,” Pavia said, “but the same problems that make it difficult to quarantine and vaccinate people make this difficult.”
Instead, Pavia and other researchers are analyzing genomes. Many variations suggest the outbreak spread weeks or months before it was discovered, infecting many more people than is known.
A less intrusive method of observation is through wastewater. This year, the CDC and state health departments began working to test wastewater from households and buildings for measles viruses shed by infected people. A study in Texas found that it could function as an early warning system, alerting public health authorities to an outbreak before people showed up in hospitals.
The quiet research by CDC scientists stands in stark contrast to the lack of public action. The CDC has not held a single press briefing on measles since President Donald Trump took office, and its last publication on measles in the agency's Morbidity and Mortality Weekly Report was in April.
Instead of acting quickly to limit the size of the outbreak in Texas, the Trump administration hampered CDC's ability communicate quickly with Texas officials and slowed down production federal emergency funds, according to research from KFF Health News. Meanwhile Kennedy broadcast mixed messages on vaccines and advertised untested treatments.
Daskalakis said that as the outbreak in Texas worsened, his CDC team was met with silence when they asked to brief Kennedy and other HHS officials.
“Objectively, they haven't helped control the outbreak in Texas, so if we lose the eradication, maybe they'll say, 'Who cares,'” Daskalakis said.
Nixon, the HHS spokesman, said Kennedy responded decisively to the outbreak in Texas, directing the Centers for Disease Control and Prevention to help provide measles vaccines and medications to the public, speed up measles testing and advise doctors and health officials. The US maintains its elimination status because there is no evidence of continued transmission of the virus for 12 months, he added.
“Preliminary genomic analysis indicates that the cases in Utah and Arizona are not directly linked to Texas,” said CDC Acting Director and Deputy Secretary of State for Health Services Jim O'Neill. wrote on social platform X.
Given Kennedy's distortions of information about vitamin A, TylenolAnd autismDaskalakis said the Trump administration could insist that the outbreaks are unrelated or that PAHO is wrong.
“If he becomes health secretary the year we lose the elimination status, it will be a real stain on the Kennedy regime,” he said. “I think they will do everything they can to question scientific findings, even if it means throwing scientists under the bus.”
