The U.S. has lost its status as a country where measles is eliminated, a public health triumph secured a quarter century ago.
Researchers with direct knowledge of the deliberations on the country's status told KFF Health News that the Pan American Health Organization reached the conclusion this week: Measles has reestablished regular transmission in the country.
PAHO had planned a public announcement on Nov. 17.
In public health parlance, measles elimination depends on a country's sporadic outbreaks ending within a year. That's no longer happening in the United States.
"It's a very sad moment," said Anne Schuchat, an epidemiologist and a former deputy director at the Centers for Disease Control and Prevention who was not involved in PAHO's decision.
"Measles causes so much unnecessary suffering, everything from a high fever and missed work and school to long-term complications like progressive degenerative nerve disease and death," Schuchat said.
Measles outbreaks are entirely preventable: Two doses of the measles-mumps-rubella vaccine prevent about 97% of infections, so when almost everyone in a community is fully vaccinated, the virus can't spread.
In the past two years, over 830 people have been hospitalized with measles in the U.S. More than 8,000 people have been sickened in outbreaks that have cost roughly $125 million in medical care, public health response, and productivity losses, Johns Hopkins University researchers estimate.
States have reported 13 measles-associated deaths, including a 7-month-old in New York and infants in Pennsylvania and Wisconsin in recent months. Babies typically aren't vaccinated before they're a year old.
PAHO, an international group that oversees health in the Americas and works with the World Health Organization, based its assessment on two analyses: one by the CDC and another by an independent group of measles experts.
Researchers anticipated this conclusion after an outbreak in Utah surpassed the one-year mark in June.
A spokesperson for the Department of Health and Human Services, Emily Hilliard, attributed the resurgence of measles to vaccination gaps that opened years before this administration. Indeed, rates of childhood vaccination have steadily declined since the COVID pandemic started.
But many scientists also blame the Trump administration for spreading vaccine misinformation and stifling a swift, strong response to outbreaks.
For example, the administration cut millions of dollars from children's immunization programs run by state health departments and terminated funds for research on vaccine hesitancy.
After Health Secretary Robert F. Kennedy Jr. sacked CDC director Susan Monarez in August 2025, she told Congress she was fired because she would not preapprove changes to vaccine recommendations "without reviewing the evidence."
Monarez added that "we already have seen the largest measles outbreak in more than 30 years" and that, "if vaccine protections are weakened, preventable diseases will return."
Spokespeople for HHS and the White House defended the administration, and Kennedy, who led a prominent anti-vaccine organization before he took the helm at HHS. "The President and the Secretary have repeatedly encouraged measles vaccination, coordinated with states, and facilitated the deployment of vaccine doses across the country," White House spokesperson Allison Schuster wrote in an email.
Past administrations sounded alarms
For more than three decades, the federal government treated measles as a preventable tragedy, with sizable outbreaks triggering national efforts to boost vaccination and stop the virus from spreading.
That's no longer the case, said Patsy Stinchfield, executive director of the Measles Collaborative, a new initiative that educates the public about vaccines and assists health workers responding to outbreaks.
Stinchfield was a pediatric nurse at a children's hospital in Minnesota during the nation's last surge of measles before elimination, from 1989 to 1991. She recalled an entire ward devoted to children with measles and the enormous effort required to prevent the virus from spreading to kids with cancer and weakened immune systems.
Two children at the hospital died of measles. "That changed my career forever," she said.
Back then, she said, the federal government "saw the urgency." Officials held press conferences, spoke on the news about vaccines, issued clinical guidelines, and published reports in the CDC's flagship journal — the Morbidity and Mortality Weekly Report, or MMWR — that drove policies.
When data suggested that some children weren't mounting a strong response to a single dose of the measles-mumps-rubella vaccine, a CDC advisory committee recommended two doses of the shot.
When CDC analyses found that many children with measles hadn't been vaccinated due to cost, the government launched the Vaccines for Children program to make immunizations available free of charge to underinsured families.
Cases plummeted. By 2000, the CDC and PAHO determined that measles was no longer a national threat — measles transmission had been eliminated.
"Elimination" allows for occasional outbreaks, because measles is not eradicated worldwide and a small fraction of people, such as young infants, can't be protected by vaccines.
People infected abroad sparked occasional outbreaks after U.S. elimination, but — until now — those fizzled out because of herd immunity, when 95% of people within a community are immunized. In those situations, outbreaks peter out and vulnerable people are protected.
It would be 14 years before another significant outbreak in the U.S. Then in 2015, the virus took off among unvaccinated children at Disney parks in California, giving rise to outbreaks elsewhere. Congress saw some 125 cases as an emergency and summoned the CDC's Schuchat to testify on the situation.
"Vaccination wasn't a partisan issue," she recalled. "This was about problem-solving: What can we do about this?"
National television aired a video of then-U.S. Surgeon General Vivek Murthy talking with Sesame Street's Elmo about vaccination. HHS officials worked with vaccine experts on strategies to boost public confidence in vaccines. California and Vermont tightened vaccine requirements.
In 2019, House and Senate committees met again about measles, as a large outbreak took hold in Orthodox Jewish communities in New York and New Jersey took hold. Congress asked HHS leaders how the administration planned to curb the rise of vaccine misinformation online.
