A Step Back for U.S. Public Health: The U.S. Is Likely to Lose Its Measles Elimination Status
An expert commission convened by the Pan American Health Organization (PAHO) is reviewing whether the U.S. still meets the standard for measles elimination, a status the country had held since 2000. The U.S. initially achieved elimination through consistent application of public health interventions such as supporting surveillance and laboratory testing to help identify measles cases quickly, building response capabilities at local, state and, federal levels to investigate and contain outbreaks, and bolstering immunization programs, especially among school-age children. The results of these investments were clear: between 2000 and 2018 the U.S. averaged fewer than 150 measles cases per year, and just three measles deaths were reported between 2001 and 2018. At the time elimination was achieved, the national rate of measles (MMR) vaccination among school-age kids was over 95%, the target threshold for interrupting measles transmission and achieving herd immunity. After an outbreak year in 2019 with 1,274 cases (for which the U.S. nearly lost elimination status), through 2024, there were no more than several hundred measles cases per year until the recent epidemic began.
Things look quite different now. Through November 5, CDC has recorded 5,182 confirmed cases in 2026, already more than twice the total for all of 2025. There have been measles cases reported in 46 states and Washington D.C., this year, and there have been 43 measles outbreaks (meaning three or more related cases). Recently, Pennsylvania confirmed its sixth measles death this year, and New York and Wisconsin each reported a measles death for the first time in more than 30 years, all of which follow three measles deaths from last year. Continuing a years-long downward trend, the national MMR vaccination rate in school-age children reached a new low of 92.4% in the 2025-2026 school year, with 39 states reporting rates that fall below the 95% target threshold.
Over the course of the current epidemic, state and local public health departments have faced cuts in funding and support under the Trump administration. HHS Secretary Robert F. Kennedy, Jr. and other federal health officials have frequently downplayed the risks of measles while giving mixed messages about the importance of vaccination, and have also changed how the CDC tracks measles deaths, no longer officially accepting initial measles death reports from states. The public is generally supportive of MMR vaccination, with nine in ten parents saying it is important for children to be vaccinated against measles, but more adults are now exposed to false claims and myths about vaccines, including that MMR vaccines are linked to autism, and there remains a stark partisan divide in views about vaccine safety, especially since the COVID-19 pandemic.
After last year’s PAHO commission meeting, Canada became the first country in the region to lose its measles elimination status. That country saw a measles epidemic that began in October 2024 and has now lasted more than two years, sustained by multiple outbreaks across a wide geographic area and concentrated in communities with low vaccination rates. While there are clear parallels between Canada’s experience and the U.S. measles epidemic, Canada’s epidemic has slowed and was declared over in October 2026, while the U.S. continues to experience an acceleration.
The loss of measles elimination status would carry primarily symbolic weight, as the effect of rising cases and deaths is already clear. Still, it is a marker of how a combination of factors — COVID-19, increasing vaccine skepticism, and a growing partisan divide about vaccines — has been a step back for public health, and it is not clear when or if this trend will be reversed.