In 2021, a team of researchers published their tally of the economic costs imposed by a measles outbreak in Washington State spanning the first four months of 2019. There were 72 cases then, as opposed to 1001 confirmed cases so far in the current US outbreak, which is not losing momentum. The results are instructive.
The overall societal cost of the 2019 Clark County measles outbreak was approximately $3.4 million ($47,479 per case or $814 per contact). The majority of the costs (≈$2.3 million) were incurred by the public health response to the outbreak, followed by productivity losses (≈$1.0 million), and direct medical costs (≈$76,000).
(“Societal Costs of a Measles Outbreak,”
https://pmc.ncbi.nlm.nih.gov/articles/PMC9004490/)
The greatest expenditures were associated with the public health response, but the productivity losses associated with those 72 cases were also impressive, far outweighing direct medical costs. We are left to conclude that a less-than-effective public health response to measles will drive escalating economic costs, including substantial productivity losses. (If costly public health efforts are reduced and if leadership is bungled, cases multiply and productivity costs soar.) Because a measles infection weakens the human immune system, those productivity losses may persist long after acute cases are resolved.
(Images sourced from Shutterstock)
In our new book, The Fed and the Flu: Parsing Pandemic Economic Shocks (https://www.thefedandtheflu.com), we discuss how the history of humanity’s age-old war against infectious diseases reveals poor learning on the part of human beings. We point to failures of governance. We also point to successes (such as the polio vaccine). The book focuses on epidemics, pandemics, and plagues and their economic impacts in terms of money, inflation, asset prices, wages, etc. But a key mechanism determining the outcomes of epidemics and pandemics is what people choose to do or not to do.
Now we are experiencing a worldwide measles resurgence. It is spreading. It has its US origins in Texas among unvaccinated citizens. And we have a Secretary of Health and Human Services who avoids decisively promoting measles vaccination as the critical action that will make the difference between watching the nation’s outbreak grow and arresting and reversing it. That secretary has his own history of failures when it comes to measles and vaccines. He owns his past. And he owns his present actions or inactions.
Here’s a history lesson to consider.
Between June 1970 and January 1971, 633 cases of measles occurred in Texarkana, a city bisected by the Texas-Arkansas state line.
A total of 606 (95.7%) of the cases occurred in Texarkana (Bowie County), Tex, a community that had never had a measles vaccination campaign. The level of prior immunity, natural plus vaccine-induced, in the 11,185 children aged 1 to 9 years in Bowie County was estimated to be 57%. Only 27 cases occurred in Texarkana (Miller County), Ark, where more than 95% of the 6,016 children aged 1 to 9 years were immune. Nineteen of the 27 Arkansas patients had documented exposures in Texas.
Twenty-seven cases of measles occurred in previously vaccinated children. Six of these children had received vaccine with measles immune globulin prior to 1 year of age. Vaccine efficacy was calculated to be 95.9%.
(“Epidemic Measles in a Divided City,”
https://jamanetwork.com/journals/jama/article-abstract/343787)
Adam Ratner, writing for Live Science, drew these conclusions from the study:
What made Texarkana different is that State Line Avenue separated two jurisdictions with quite different approaches to measles vaccination. Texas had no requirement for measles vaccination prior to school entry and generally eschewed mass vaccination campaigns.
Fewer than 60% of 1- to 9-year-olds on the Texas side were immune to measles either through vaccination or prior illness. In contrast, Arkansas maintained a school mandate and had held mass immunization campaigns for preschool- and school-aged children in each of the two years prior to the outbreak. An estimated 95% of their 1- to 9-year-olds were immune.
The result was striking. A political division, not a physical one, determined who got measles and who didn’t. Of the 633 Texarkana measles cases, 606 (nearly 96% of the total) occurred in people who resided in the Texas portion of the city. This disparity in rates occurred despite significant contact between residents from the two sides. The messages were clear — vaccination had protected children who happened to reside on the Arkansas side of town, and community campaigns and school mandates were highly effective in preventing measles spread.
(“‘A political division, not a physical one, determined who got measles and who didn’t’: Lessons from Texarkana’s 1970 outbreak,”
https://www.livescience.com/health/viruses-infections-disease/a-political-division-not-a-physical-one-determined-who-got-measles-and-who-didnt-lessons-from-texarkanas-1970-outbreak)
The CDC’s measles update for Friday, May 9, 2025, reports that confirmed US measles cases now top 1000.
As of May 8, 2025, a total of 1,001 confirmed* measles cases were reported by 31 jurisdictions: Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, New Mexico, New York City, New York State, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia, and Washington.
There have been 14 outbreaks (defined as 3 or more related cases) reported in 2025, and 93% of confirmed cases (928 of 1,001) are outbreak-associated. For comparison, 16 outbreaks were reported during 2024 and 69% of cases (198 of 285) were outbreak-associated.
