Photo: RONALDO SCHEMIDT/AFP via Getty Images
Vaccines to prevent infection with measles, a highly transmissible and potentially deadly virus, were first introduced in the early 1960s. Over the last 50 years alone, they have protected the health of children and communities globally, saving an estimated 94 million lives. However, a number of factors—including the disruptions to health services during the Covid-19 pandemic; limited recognition by parents of the potential severity of measles infection; the rapid circulation of vaccine misinformation in digital media; and decreased funding for domestic and global immunization and disease surveillance programs—have all contributed to lower measles vaccine coverage. Falling vaccination rates now threaten to provoke more widespread and costly outbreaks—and undermine global health security.
In 2000, the United States was certified as having eliminated measles, meaning that no generalized transmission of the virus had been detected for a period of one year. Over the years, periodic outbreaks, including more than 1,200 measles cases in 2019, have brought the country close to losing that certification. But reasonably high rates of vaccination among children aged five and over, along with robust disease surveillance programs, have ensured that measles introduced by infected travelers returning to the United States from countries with high caseloads have not seeded sustained spread of the disease.
Over the past three months, however, a cluster of infections first reported in West Texas has led to more than 400 cases and two deaths, once again endangering the United States’ record of eliminating measles for the last quarter-century. Children are required to have received two doses of the measles vaccine to enter kindergarten in Texas, but the percentage of families in the state successfully seeking immunization exemptions increased over the last decade. These choices have been driven by false claims that the vaccines are harmful and social media posts downplaying the potential complications associated with measles and touting the benefits of building immunity through infection rather than vaccination.
In the Texas county where the majority of cases have been reported, measles vaccine coverage had recently fallen to around 80 percent, far lower than the 95 percent coverage required to effectively limit measles transmission. Measles cases related to the Texas outbreak have also been reported in neighboring New Mexico and Oklahoma, as well as across the border in Mexico. Other states across the Midwest and Southwest have also seen coverage slide in recent years, leaving pockets of partially vaccinated and unvaccinated children at risk of infection across wide swaths of the country.
Several recent actions now further imperil sustained measles elimination in the United States and could intensify outbreaks overseas. On January 20, President Trump issued an executive order announcing the United States would withdraw from the World Health Organization (WHO). That action also pulled U.S. funding for the Global Measles and Rubella Laboratory Network (GMRLN), which supports measles case identification and surveillance worldwide. Then, in early March, the National Institutes of Health (NIH) terminated several dozen grants supporting behavioral science projects aimed at understanding the drivers and consequences of vaccine hesitancy in the United States and abroad.
More recently, on March 26, the Trump administration rescinded over $11 billion in pandemic-era grants to state and local health entities, including agencies in West Texas, which were being used to investigate outbreaks, contact people who may have been exposed to infectious diseases, and build support for immunization programs to prevent disease transmission.
The same day, the Trump administration reportedly provided Congress with a spreadsheet detailing plans to terminate foreign assistance programs. In addition to cutting bilateral programs providing technical assistance to strengthen immunization rates in countries that had seen coverage drop over the course of the pandemic, a public international organization (PIO) contract for Gavi, the Vaccine Alliance, a public-private partnership that supports low-income countries in purchasing and delivering vaccines, was on the list. Recognizing that preventing outbreaks of infectious disease overseas protects the health of people at home, the United States has supported Gavi since the organization’s founding in 2000. In 2020, the Trump administration made a three-year pledge to Gavi during the organization’s fundraising cycle, and Congress had budgeted annual commitments in 2024 and 2025. In June 2024, then-First Lady Jill Biden pledged $1.58 billion from the United States over five years for Gavi’s next phase of operations, from 2026 to 2030. While Gavi CEO Sania Nishtar has stated that the organization has not yet received an official termination notice from the United States, the fate of $300 million in funds for 2025 and the pledged funds for 2026–2030 appears to be in jeopardy. The eliminated funding will leave the organization, which is seeking $9 billion for its next work cycle, with a significant gap unlikely to be filled by other top donors, such as the United Kingdom, which have also recently trimmed development assistance.
Reducing funding for U.S. and global immunization programs now, when there are cases of vaccine preventable diseases, notably measles, being reported in all world regions, seems shortsighted and is certain to slow progress in preventing deadly outbreaks. Beyond hampering support for low-income countries that depend on funding to purchase vaccines and technical assistance to deliver them, a loss of momentum in strengthening vaccine coverage in the most vulnerable countries will also have negative implications for outbreaks in higher-income areas. The WHO European Region, which has seen uptake of measles vaccine drop in recent years, reported more than 120,000 cases in 2024, the highest number in nearly three decades.
Responding to measles outbreaks is far costlier than preventing them. It is less expensive to provide two doses of measles vaccine than it is to stop an outbreak, which can involve providing treatment, contact tracing, quarantining suspected cases, and administering an immunization campaign. UNICEF estimates the cost of fully protecting a child from measles to be less than $8 for Gavi-eligible countries, while the U.S. Centers for Disease Control and Prevention (CDC) lists the U.S. price per measles mumps rubella (MMR) vaccine dose at around $26, or slightly more than $50 per fully vaccinated child. A recent study estimated that the public health response to the measles outbreak in Washington state in 2018–2019 cost nearly $50,000 per person, 1,000 times higher than providing two doses through routine health services. For decades, the CDC has been at the forefront of outbreak response, assisting health authorities in the United States and overseas upon request, but the cuts to agency personnel announced on April 1 raise questions about the organization’s ongoing capacity in this area.
For the last 25 years, a focus on improving access to measles vaccines in the United States and overseas has driven down cases and deaths, enabling children to survive, thrive, attend school, and grow up to live productive lives and have families of their own. Not only does cutting support for national and global immunization programs threaten the U.S. measles elimination certification, it also limits economic growth, undermines the viability of U.S. trading partners, and imperils the health of children around the world.
Katherine E. Bliss is a senior fellow and director of Immunizations and Health Systems Resilience with the Global Health Policy Center at the Center for Strategic and International Studies in Washington, D.C.
The author is grateful to Priya Chainani for her research assistance in the preparation of this commentary.
