In the shadow of escalating measles outbreaks across the United States, public health experts are grappling with a troubling question: Will the resurgence of this once-eliminated disease finally spur a nationwide push for vaccination, or has a fractured landscape of misinformation and policy shifts made that rebound impossible? Since January 2025, the country has recorded its two largest measles epidemics in over three decades, with the ongoing outbreak in South Carolina surpassing 875 cases and still growing. Officials warn that by April, measles could be declared endemic in the U.S. for the first time since its elimination 26 years ago.
The logic behind measles control has long been straightforward, according to Paul Offit, a pediatrician and vaccine expert at Children’s Hospital of Philadelphia. “When vaccination rates fall, infections rapidly rise; when vaccination rates increase, cases abate,” Offit said. Yet, as rates of the measles-mumps-rubella (MMR) vaccine have steadily declined for several years—dropping unevenly since the start of the coronavirus pandemic—the nation is witnessing the harsh consequences of that first dynamic. Recent research led by Eric Geng Zhou, a health economist at the Icahn School of Medicine at Mount Sinai, highlights stark regional disparities: While communities in the Northeast and Midwest maintain generally high MMR uptake, areas in West Texas, southern New Mexico, the rural Southeast, and parts of Mississippi offer little protection, with vaccination rates far below the 92 to 95 percent threshold needed to prevent outbreaks.
The West Texas outbreak, which ignited around this time last year in and around rural Mennonite communities distrustful of vaccines, marked the beginning of the current wave. It prompted a rush among some local families to vaccinate, including early doses for infants, but many in the hardest-hit areas stood firm in their refusal. Similarly, the South Carolina epidemic, now larger than its West Texas counterpart, has seen free vaccination clinics established, though attendance has been spotty. Even in distant states like Wisconsin, health-care providers have noted upticks in vaccination interest, said Jonathan Temte, a family-medicine physician and vaccine-policy expert at the University of Wisconsin at Madison. However, Temte emphasized that these increases are mostly among those already supportive of vaccines, seeking extra protection amid the national crisis, rather than swaying the hesitant.
Contributing to these pockets of vulnerability is the lingering impact of the COVID-19 pandemic, which disrupted routine pediatric visits and led to delayed or missed vaccinations. “COVID can bear some of the blame for these patches of slipping vaccination,” Zhou said. Interruptions resolved quickly for some families but persisted for others, particularly those with lower socioeconomic status facing inconsistent access to health care and reliable information. The pandemic also exacerbated political divides, with Republicans showing substantially more hesitation toward child immunizations than Democrats in recent years. “The COVID pandemic created this persistent divergence,” Zhou added.
Under-vaccinated groups have historically overlapped with those less engaged in medical care, including people with lower education or income levels and certain ethnic minorities. Anti-vaccine activism has further eroded trust, amplified by figures like Robert F. Kennedy Jr., now serving as secretary of the Department of Health and Human Services. Kennedy and others have spent years disseminating misinformation about vaccine safety. Compounding this, vaccination decisions often cluster within communities, influenced by parents' own immunization histories. For a highly contagious virus like measles—which infects an estimated 90 percent of unvaccinated people it encounters—these widening chasms between vaccinated and unvaccinated populations pose a grave risk.
Tragedy has already struck amid the outbreaks. Since the start of 2025, three unvaccinated individuals have died from measles, including two young children in the West Texas cases. Experts initially hoped such losses might shift public attitudes, but the deaths, centered in insular Mennonite communities, have been perceived by many as an isolated issue. Noel Brewer, a vaccine-behavior expert at the University of North Carolina Gillings School of Global Public Health and a former member of the CDC’s Advisory Committee on Immunization Practices—before its overhaul by Kennedy last year—said many Americans viewed the fatalities as distant from their own experiences.
