What Losing Measles Elimination Status Means and Costs
By Molly Cavanaugh, February 2026
On January 20th, in response to the idea that the US could lose its measles elimination status, the deputy director of the Center for Disease Control and Prevention, Ralph Abraham, was quoted as saying, “it’s just the cost of doing business with our borders being somewhat porous for global and international travel (1). This article explores what losing elimination status means to Americans as far as potential illness and financial cost.
What does losing elimination status mean?
To gain elimination status, a country must have a year of no continuous virus outbreaks. The US first made elimination status in the year 2000. World-wide deaths from measles have dropped 88% since 2000 (2). After years of relative stability, measles is on the rise in the United States with 2,240 cases in 2025, up 3,555.5% in just two years (3). While it has not been confirmed, there is a possibility that we have already lost our measles elimination status (4). The answer to this will depend on if different outbreaks are linked together. For example, if someone from Texas went to Florida and got one person sick and started an outbreak, this would continue to keep the virus passing from person to person. And if this happens for a year, we will lose our elimination status.
Will elimination status change if we stopped requiring the measles vaccine?
The head of the Advisory Committee on Immunization Practices said on January 23rd, that while he was concerned about children dying from diseases like measles and polio, vaccinations should not be mandatory. He elaborated, claiming that “If there is no choice, then informed consent is an illusion. Without consent it is medical battery” (5). Many adults in the US agree with this. A study by Harvard T.H. Chan School of Public Health and the de Beaumont Foundation reported that 21% of US adults are against mandatory vaccines for diseases like measles or polio (6). Another study found that 19% of adults surveyed thought vaccines were not tested well enough to be known to be safe or that the children’s vaccine schedule is safe (7). With 19% of Americans thinking children’s vaccines are unsafe and 21% thinking we should remove vaccine mandates, it leads to the conclusion that around 20% of people in the US would not vaccinate their children for measles. Different viruses spread person to person at different rates; measles is the most contagious disease known to man (8). Simply breathing the same air as someone sick with measles can result in infection. And the virus can live up to 2 hours on surfaces, meaning you would never even have to see someone to get infected by them.
Measles requires a 95% vaccination rate for a population to stay measles free (9). To keep our elimination status, this number is important. The US rate of vaccination during 2025 was 92.5%, already below the limit, which is why we are seeing increasing measles outbreaks. 3.6 % of children were not vaccinated during this time due to medical exceptions; there will always be medical reasons why people cannot get vaccines. In addition, 3.9% of people in the US do not get vaccinated due to religious or personal beliefs (10 , 11 , 12). It is reasonable to conclude that the 3.9% of people who do not get vaccinated due to religious or personal belief are part of the approximately 20% stated above. If we then assume that all these people would not vaccinate against measles if the country dropped mandatory measles vaccines, the overall vaccination rate in the US could drop to arouond 76.4%. If 1 in 4 children do not get vaccinated against measles, measles outbreaks would be expected to spread across the United States to every community. Since infants under 6 months of age cannot be vaccinated for measles, these most defenseless members of our society would be most vulnerable to bad outcomes from measles infections (13). In addition, other people do not have a choice medically and cannot be vaccinated, leaving them vulnerable as well.
How much would making the measles vaccine mandatory cost us?
The spread of measles has both financial and health consequences. Almost all health insurance plans include the measles vaccine for free and there are many organizations like Vaccines for Children Program which provide measles vaccinations for people who are uninsured or cannot afford it (14, 15, 16), There is the additional cost of time taken to bring the child to the doctor or pharmacy. On the other hand, getting measles is far more expensive, for both parents and the government. Assuming that the infected person only has a mild case without long term impacts, the person will lose 4 days of work because anyone infected with measles must isolate themselves for 4 days after the rash appears (17). Unfortunately, by the time a person develops a rash they could have been contagious for 4 days, meaning the infected person could have spread the virus unknowingly to people who did not have had the chance to get vaccinated or cannot get vaccinated as discussed above.
Many cases of measles are not mild. One in five unvaccinated people who get infected with measles will be hospitalized and 1 to 3 of every 1,000 children will die (18). If a child survives the infection, they are still not out of danger. Measles can hurt a child’s immune system for years, making them more vulnerable to more diseases (19). It can also cause permanent brain damage, blindness, and hearing loss (20, 21, 22). Lastly, even decades later it can cause a devastating disease called SSPE which causes progressive brain damage and kills 1 in 600 children who contracted the virus as babies (23 ). In addition to the human cost of time, health, and life, measles is expensive to treat. From 2000-2025, the average cost of treating a single case of measles was $43,000 (24). In 2025, it is estimated that the US spent 90 million dollars fighting 1500 measles cases (25).
Dropping the mandatory vaccines against measles will undoubtedly result in more cases and more deaths, including those who were unable to be vaccinated due to age, medical conditions or religious beliefs. It will increase the cost and the resources needed to treat measles. While it is tempting to rely on other people for herd immunity – the idea that other people vaccinating means you are protected – this will not keep people safe in a country without measles elimination status. It can be hard to balance personal freedoms and protecting all members of society from disease. At the end of the day, mandatory vaccines save lives and without them, the United States will certainly lose its measles elimination status and spend millions of dollars fighting outbreaks.