*NOTE: CDC is aware of probable measles cases being reported by jurisdictions. However, the data on this page only includes confirmed cases.
(“Measles Cases and Outbreaks,”
https://www.cdc.gov/measles/data-research/index.html)
The same CDC page maps these cases:
Here are ten key points to know about measles. The first five are covered by the American Medical Association in the first 3 minutes and 45 seconds of their April 30 update. (The American Medical Association updates are an excellent resource.)
- One in three US adults have encountered the false claim that the vaccine is more dangerous than infection.
- One in 5 people who fall ill with measles require hospitalization.
- At current measles vaccination levels, measles is likely to become endemic again.
- If measles vaccination rates drop by 10%, we’ll see 11.1 million cases over 25 years.
- If measles vaccination rates decline by 50%, we’ll see 51.2 million cases over 25 years.
- Measles “is so contagious that if one person has it, 9 out of 10 people of all ages around him or her will also become infected if they are not protected.”
- People who received their measles vaccines between 1963 and 1967 may need to be revaccinated. They may not have immunity.
- Measles causes immune system “amnesia”: Our immune systems forget their battle plans for defending against infections already encountered. Vaccination against measles does not have this effect; only a measles infection does.
- Besides a rash and potential pneumonia, measles can cause neurological issues, including brain damage, deafness, and blindness.
- “About 95% of a population needs to be immunized to prevent community transmission of measles, a virus that can linger in the air for up to two hours after an infected person breathes, coughs, or sneezes.”
Humanity once again stands at the crossroads: Will we learn what we need to know and act on it to reduce the human and economic costs imposed by a preventable infectious illness? Or will we opt for infections and their consequences?
(See also “Measles and US Public Health,” at the Kotok Report.)
Resources
“Epidemic Measles in a Divided City,”
https://jamanetwork.com/journals/jama/article-abstract/343787
“Societal Costs of a Measles Outbreak,”
https://pmc.ncbi.nlm.nih.gov/articles/PMC9004490/
“‘A political division, not a physical one, determined who got measles and who didn’t’: Lessons from Texarkana’s 1970 outbreak,”
https://www.livescience.com/health/viruses-infections-disease/a-political-division-not-a-physical-one-determined-who-got-measles-and-who-didnt-lessons-from-texarkanas-1970-outbreak
“Anti-Vaxxers Are Grifting Off the Measles Outbreak—and Claim a Bioweapon Caused It,”
https://www.wired.com/story/antivax-grift-measles-crisis-bioweapon/
“US Measles Cases Hit 935 as RFK Jr. Pushes Treatment Study,”
https://www.bloomberg.com/news/articles/2025-05-02/us-measles-cases-reach-935-as-rfk-jr-pushes-new-treatment-guide?sref=TG2o5EVv
“Anti-Vaxxers: The Dog That Caught the Car,”
https://open.substack.com/pub/pauloffit/p/anti-vaxxers-the-dog-that-caught?r=1hfyu&utm_campaign=post&utm_medium=email
“Vaccine expert worries child measles deaths are being ‘normalized,’”
https://www.npr.org/2025/04/14/1244690933/vaccine-expert-worries-child-measles-deaths-are-being-normalized
“Is measles spreading in Florida? Hard to know. State’s disease-tracking data no longer available,”
https://www.sun-sentinel.com/2025/05/09/is-measles-spreading-in-florida-hard-to-know-states-disease-tracking-data-no-longer-available/
“An Insider’s View of the Texas Measles Outbreak,”
https://www.npr.org/sections/shots-health-news/2025/05/09/nx-s1-5392323/an-insiders-view-of-the-texas-measles-outbreak
Ten Things to Know About Measles
AMA Update, April 30: “Measles misinformation, new long COVID-19 symptom studies, plus childhood antibiotics and gut health,”
https://www.youtube.com/watch?v=5Ziown8qlfA
“Scientists Find Measles Likely to Become Endemic in the US Over Next 20 Years,”
https://www.wired.com/story/scientists-say-measles-likely-to-become-endemic-in-us-polio-diphtheria-rubella/?_sp=f59a8e6d-ea98-40db-a52e-a2fc2327f457.1745515945563
“Measles is Highly Contagious Infographic,”
https://www.cdc.gov/measles/resources/contagious-infographic.html
“Measles is unlike other viruses: What to know about long-term complications,”
https://www.nbcnews.com/health/health-news/measles-immune-system-brain-swelling-long-term-rcna195918
“Measles can ravage the immune system and brain, causing long-term damage – a virologist explains,”
https://theconversation.com/measles-can-ravage-the-immune-system-and-brain-causing-long-term-damage-a-virologist-explains-252354
“Tariffs Have Stifled Trade, Yet Measles Is Spreading With Few Limits.
https://www.bloomberg.com/news/newsletters/2025-04-14/tariffs-have-stifled-trade-yet-measles-is-spreading-with-few-limits?sref=TG2o5EVv
