Stop Blaming The US For Measles

Public health officials are leaning into a "Blame America First" rhetorical strategy, implying doom and panic while ignoring the reality of the 2025 measles situation.

This is a bad year for measles in the US. I’ve been noticing more and more chatter around the measles situation in the US despite the fact that new cases have dropped substantially in the last several months. The reason is because the US recently surpassed a 30 year high in overall measles cases. That article is a pretty typical example of the kind of rhetoric we’ve been seeing around this auspicious milestone. It accurately notes:

1. measles cases are at a 30 year high

2. measles vaccination rates have been dropping

3. that is bad

These things are technically true but they aren’t telling a full story. The measles vaccination rates have not dropped so far that we should expect these results. The last time we had a higher measles count was in 1992, when MMR vaccination rates were at a mere 61-66%.

The latest rate (2023) was over 91.3%. This is down from an all-time high of 92.4% in 2020. Technically, that shows that vaccination rates are “dropping” but it clearly does not tell the whole story. I’m increasingly resentful of public health messaging that paints a picture of doom over a percentage drop in vaccination rates.

Let me say this as plainly as I can: I am extremely pro-measles vaccine. The success of the measles vaccine is why I am able to write this post about how the decline of measles vaccination isn’t as terrifying at is it made out to be. The reason we can decide not to panic is because the vaccine is incredibly effective and most of the country has a 90% vaccination rate.

But I also want to say that I’m annoyed with the unrealistic rhetoric of an administrative elite class. For all the good that someone like Scott Gottlieb has done, I believe he ultimately thinks that normal people are stupid and must be manipulated with proclamations of doom. I do not think normal people are stupid. I think we would all benefit from an representation of reality that will stand up when we observe the world around us.

You may have seen articles talking about how measles has been “eliminated” in the United States. This is true because the definition of the word “eliminated” means that measles no longer spreads in an uncontrolled manner in the United States. Almost all cases of measles are introduced from a foreign source. If the virus is lucky and we humans are unlucky, the measles virus will spread from the initial foreign introduction to an incubation environment with a very low vaccination rate. Within this community, it can infect, spread, and kill.

But what does a “very low vaccination rate” mean? This is something that I’ve been trying to figure out over the past few years. Whenever you see “red vs blue” debates of measles vaccination, this is your indication that the person who is fighting this battle is doing so in a state of deep ignorance. State MMR vaccination rates are not a red vs blue phenomena.

The reality is that state vaccination rates aren’t actually that helpful for determining what states will have measles outbreaks. This is because, while the target vaccination rate for stopping measles spread is 95%, the actual number is likely closer to 80%. Almost every state in the US ends up seeing measles cases in a scenario where the initial case was imported from overseas, then they detect one or two cases, often in the few people who have not yet had the MMR vaccination. Then, as they test more people, they find 3 or 4 more infected. Then everyone recovers and that is the end of it.

Very rarely does a measles introduction result in substantial spread within the United States. And, when it does (as it has this year in Texas), it is almost always within a community with very low vaccination rates. I’m not talking “Idaho” low (the lowest vaccination rate of any state with only 80% vaccinated). I’m talking “close-knit evangelical community whose participants prefer holistic medicine” levels of low, which is often lower than 50%. Or, if that proposed example offends you, we can talk about NYC Orthodox Jewish community levels of low vaccination. Or, if that example offends you, we can talk about Muslim Somali immigrants in Minnesota levels of low vaccination.

My point is that measles spread is much more common in tight-knit often religious communities with a lot of kids in which a significant subset of the community rejects the value of vaccination. If you are a normie with a normie kid following the normal vaccination schedule in a normie school you are such a low risk that it shouldn’t really even show up on your radar.

The greater concern in my mind is not the problem of low measles vaccination coverage in the United States, but among our immediate neighbors. In Ontario, the MMR vaccination rate among 7-year-olds is under 70%. As in the examples above, this rate seems to be particularly low “in specific communities”, whatever that is supposed to mean. This has resulted in the ongoing spread of measles such that Ontario’s measles infection rate is 40 times higher than the United States. Canada officially “eliminated” measles in 1998. But with vaccine rates as low as they are, it seems like Canada is at risk for losing that “elimination” status and becoming an international source for measles.

Similarly, Mexico is having a measles outbreak that is substantially worse than the US outbreak. Importantly, the Mexican outbreak has been the worst in the Chihuahua province (over 3,000 cases), which borders Texas and New Mexico.

This visualization is kind of terrible for reasons that I’ve noted on twitter but there are substantial measles outbreaks all along the US border.

Having our immediate neighbors as a source of measles is clearly bad for the United States because travel between these bordering countries is frequent. Our vaccine rates have dropped a bit, but they are not terribly low and that 1-2% dip in vaccination rates is certainly not the reason for our high measles count this year.

Yes, it is important to highlight the value of measles vaccination, which has been a wonderful boon to the world and has led to the elimination of measles in the US. But the vaccination story alone does not tell us why we are seeing these high rates of measles this year. This is also a story about international disease introductions and the role our neighbors play in our security.

We obviously cannot force Canadians or Mexicans to get vaccinated, but we do have vaccine requirements for visa and immigration entry. It may be worth ramping up that enforcement in a time with current measles rates are at a 30 year high.