The report of two measles deaths in Lancaster County, Pennsylvania, is already mired in controversy. Since the deaths were first reported on Tuesday, a local county coroner has said he does not consider measles to be the cause of one of the deaths, a newborn diagnosed with a ruptured spleen and evidence of measles infection. The Pennsylvania health secretary stands by the initial report that both deaths are related to measles.
But regardless of what we else we find out about the Pennsylvania situation, we’re in the middle of the worst measles outbreak the United States has experienced in 35 years. We have lost our path and are headed for more cases, more suffering, more deaths and enormous financial costs.
In addition to Pennsylvania, new cases have been reported over the past two weeks in Ohio, California, Washington, Oregon, Wisconsin and New York.
Our last large measles epidemic lasted from 1989 until 1991, with more than 55,000 cases and at least 132 deaths. By the end of the decade, endemic measles was officially eliminated from the U.S. — a status we will soon lose. Between 2000 and 2024, there were total of 4,485 cases. Since January 2025, there have been more than 5,000 confirmed cases.
Throughout that increase, Health and Human Services Secretary Robert F. Kennedy Jr. has reacted with denial. This week, he suggested that the deaths announced in Pennsylvania “may even have been altogether fabricated” by Gov. Josh Shapiro or his staff. Kennedy has been a leading anti-vaccine advocate for 20 years, since the publication of his article “Deadly Immunity” jointly in Rolling Stone and Salon. Both publications later retracted his error-ridden article. In 2021 the Center for Countering Digital Hate named Kennedy one of the “Disinformation Dozen,” a collection of leaders it said were responsible for the majority of anti-vaccine misinformation circulating on social media.
Kennedy has made regular appearances in communities ripe to distrust vaccines, including Samoa after a scare over the measles-mumps-rubella shot there decreased vaccination rates and led to an epidemic in 2019. Although he testified at his Senate hearing that the trip was unrelated to vaccines, documents published by The Guardian and The Associated Press show that an investigation of the MMR vaccine there was key to his visit. Months later, a measles outbreak in Samoa killed 83 people, primarily children.
In 2021, while still leading the anti-vaccine organization Children’s Health Defense, Kennedy spoke in Lancaster, Pennsylvania, and said that “the cure for measles is chicken soup and vitamin A.” Lancaster, with a large Amish and Mennonite population, is currently the epicenter of Pennsylvania’s large measles outbreak and is the location of the reported deaths.
On Aug. 10 of this year, Kennedy stood by Donald Trump as the president signed an executive order that included a call for the separation of the current MMR vaccine into three individual shots. During the press conference, Trump said “there could be a possibility they are quite lethal,” referring to the combined vaccine as he cast doubt on the vaccine’s safety. Although Dr. Mehmet Oz countered that statement days later, noting that the MMR is “not a lethal vaccine,” Kennedy himself has not defended its safety. (He has occasionally confirmed that it is effective.)
A recent analysis found that a 1% decrease in the vaccination rate per year could result in 17,000 cases, 4,085 hospitalizations and 36 measles deaths annually.
It is in this environment that our current measles epidemic is growing. In addition to Pennsylvania, new cases have been reported over the past two weeks in Ohio, California, Washington, Oregon, Wisconsin and New York. While Kennedy told CNN that the U.S. is “doing better at handling [measles] than any country in the world,” the data does not bear that out.
Since the start of the Covid-19 pandemic, uptake of the MMR vaccine has declined in kindergarteners, who are old enough to have been fully vaccinated (with two MMR doses). Although the decline since 2020 is relatively small — 92.4% are vaccinated currently, down from 95% in 2019 — it represents approximately 90,000 additional unvaccinated children each year, or almost half a million more since the start of the pandemic. Because measles is so easily transmitted, vaccination rates need to stay above 95% to prevent outbreaks.
Vaccine uptake is also not equal among states. Eighteen had rates below 90%, while only 10 had rates of 95% or higher. Drilling down to individual cities or school districts shows that particular areas may have rates far lower than a state’s average. Those with the lowest rates are at greatest risk of epidemics.
A reason for reduced uptake is the increased availability of vaccine exemptions, which have increased on par with the decrease in vaccine uptake. Twenty-four states have a vaccine exemption rate of 5% or greater, meaning that even if every eligible child without an exemption receives their vaccination, a 95% overall rate still cannot be reached.
All this leaves us increasingly vulnerable to the growth of measles outbreaks — in both size and frequency — and increased challenges in responding to them.
A recent analysis found that a 1% decrease in the vaccination rate per year — leading to a national vaccination rate of 87% by 2030 — could result in 17,000 cases, 4,085 hospitalizations and 36 measles deaths annually. There’s also the specter of a condition called subacute sclerosing panencephalitis, or SSPE, a delayed effect of measles that can cause neurological impairment and certain death years after a child appears to recover. Although SSPE is a rare condition overall, among infants its incidence is similar to the overall measles fatality rate, about 1 in 600 cases.
A multipronged campaign is necessary to address vaccine hesitancy and misinformation, increase community engagement, and meet people where they are regarding vaccine questions.
Beyond the human suffering, the financial cost would also be enormous: an estimated $1.5 billion in 2030 alone. Much of that would fall on public health systems that are already chronically underfunded. Morale among public health workers is already low, thanks to years of targeted harassment and lack of support from leaders like Kennedy. Trying to do more on a shoestring budget at some point will not be not tenable.
Will this be our “new normal”? Or can we reverse this?
The challenge is much greater now than it was 30 years ago. The 1989-91 epidemic stemmed from two issues. First, a small percentage of vaccinated individuals do not respond well to the first MMR dose. To solve this, in 1990 the U.S. added a second MMR dose at kindergarten. Second, some young children lacked access to the shot, even when their parents wanted to have them vaccinated. Allocations for more vaccine clinics helped to get toddlers their first dose. After the outbreak, the Vaccines for Children program was created to help low-income parents access vaccines. Combined, these changes increased vaccination rates and stopped the virus from regularly circulating in the country.
Today, issues with vaccine access remain, but the larger problem is vaccine refusal. Vaccine dosing is a scientific challenge and vaccine access a policy problem. But vaccine refusal is a much bigger obstacle, made even harder by a growing political divide in vaccine acceptance. A multipronged campaign is necessary to address vaccine hesitancy and misinformation, increase community engagement and meet people where they are regarding vaccine questions. But it won’t succeed when the head of our country’s health program is determined to undermine every move.
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