As of March 11, 2025, Texas (223), New Mexico (33), and Vermont (1) have reported a combined 257 cases of measles, with the majority concentrated in Texas. This marks one of the most significant outbreaks in recent years. Public health officials are largely focusing on the role of unvaccinated individuals. But is this the full story?
Measles Doesn’t Just Appear—It Must Be Imported
The CDC has stated that measles was eliminated from the United States in 2000 thanks to widespread vaccination efforts. Since then, every case of measles in the U.S. has been the result of the virus being reintroduced. Measles, unlike other diseases, does not naturally occur in the U.S. It requires an external carrier to bring it in.
Since measles is no longer endemic to the U.S., every outbreak must begin with the virus being introduced from outside. The key question is: How is the virus entering the country, and what measures are in place to prevent its introduction?
To further illustrate the point, consider rinderpest, a viral disease that once plagued cattle populations worldwide. Scientists believe that measles actually evolved from rinderpest thousands of years ago, when a mutation allowed the virus to jump from livestock to humans. However, rinderpest was declared eradicated in 2011, making it the second virus in history (after smallpox) to be wiped out.
Why is this relevant? Because rinderpest was the original source of measles, and now that it’s gone, measles has no natural reservoir in the environment. Unlike some viruses that persist in wild animal populations (like rabies or influenza), measles cannot spontaneously reappear in the U.S. It has to be brought in by infected individuals—meaning every outbreak must have a source outside the country.
Measles continues to circulate in humans in regions with low vaccination rates, and every outbreak in the U.S. begins with the virus being imported.
The Herd Immunity Debate
Public health officials frequently state that 95% vaccination coverage is needed to maintain herd immunity and prevent the spread of diseases like measles. This figure is widely accepted by health agencies such as the CDC and the WHO. However, the situation is more complex than it might appear.
The issue isn’t just about domestic vaccination rates. If measles continues to be reintroduced through travelers from regions with low vaccination coverage, how many infected individuals would it take to cause an outbreak in a 95% vaccinated population?
While the CDC points to the 95% threshold for herd immunity, it’s unclear how many unvaccinated or infected individuals would need to enter a community before an outbreak occurs. Could it take just a few? Do we need hundreds of infected individuals? Without research into these critical questions, it’s difficult to understand exactly what drives the spread of the disease.
Is the Focus on the Unvaccinated Misplaced?
Whenever a measles outbreak occurs, media coverage overwhelmingly focuses on unvaccinated Americans as a contributing factor, often downplaying the role of how the virus was introduced in the first place. But if measles is no longer endemic to the U.S., then the unvaccinated aren’t the ones bringing it here—infected individuals from outside the country, and unvaccinated Americans bringing it back with them, are. The real issue is not that unvaccinated Americans are spreading measles, but that they are the ones at risk when the government fails to prevent the virus from being reintroduced in the first place.
Despite the U.S. maintaining a high vaccination rate—around 95% for measles—outbreaks continue to occur. This raises a fundamental question: Is the public focus on unvaccinated Americans an intentional distraction from the real issue—how measles is getting into the country in the first place?
One key distinction is that the government is responsible for securing the borders and ensuring that individuals entering the country are not carrying infectious diseases. It is not the responsibility of American citizens to ensure that measles does not enter the country—it is the responsibility of public health and immigration authorities to protect the population by screening travelers and migrants from countries with known measles outbreaks.
Even if the U.S. achieved a 100% vaccination rate, those who cannot be vaccinated due to health reasons—such as infants and the immunocompromised—would still be at risk if measles continues to be imported. This highlights the need for stronger measures to prevent the virus from entering the country, rather than relying solely on domestic vaccination coverage to contain outbreaks.
This leads to the next question: Should more attention be given to preventing the introduction of measles at the border and other points of entry, rather than focusing primarily on the vaccination choices of U.S. residents?
The Real Science Question
Rather than continuing the debate over vaccination rates, there may be a more pressing scientific question that has yet to be addressed:
What is the threshold of infected individuals that need to be introduced into a highly vaccinated population to trigger a measles outbreak?
It would be valuable for researchers to explore how the introduction of infected individuals from measles-endemic areas can cause an outbreak even in a population where 95% of people are vaccinated. How many carriers need to be introduced to overcome herd immunity? This data is essential for understanding how measles outbreaks occur and how they can be prevented in the future.
Until this question is addressed, it may be premature to place the blame entirely on those who choose not to vaccinate. Instead, the focus could shift toward better border control and screening measures to prevent the entry of infectious diseases.
Conclusion
As measles cases continue to rise in the U.S., the conversation should shift from simply debating vaccine mandates to a broader discussion about the introduction of measles from abroad. While vaccination remains a critical tool in preventing outbreaks, it’s clear that we must ask how many infected individuals can be introduced into a vaccinated population before an outbreak occurs.
Ultimately, preventing future measles outbreaks may depend less on domestic vaccination rates and more on how we address the source of the disease: travelers and migrants from regions where measles is still common.
Dave Soulia | FYIVT
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