A national shame
The country's
status is being reconsidered at a meeting of a PAHO commission in Washington, DC, starting today
and lasting through Friday.
Countries that
have eliminated measles still have occasional outbreaks, often stemming from
international travel. In these rare instances, public health agencies can
intervene before the extremely contagious virus becomes endemic.
'A loss of
achievement'
"It's just
like popcorn: outbreak, outbreak, outbreak, outbreak. All over the
country," she said. "They grow in size, and then they shrink. And
then they move somewhere [else]."
More than 5,100
cases of measles have been reported by the Centers for Disease Control
and Prevention (CDC) in 2026, though it's conceivable that number could surpass
7,000 before the end of the year. In the year the nation eliminated measles,
the CDC reported just 85 cases.
So far, at least
eight people in the United States have died from measles in 2026, as well as
three last year. And for the first time in generations, congenital
measles—passed from an infected pregnant woman to her newborn—poses a serious
threat to public health.
In light of this growing crisis, PAHO will almost certainly deem measles to be endemic in the United States, several epidemiologists and infectious disease physicians told CIDRAP News. They all agreed the country could reverse course by increasing measles vaccination rates.
"It's a
symbolic loss," said Nuzzo. "It's a loss of standing. It's a loss of
stature. It's a loss of achievement."
Status might
hinge on genomic sequencing data
A country loses
measles elimination status if transmission is re-established and continues
uninterrupted for at least 12 months, according to PAHO's Measles and Rubella
Elimination Regional Monitoring and Re-Verification Commission (RVC).
RVC is an
independent technical body of infectious disease experts that reports directly
to PAHO. At its November 2025 meeting, RVC found that measles was again endemic
in Canada. At that same meeting, the United States' measles
status was classified as "sustained with major concerns," along with
that of Mexico, Honduras, and Venezuela.
"It's
just like popcorn: outbreak, outbreak, outbreak, outbreak. All over the
country.
The commission
considers several factors, including outbreak size and quality of disease
surveillance. But perhaps the most influential are viral genomic
sequencing data to reveal whether outbreaks within a geographic area are driven
by the same virus genotype and lineage.
Sequencing can't definitively show that cases are linked.
Still, if the data presented this week fail to find that the many measles
outbreaks plaguing the United States are genetically related, it's possible the
country will keep its elimination status.
Such an outcome
would be like getting out of a speeding ticket on a technicality, said Nuzzo,
since measles outbreaks are clearly becoming larger and more frequent.
Too much emphasis
on genomic data might be misplaced, agreed Michael T. Osterholm, PhD, MPH,
director of the University of Minnesota's Center for Infectious Disease
Research and Policy (CIDRAP), publisher of CIDRAP News.
"You get hit
by a semi at 60 miles an hour in an intersection, you pretty much know you've
had an accident," he said.
Endemic
measles a loss of credibility, global standing
RVC's meeting to
assess the status of measles in the United States and Mexico was initially
scheduled for mid-April but got pushed back to this week. The commission said it would rather conduct the review at its annual November meeting.
The postponement
raised some eyebrows. The RVC may not have wanted to meet until after the US
midterm elections, speculated Tom Frieden, MD, MPH, who led the CDC from 2009
to 2017.
"One could
hypothesize that they didn't want to annoy the administration before the
election. I don't know if that's true," said Frieden, who now runs Resolve
to Save Lives, a global health organization focused on epidemic
prevention.
Losing
elimination status isn't like losing a bond rating or receiving a criminal
penalty, explained Nuzzo. Rather, it indicates the country is less healthy than
it was 26 years ago, when it achieved elimination.
One could
hypothesize that they didn't want to annoy the administration before the
election.
Other countries
often look to the United States for technical assistance and guidance on
vaccines and vaccination strategies, said William Moss, MD, MPH, an infectious
disease epidemiologist at Johns Hopkins University.
"Loss of
measles elimination status in the US signals to the world that we are not up to
this task and may diminish their own aspirations to achieve and sustain measles
elimination," he said.
A Democratic
Congress might take measles more seriously
Democrats won big
in last week's midterm elections. Because the party tends to be a strong
proponent of public health funding, the United States losing measles
elimination status could spur a Democratically controlled Congress to invest
more in measles prevention, said Josh Michaud, PhD, MHS, of the health policy
research group KFF.
Donald
Trump, however, has two more years in office. His veto pen could strike down
bills that fund state and local measles prevention efforts. Or the
administration might decline to release money allocated through legislation, as
it has done with global health funding.
Loss of
measles elimination status in the US signals to the world that we are not up to
this task.
The loss of
elimination status might have little effect on the Trump administration, since
the president seems uninterested in replacing long-time vaccine skeptic Robert
F. Kennedy Jr. as secretary of the Department of Health and Human
Services.
Additionally,
Trump's history of devaluing multinational institutions like PAHO might mean
any announcement from the organization will be met with ambivalence, Michaud
speculated.
The path to
redemption is through vaccination
Measles is the
most contagious virus known to humans: If an infected person walks into a room
with 100 unvaccinated people, it's estimated that 90 will get the virus.
For this reason,
the virus is a bit of a canary in the coal mine for other infectious diseases,
warned Frieden, who expects that other vaccine-preventable illnesses,
like pertussis (whooping cough), will make comebacks.
It shows to
both our allies and our enemies that the United States is no longer able or
willing to protect itself.
That includes
mumps and rubella, vaccines for which are administered with measles in the
combination MMR shot. Last month, a mumps outbreak hit San Diego State
University's football team.
The resurgence of
measles also carries troubling implications for future pandemics, lab leaks,
and biological warfare.
"It shows to
both our allies and our enemies that the United States is no longer able or
willing to protect itself in a way that we once were," said Nuzzo.
There is hope for
the United States: Brazil lost its measles elimination status in 2019 but got
it back in 2024.
But for the
United States to regain measles elimination status, people will need to get
vaccinated.
Measles vaccine supplies are ample. The vaccine is safe. And two doses are 97% effective at preventing infection.