The US is on the verge of losing its measles elimination status. Here's
why that matters
[January 21, 2026]
By DEVI SHASTRI
It’s been a year since a measles outbreak began in West Texas, and
international health authorities say they plan to meet in April to
determine if the U.S. has lost its measles-free designation.
Experts fear the vaccine-preventable virus has regained a foothold and
that the U.S. may soon follow Canada in losing the achievement of having
eliminated it.
The reevaluation is largely symbolic and hinges on whether a single
measles chain has spread uninterrupted within the U.S. for at least 12
months.
Public health scientists around the country are investigating whether
the now-ended Texas outbreak is linked to active ones in Utah, Arizona
and South Carolina. But doctors and scientists say the U.S. — and North
America overall — has a measles problem, regardless of the decision.
“It is really a question of semantics,” said Dr. Jonathan Temte, a
Wisconsin family physician who helped certify the U.S. was measles-free
in 2000. “The bottom line is the conditions are sufficient to allow this
many cases to occur. And that gets back to de-emphasizing a safe and
effective vaccine.”
Last year, the Centers for Disease Control and Prevention confirmed
2,242 measles cases across 44 states — the most since 1991 — and nearly
50 separate outbreaks.
The problem has been years in the making, as fewer kids get routine
vaccines due to parental waivers, health care access issues and rampant
disinformation. More recently, Trump administration health officials
including Health Secretary Robert F. Kennedy Jr. have questioned and
sown doubt about the established safety of vaccines at an unprecedented
level while also defunding local efforts to improve vaccination rates.
“The most important thing that we can do is to make sure the people who
aren’t vaccinated get vaccinated,” said Jennifer Nuzzo, director of
Brown University’s Pandemic Center. “We have not issued a clear enough
message about that.”
A Department of Health and Human Services spokesperson said Thursday
that Kennedy has emphasized vaccines as the best way to prevent measles,
adding that the CDC is responding to outbreaks and working to increase
vaccination rates.
In a briefing Tuesday, department officials said they don't yet have
evidence that a single chain of measles has spread for a year.
But CDC’s principal deputy director said he would consider the loss of
elimination status to be the “cost of doing business" globally.
“We have these communities that choose to be unvaccinated," said Dr.
Ralph Abraham. “That's their personal freedom.”
Measles finds the unvaccinated
There is little room for error in trying to stop measles. The virus is
one of the most contagious, infecting 9 out of every 10 unvaccinated
people exposed. Community-level protection takes a 95% vaccination rate.
The current rate nationally is 92.5%, according to CDC data, but many
communities fall far below that.
The patient in Texas’ first known case developed the telltale rash on
Jan. 20, 2025, according to state health department data.
From there, the outbreak exploded. Officially, 762 people fell ill, most
of them in rural Gaines County, and two children died. Many more got
sick and were never diagnosed: 182 potential measles cases among
children in Gaines County went unconfirmed in March 2025 alone, state
health officials said, a possible undercount of 44% in that county.
Such data gaps are common, though, making it especially hard to track
outbreaks. Many people living in communities where the virus is
spreading face barriers, including access to health care and distrust of
the government.
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Health department staff members enter the Andrews County Health
Department measles clinic carrying doses of the measles, mumps and
rubella vaccine, Tuesday, April 8, 2025, in Andrews, Texas. (AP
Photo/Annie Rice, File)
 Contact tracing so many cases is
also expensive, said behavioral scientist Noel Brewer, who chairs
the U.S. committee that will finalize the data for international
health officials. Research shows a single measles case can cost
public health departments tens of thousands of dollars.
CDC data on measles is still among the best worldwide, Brewer said,
but “the U.S. has changed its investment in public health, so we’re
less able to do the case tracking that we used to do.”
Genetic sequencing can fill some gaps.
Scientists have confirmed the same measles strain in Texas, New
Mexico, Utah, Arizona, South Carolina, Canada, Mexico and several
other North American countries, said Sebastian Oliel, a spokesperson
for the Pan American Health Organization, which plans to make the
final decision on U.S. measles elimination at an April 13 meeting.
But that's not always enough to say the outbreaks are connected.
Genetically, the measles virus doesn't change as often as, say, flu.
“Within an outbreak, everybody is going to look the same,” said
Justin Lessler, a University of North Carolina disease researcher.
The key question may then be how PAHO experts will navigate final
data gaps, said Dr. Andrew Pavia, a Utah physician and longtime CDC
consultant.
“My best guess is we will lose elimination status,” Pavia said. “The
case for this not being continuous transmission is tenuous, and I
think they are likely to err on the side of declaring it a loss of
elimination status.”
Oliel said when there is a case of unknown origin in a country with
ongoing local spread, “the most conservative approach is to consider
the case part of the existing national transmission.”
Mexico also up for review
PAHO will review Mexico's measles-free status alongside the U.S.,
Oliel said. The country's largest outbreak has roots in Texas. It
started when an 8-year-old boy from Chihuahua state got sick after
visiting family in Seminole, Texas. Since last February, 6,000
people have gotten sick in Mexico, and 21 have died in Chihuahua
state.
But under PAHO's definition of elimination, borders matter. If, for
example, the chain of measles that started in the U.S. spread to
Mexico and then returned to the U.S. anew, it would be considered a
new chain, experts said. Still, many experts call that standard
outdated.
What's clear is that measles found ample ground in the U.S. in 2025,
infiltrating schools and day cares, churches, hospital waiting rooms
and a detention center. New Mexico logged 100 cases and one adult
died. Kansas officials spent seven months trying to control an
outbreak that sickened nearly 90 people across 10 counties. Ohio
confirmed 40 cases. Montana, North Dakota and Wisconsin each had 36.
Now, more than 800 people have gotten sick across Utah, Arizona and
South Carolina since late summer, with no end in sight.
“2025 was the year of measles,” Brewer said. “Will 2026 be the year
of rising or falling measles cases? Does it get worse or does it get
better? No one knows the answer.”
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