"Internet fraudsters who claim that vaccines are not safe are preying on the unfounded fears and daily struggles of parents, and they are creating a public health hazard that is entirely preventable," Lamar Alexander, then a Republican senator from Tennessee, said at the time.
Alex Azar, health secretary during the first Trump administration, and then-CDC Director Robert Redfield held a press conference stressing the "importance of on-time vaccination."
And during the 2014, 2015, and 2019 outbreaks, the CDC's MMWR published detailed articles within weeks of data collection. Timing matters since the reports guide emergency response. "The MMWR is the voice of the CDC," Schuchat said, "alerting the nation, the media, clinicians, and public health experts to events that require action."
'The dog didn't bark'
Just after President Donald Trump took office in 2025, a measles outbreak exploded in West Texas. Within seven months, it surpassed the size of any in the U.S. since 1992, spread to Mexico and at least three other states, sickened more than 4,500 people in the two countries, and killed at least 16.
Instead of broadcasting clear, repeated messages on the importance of measles vaccines, Kennedy falsely claimed on Fox News that they lead to "deaths every year."
Congress didn't call a hearing, and HHS didn't send funds until after the emergency in West Texas had subsided. Besides an annual measles update, the MMWR didn't publish a single report on the outbreaks that year.
"A lot of this is the dog didn't bark," said Dorit Reiss, a vaccine policy researcher at the University of California Law San Francisco. "Something that normally happens isn't happening."
Political appointees have delayed or blocked several MMWR articles, according to multiple CDC officials whom KFF Health News agreed not to identify because they feared retaliation for speaking with the press. "There's a deliberate effort to downplay vaccine-preventable diseases by the administration," one official said.
"Measles reports from West Texas and New Mexico were intentionally shelved," another scientist at the agency said. In April, The Washington Post reported that Jay Bhattacharya, who temporarily led the CDC this year and remains head of the National Institutes of Health, had blocked the publication of a study in the MMWR finding that COVID vaccines halved the likelihood of emergency department visits.
"The suggestion that HHS is deliberately suppressing information about measles or other vaccine-preventable diseases is false," Hilliard, the HHS spokesperson, said in an email to KFF Health News.
Hilliard said Kennedy and the CDC have provided approximately $100 million in additional funding to respond to outbreaks. The timing of MMWR reports, she added, varies due to factors such as data analysis and scientific review.
More than a year after data was collected from Texas, a few reports came out in the CDC's journal. One study on 60 people hospitalized for measles in West Texas revealed that two required intubation and mechanical ventilation and that a baby born to a mother with measles experienced dangerous brain swelling due to the virus.
The MMWR still hasn't published detailed reports on massive outbreaks in South Carolina, Utah, and Pennsylvania. The CDC's national measles update hasn't appeared in the MMWR this year either. Instead, the journal has featured less urgent articles on scientific techniques that may help characterize future outbreaks.
CDC scientists told KFF Health News that they continue to analyze data but no longer expect to publish their findings in the MMWR because the process has become slow, opaque, and unpredictable. An urgent CDC report on the risks of measles to pregnant women was withheld, The Washington Post reported recently.
"We have two CDCs now," an official at the agency said. "One is staffed by CDC scientists and civil servants who are committed to public health, and the other is political appointees who go in and change the website."
The CDC's measles dashboard counts four fewer measles deaths than state health departments have reported this year. Kennedy has disputed some deaths and made unsubstantiated claims that Pennsylvania health officials misrepresented data.
Kennedy personally instructed the CDC to alter language on a webpage that said vaccines do not cause autism, he told The New York Times last year.
The page now suggests a potential link between the two and no longer lists a slew of peer-reviewed studies that rigorously searched for an association and found none. These have been replaced with speculation about a correlation and unsubstantiated accusations that the scientific establishment has buried a potential link in order "to prevent vaccine hesitancy."
The Trump administration has muddied the message on vaccines in other ways, Reiss said. Trump incorrectly said in August that the measles-mumps-rubella vaccine could be "quite lethal," and he repeated the debunked idea that vaccines may cause autism.
Stephen Miller, now Trump's White House chief of staff, has falsely said doctors "pump your kids full of shots days after birth with no understanding of the long-term consequences." Recommended vaccines and the vaccine schedule have been thoroughly studied.
Kennedy has made such claims for two decades, including as health secretary. "Having top leadership disseminating rumors, disinformation and flat-out falsehoods has been unforgivable," Schuchat said.
When pressed by journalists and Congress, Kennedy and Trump have recommended measles vaccines. But they haven't repeated the message clearly and unprompted on social media or on the podcasts and videos that Kennedy regularly appears in.
Kennedy also replaced vaccine experts on a panel advising the CDC with fringe researchers holding anti-vaccine views. And under his leadership, the CDC has laid off or forced out many vaccine specialists, including all of those in a group that partners with community organizations and pharmacies, the Immunization Services Division partnership branch.
At the same time, Kennedy has devoted resources to searching for potential harms from vaccines, including through an attempted clinical trial considered unnecessary and unethical by medical societies and the WHO.
To regain measles elimination status, the current U.S. outbreaks must end — then, future outbreaks must stop spreading within a year, said Paul Rota, a microbiologist and former CDC official. With outbreaks expanding in several states, he said, that moment isn't on the horizon.
"Bigger fires create more embers, and any one of those embers can seed another fire," he said.
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