Eight experts weigh U.S. measles elimination status this week

U.S. faces worst measles outbreak since 1991 with more than 5,400 cases

A panel of eight independent experts will meet in Washington, D.C., this week to consider whether the United States should retain its measles elimination status. The panel is part of the Pan American Health Organization (PAHO), a regional branch of the World Health Organization (WHO), and PAHO’s director will make the final call. Losing the status would place the United States alongside Canada and several European and Asian nations that eliminated the disease before it returned.

The Johns Hopkins University International Vaccine Access Center tracker showed more than 5,400 cases nationally, and the United States is in its worst measles outbreak since 1991. Nearly every state has an active outbreak. This year, six people have died in Pennsylvania, a child died in New York on election day and an infant died in Wisconsin days later.

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 critic of Health Secretary Robert F. Kennedy Jr., said: “That is a tremendous step backwards.” Offit also said: “Independent of what PAHO says, measles is now endemic in the US. Measles has a foothold in the US.” He added: “We’re going to see it this year, we’re going to see it next year,” because, he said, the US had “critically decreased the percentage” of people vaccinated.

The Guardian reported that measles is one of the most infectious diseases known to medicine and that even small dips in immunity allow it to spread, despite the overwhelming majority of Americans vaccinating themselves and their children. It said measles kills one to three people per 1,000 and hospitalizes about one in five unvaccinated people who become infected. 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, Dr. David Margolius, Cleveland, Ohio’s director of public health, is warning people to find proof of their measles vaccination if they are exposed. Margolius is also a director-at-large of the Big Cities Health Coalition. “Now is the time to go and find that evidence, because now this is a real day-to-day life thing that could happen to you,” he said. Patients without proof face either an immunology blood draw or a 21-day quarantine.

Cleveland health authorities have tracked down people exposed in hospital waiting rooms and elevators this year. “We reach out to people and for most people, including myself, we have no personal experience with measles,” Margolius said. “They’ve got everything else going on in their life, and now they’re getting this call.”

When the vaccine was first licensed in 1963, measles was considered a childhood disease, and most children contracted it by age five. “Now you’re seeing the epidemiology shift,” Offit said. Two-thirds of people infected in Pennsylvania are adults, a group on which researchers have little information. Mothers have given birth to babies with measles. “Now, you’re seeing something we just didn’t see at all – congenital measles,” Offit said.

The status decision coincides with a change in the political environment around the Trump administration. The Guardian reported a historic defeat for Republicans in the midterm elections and said several new Democratic doctors and scientists are slated to take seats in Congress with promises to hold Kennedy accountable. Trump appointed Stephen Miller as chief of staff. In a statement about the appointment, Kennedy said: “Next to me, Stephen Miller is the strongest Maha supporter in the administration.” He added: “It’s time to unleash the Kraken.”

The Guardian also reported that the Trump administration had significantly hampered the Centers for Disease Control and Prevention’s capacity to respond. The agency has lost up to one-third of its staff, Kennedy has interfered in the agency’s reporting of measles deaths and Kennedy has spread misinformation about measles vaccines, according to the report.

Margolius did not place all the blame on Kennedy. He said vaccine hesitancy was increasing before Trump took office and pandemic-era disruptions were real. “Some of the narrative has been to pin this on our health secretary, which certainly I think he could do much more to help the situation rather than hurting the situation, but I do think the case count is climbing everywhere,” he said. “This could happen even under a more pro-public health administration.”

The Guardian reported that the second Trump administration also made broad changes that challenge measles elimination globally. Some of Trump’s first acts in 2024 included withdrawals from the World Health Organization (WHO) and the Global Vaccine Alliance (GAVI). GAVI provides measles vaccines to nations such as India and Malawi. The WHO estimates about 95,000 measles deaths globally, mostly among unvaccinated children under five years old.

At home, The Guardian reported that Republicans enacted the largest-ever federal cut to health insurance, with changes expected to result in more than 17 million people losing insurance through 2034. The Guardian reported that the cuts have challenged health officials such as Margolius, who struggle to connect people with vaccines when insurance coverage is unstable. “Until we can rejoin the WHO and cooperate with other health agencies all over the world … This will continue,” Margolius said.

The final decision on the United States’ measles elimination status remains with PAHO’s director after this week’s evidence review. In Cleveland, exposed residents without proof of vaccination already face an immunology blood draw or 21-day quarantine under the city’s public-health response.