Measles retains a deceptively mild reputation in the public mind, despite its potential for severe complications. “It’s not a big deal if you get it,” said Rupali Limaye, a vaccine-behavior expert at Johns Hopkins University, capturing a common misconception. Even if awareness of risks grew, experts doubt it would drive widespread action. For comparison, COVID-19 vaccines, which mitigate severe outcomes, have seen only 17 percent of adults and 8 percent of children vaccinated this winter. Flu shots, despite hospitalizing hundreds of thousands annually and causing tens of thousands of deaths, achieve uptake below 50 percent. “How many deaths is enough to be a tipping point?” Offit asked. “I don’t know that.”
“When and if the maxim’s second part—a rebound in vaccination—might manifest ‘is the key question,’” Offit told The Atlantic.
The federal response under the Trump administration has drawn sharp scrutiny from experts. Following the 2025 deaths, officials issued muted endorsements of MMR vaccines—highly effective at preventing severe illness, infection, and transmission—while emphasizing vitamin A supplementation. More pointedly, Ralph Abraham, the CDC’s new principal deputy director, described the prospect of endemic measles as “just the cost of doing business.” Last month, the CDC ended its long-standing recommendation for annual flu shots for all Americans; shortly after, Kennedy told CBS News it might be “a better thing” if fewer children received flu vaccines. Kirk Milhoan, the new chair of the CDC’s vaccine advisory committee, has questioned the necessity of the MMR vaccine, suggesting measles risks are lower today due to improved hospital treatments.
HHS spokesperson Andrew G. Nixon pushed back on claims of hindered response in an email, stating, “Under Secretary Kennedy, CDC surged resources and multiple states declared measles outbreaks over in 2025.” He added that “Secretary Kennedy and other leaders at HHS have consistently said that vaccination is the best way to prevent the spread of measles.” Nixon highlighted the U.S. approach mirroring peer nations that achieve high rates through trust, education, and doctor-patient relationships, without mandates. Yet Kennedy has publicly urged skepticism toward “trusting the experts,” and the CDC’s website now challenges the scientific consensus that vaccines do not cause autism—a move that has sown confusion among families.
Limaye, who advises local health-care providers, reported that the most frequent question from parents is now “Who am I supposed to believe?” Health-care providers remain the strongest influence on immunization decisions, but historical rebounds in vaccination have often relied on robust government backing. In the 1970s, after false safety fears about the whooping-cough vaccine caused outbreaks in the United Kingdom, a government campaign limited the decline. California’s 2010s Disneyland measles outbreak, which spread to six states, Canada, and Mexico, saw MMR rates climb above 95 percent only after stricter school mandates. In the early 1990s, Philadelphia officials ended a epidemic sickening 1,400 and killing nine children via a court-ordered vaccination drive.
Conversely, government withdrawal can devastate rates. In 2013, Japan suspended HPV vaccine recommendations over unfounded concerns, dropping uptake from 70-80 percent to under 1 percent within a year; reinstatement came nearly a decade later, with coverage recovering to only half its prior level, according to Brewer, who is co-authoring related research. Experts predict any MMR rebound now would be uneven, likely bypassing politically conservative regions where boosts are most needed. “Leaving enough places lingering below the crucial measles-vaccination threshold ‘will ensure repeated and large outbreaks,’” Brewer said. West Texas and South Carolina, he noted, were merely the start.
As measles cases mount this year, more illnesses and deaths are expected, testing the resilience of U.S. vaccination efforts without federal reinforcement. The disease’s fragility demands near-universal coverage, yet the interplay of pandemic disruptions, political polarization, and official ambivalence has deepened divides. While some communities double down on protection, others remain exposed, perpetuating a cycle of vulnerability. Public health leaders, from local clinics to national agencies, face an uphill battle to restore confidence and access, with the stakes rising as April’s potential endemic declaration looms.
Looking ahead, the path to containment hinges on whether grassroots efforts and provider trust can overcome the void left by shifting federal priorities. Outbreaks in 2022, like the polio case in Rockland County, New York, that paralyzed an unvaccinated man and prompted over 1,000 families to vaccinate, offer glimmers of hope. But in today’s environment, experts like Offit and Limaye express pessimism that suffering alone will suffice. The U.S. is navigating uncharted territory, where the “homeostatic pull” of vaccination—dipping in response to complacency and rebounding amid crisis—may falter without unified support.