Cases of measles are rising across the country and seem to be striking counties at random, but experts say there is one thing the public health system can do to turn the tide, and that’s to stem the post-pandemic vaccine lag and get parents to vaccinate their kids.

General vaccination rates, including measles vaccination, declined during the COVID-19 pandemic, as people had less access to health care and kids were unable to access in-school vaccine clinics.

That, combined with a new wave of vaccine skepticism and anti-vaccine sentiment has contributed to a wave of unvaccinated kids falling sick with the once-eradicated virus.

“It sort of boggles the mind as a pediatrician,” said Jesse Hackell, chair of the Committee on Practice and Ambulatory Medicine at the American Academy of Pediatrics. “I never want to go back to practicing medicine like it’s the 1950s.”

Measles is highly transmissible, but the measles vaccine is highly effective — and thanks to vaccination efforts, the U.S. was able to officially eradicate the disease in 2000. 

But that didn’t last.

Only 92 percent of U.S. adolescents have been vaccinated against measles, according to a 2023 Centers for Disease Control and Prevention report, and a 95 percent vaccination rate is considered enough to ward off future outbreaks or create herd immunity. 

No one child can import a case of measles if everyone else in the school is vaccinated. But if 5, 7 or 10 percent of students are not vaccinated, the disease can spread like wildfire, Hackell said.

“Unfortunately, we’re going to end up seeing some kids get very sick,” he said.

In the first months of 2024, the CDC reported a total of 35 cases in 15 jurisdictions, and that number is rising. 

And states aren’t reacting the way they once did. Florida Surgeon General Joseph Ladapo encouraged unvaccinated children not to miss school during the latest Broward County outbreak. 

Politicians and pediatricians have widely criticized this move, arguing it only motivates the anti-vaccine crowd and will lead to more virus spread.

“Sadly, Florida’s surgeon general stands in stark contrast to America’s proud legacy of bipartisan public health success,” Florida Democratic Rep. Debbie Wasserman Schultz said during a press conference in her home state earlier this week, during which she called on Ladapo to resign. “Ladapo instead politicizes public health and peddles risky ‘freedom of choice’ rhetoric that fuels vaccine hesitancy and downplays the public and personal health necessity for vaccination.”  

The politicization of routine vaccinations

The anti-vaccine movement was supercharged during the pandemic, according to American Public Health Association Executive Director Georges Benjamin, and the effects of this are playing out across the country.

All 50 states require routine vaccinations, including measles, for children to attend school. But parents can request exemptions for religious or medical reasons, and the number of exemptions is increasing, according to the CDC. 

Some states that didn’t have vaccine exemptions before the pandemic have now created some wiggle room in their policies to respond to anti-vaccine sentiment. 

For example, prior to the COVID-19 pandemic, Mississippi had one of the highest measles vaccination rates in the nation — with more than 99 percent of kids inoculated against the virus — because the state only allowed medical exceptions to routine vaccinations. 

But last year, Mississippi added a religious exemption for all vaccines, after a federal judge ruled in favor of a medical freedom group challenging the law. 

Now, more than 2,600 parents have requested religious vaccine exemptions for their kids, according to the Mississippi Department of Health.

“We know we’re certainly going to fall off a little bit,” said Greg Flynn, a Mississippi health department spokesperson of state vaccination rates. “Our concern is for the children that can’t be vaccinated for medical reasons being exposed to a disease that’s not being eradicated.”

While Mississippi has yet to see a case of measles during this current wave, Flynn said the department is concerned about the spread from Florida to nearby New Orleans.

But despite concerns about the spreading virus, experts warn that tightening vaccine requirements will only create more backlash because of how politicized vaccination has become.

“This is not a time that most states are gonna get more aggressive about tightening up any kind of mandate just because things are so polarized,” said Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials.

Missed opportunities

Before the pandemic, many kids received routine vaccinations, including measles, at back-to-school clinics. 

But those opportunities disappeared during the pandemic and people also fell behind on routine pediatrician appointments. So as parents play catch-up, many states have waived the once-strict vaccine requirements to give families time to get back to the doctors.

Unlike COVID-19, measles infects almost every unvaccinated person it comes into contact with. Also, unlike COVID-19, almost every person who receives the measles shot is protected from the disease for life.

“Measles was one of those diseases that you know, somebody walks through the room with measles, and you know, everybody’s unvaccinated; nine out of 10 people get it,” Benjamin said.

When an unvaccinated person comes in contact with measles, CDC guidance is to quarantine for 21 days — a time period that is not realistic for most children.

New York state saw a significant measles outbreak in 2019, pre-pandemic, that was isolated mainly to the Hasidic Jewish communities in Brooklyn. The New York  Department of Health quickly quarantined the community.

“This outbreak could get to be just as bad if we don’t know when we need to act,” Plescia said. “And now the political environment is obviously much different.”