Decades after it was officially declared eliminated in the United States, measles has made a resurgence, with the US Centers for Disease Control and Prevention (CDC) announcing the third death of the year from the virus.
Matt Ferrari, director of the Center for Infectious Disease Dynamics at Pennsylvania State University, said the United States has been so successful in eradicating measles that it has “the luxury of forgetting” that it is a serious problem.
Recommended Stories
list of 3 itemsend of list
“It’s been a long time, and for many of us in the United States, and indeed throughout the Western Hemisphere, we have been able to forget how nasty measles is,” Ferrari told Al Jazeera.
Pennsylvania was particularly hard hit during the latest outbreak. In September, the state requested emergency help from the CDC to control the spread, even as state and federal health officials argued over the number of deaths associated with measles — differing over how the deaths should be classified. State officials have recorded more than 1,200 cases and more than 240 hospitalizations in 42 counties so far this year.
This increase in the number of cases has raised concerns in neighboring US states. On October 5, New York State Governor Kathy Hochul declared a state of emergency in response to rising cases in rural areas, increasing the number of health care professionals authorized to vaccinate and test for measles.
“No one should get seriously ill or die from a vaccine-preventable disease,” Hochul said.
But experts warn that the risks extend far beyond U.S. state borders. The resurgence in the United States comes as measles cases are increasing globally, particularly in communities that are skeptical of vaccines or where there are gaps in access to health care.
Vaccination coverage among kindergartners in the United States increased from 95.2% in the 2019-2020 school year to 92.4% in the 2025-2026 school year. Experts warn that falling vaccination rates in one geographic area can leave people thousands of miles away vulnerable, making measles prevention a shared global responsibility.
Building Trust in Vaccine Skeptical Communities
Pennsylvania reported in August that two unvaccinated people died from measles in Lancaster County, located in the south-central part of the state. Lancaster is considered the center of Pennsylvania Dutch country and is home to the nation’s oldest Amish and Mennonite communities, whose population is under-vaccinated.
In Pennsylvania, public health officials have worked with community leaders to share information and expand access to vaccination. Joshua Good, principal of Ephrata Mennonite School in Lancaster County, where two students contracted measles earlier this year, worked with state officials to host a pop-up vaccination clinic at the school.
He said officials also provided communications materials that the school tailored to its community and helped identify at-risk families.
Although Good said the response has been productive, he told state officials that the Mennonite community is still very skeptical of vaccines.
“I said, look, if we do this, keep in mind that our community as a whole… made this decision not because they don’t have access to vaccines. They made the decision based on their own judgment,” he told Al Jazeera.
Good, who is vaccinated and has his children vaccinated, considers himself an advocate in the community. If families have questions about the measles vaccine, he will answer them as best he can.
“I have honest conversations with people, I try to engage in a respectful and charitable way,” he said. “I will try to understand what their hesitations are. That said, I respect their concerns.”
Although several community members have received the measles vaccine at the Ephrata clinic, vaccination rates remain below the herd immunity threshold.
Public health officials advocate investing in strong community outreach before outbreaks occur.
“You can’t just show up in a community in an emergency — an emergency where they might feel like you’re there to blame or shame them,” Jennifer Nuzzo, director of the Pandemic Center at Brown University’s School of Public Health, told Al Jazeera. “You have to know them so they see public health as a resource rather than law enforcement.” »
She said low vaccination coverage and distrust of the government allow measles to spread even when vaccines are available. But that shouldn’t stop governments from building relationships with vaccine-skeptical communities.
“I worry that by framing it around their demographics, it lets governments off the hook for what they’re supposed to do, which is stop the spread of this dangerous disease,” Nuzzo said.
Experts say declining vaccination rates not only put these communities, but also immunocompromised people, at greater risk of disease. Herd immunity among the population as a whole once helped protect those most vulnerable to infection.
“These are communities that have been in danger for years,” Ferrari said. “But higher vaccination rates in surrounding communities posed a barrier. »
A shared global risk
The continental Americas was the first World Health Organization (WHO) region to eliminate endemic measles transmission in 2016. Maintaining this status requires consistently high vaccination coverage. The Pan American Health Organization (PAHO) says coverage in the region remains below target for both doses of the measles vaccine, contributing to notable consequences.
PAHO holds an annual RVC Conference on Measles Elimination Status at which an independent technical body composed of international experts monitors and reviews whether countries in the Americas have successfully eliminated measles, rubella, and congenital rubella syndrome. A country can lose its “elimination status” when the same measles virus genotype has been circulating continuously for at least 12 months.
Last year, Canada became the first country in the Americas to lose its status after an outbreak that began in 2024. Some have warned that the United States could be on the verge of losing its status this year.
But Dr. Daniel Salas, executive director of the Special Program for Comprehensive Immunization at PAHO, told Al Jazeera that the United States would not be the only one under review.
“We have Mexico, we have Bolivia who are going to be closely evaluated because they could also lose their status,” he said.
US Secretary of Health and Human Services Robert F Kennedy Jr has repeatedly defended the US response to measles.
“We are doing a better job than any other country in the world in controlling the measles epidemic,” Kennedy said at an Aug. 26 event in Florida. He cited higher case numbers in Mexico, Canada and Britain.
But Nuzzo said repeated outbreaks across the United States indicate the country is struggling to contain transmission.
“We haven’t seen it this bad,” she said. “It’s like this perpetual game of Whac-A-Mole. As long as there are vulnerable communities, as long as we don’t have early detection, rapid response and containment strategies, measles will continue to spread, over and over again.”
Dr Salas told Al Jazeera that it is essential to act within three days of a suspected case and that health authorities should start investigating and taking response measures without waiting for laboratory confirmation. Delays of a week or more can allow the highly contagious virus, marked by fever, cough and a rash all over the body, to spread further.
Experts warn that outbreaks cannot be treated as isolated local events. Scientific reviews have found evidence that the viral strain in Canada’s latest measles outbreak was genetically linked to cases reported in Mennonite communities in the United States. This is the same outbreak that caused Canada to lose its measles elimination status.
“The spread of measles in the United States puts other countries at risk,” Nuzzo said. “It’s easy to point the finger at other countries and say they’re the problem, but the reality is we all depend on each other, and it’s very difficult to protect yourself when measles spreads elsewhere.”
Gn Health
