In 2000, the CDC declared that measles had been eliminated from the United States, thanks to a widely available two-dose regimen of a compound vaccine for measles, mumps, and rubella. This means the measle virus is not spreading within the country and new cases are only found when someone contracts it abroad and brings it back into the country. In 2016, the Pan-American Health Organization (PAHO) declared that measles was the fifth disease to be eliminated from the entire North and South American continents. Rubella was also eliminated, and in 2015, Brazil was the last country in the region to experience a case of endemic measles (PAHO, 2025).

It looked like a highly contagious disease that had been killing people for over a thousand years had been suppressed by two doses of a cheap, easily administered vaccine. Fallout from a 1998 hoax that falsely claimed a connection between autism and vaccines appeared to have been contained.

But over the years, as measles became rarer, vaccine skepticism has led to outbreaks in the United States. An outbreak at Disneyland (2014-15) occurred amidst a trend of nonmedical vaccine exemptions and spread to seven states, Canada, and Mexico (Doll, Corriera, 2021).

In 2019, twenty-two outbreaks across 17 states hit under-immunized, close-knit communities especially hard, accounting for 85% of the cases. Over 1,200 people in the U.S. developed measles that year, and one death was documented (Patel, et al., 2019). Vaccine skepticism accelerated during and after the COVID-19 pandemic, as hostility toward government-mandated health measures proliferated.

2.1 Arguments For the Measles Vaccine

The measles vaccine is one of the most successful public health campaigns of the last half century. It has effectively eradicated measles in the U.S., is cost-effective and easy to administer, and, when a high enough percentage of the population is vaccinated, creates herd immunity.

2.1.1 Effectiveness

Prior to 1963, when the MMR vaccine against measles, mumps and rubella was approved, there were about 500 measles deaths a year in the U.S., mostly among children under five. By the 1970s, the incidence of the disease had dropped by about 90%. The single-shot regimen conferred 93% immunity to measles. By 1981, all 50 states had school mandates that students must be vaccinated.

In 1989, researchers learned that a second dose of the MMR vaccine raised immunity to 97%. Because the virus has not mutated, the readily available vaccine remains effective. Most people who receive this vaccine are protected for life from measles and rubella, though immunity to mumps may fade over time. Today, children up to 12 years of age can get an MMRV vaccine, which also confers immunity to varicella, or chickenpox.

2.1.2 Simplicity

Measles vaccines are widely available, easily administered, and currently covered under most health insurance and private plans. Income eligible children can receive free vaccines through the CDC’s Vaccines for Children program. This program was started after a three-year measles epidemic (1989-1991) caused a suspected 166 deaths in the U.S., mostly among preschool-aged children whose families could not afford vaccines.

2.1.3 Minimal Cost

All Health Insurance Marketplace plans and most other private insurance plans cover certain vaccines, including MMR, without charging a copay or coinsurance when the vaccines are provided by an in-network provider. Under the Affordable Care Act, insurance plans that cover children allow parents to add or keep adult children on their health insurance policy until they turn 26 years old. As of 2023, most adults with coverage from Medicaid and CHIP (Children’s Health Insurance Program) are guaranteed coverage of all vaccines recommended by the Advisory Committee on Immunization Practice at no cost to them (CDC, 2024a).

Without insurance, or under some plans with high deductibles, an MMR vaccine costs between $100-150. Providers working with UNICEF, the CDC, or public health departments offer free or low-cost vaccinations. Low-income, uninsured, and Native American or Alaskan Native peoples are eligible for these programs.

2.1.4 Herd Immunity

Herd immunity, also called community immunity, occurs when enough people in a population are vaccinated against a disease or have antibodies from surviving the disease, thus interrupting the chain of infection. This means the virus cannot travel as easily from person to person and everyone in the community is less likely to become infected.

The Spread of Infection

The spread of infection can be described as a chain with six links:

• Pathogens or infectious agents
• The reservoir (the normal location of the pathogen)
• A portal of exit from the reservoir
• A method of transmission
• A portal of entry into a host
• A susceptible host

Infection control measures are designed to break the links and thereby keep the infection from spreading.

Epidemiologists refer to the “herd immunity threshold” for a given virus as the percentage of the population that must be immune to ensure that introduction of the disease will not cause an outbreak. Herd immunity is usually discussed in the context of vaccination. For example, if 90% of the population (the herd) has received a chickenpox vaccine, the remaining 10% (often including people who cannot become vaccinated, such as babies and the immunocompromised) will be protected from the introduction of a single person with chickenpox.

Measles is one of the most contagious diseases in the world. It can be transmitted as early as four days before a rash erupts and up to four days after the onset of the rash. Because it is so transmissible, the level of vaccination that’s required to maintain herd immunity is very high.

To reach herd immunity for measles, at least 95% of the population must be vaccinated. Some researchers estimate that in 2021, up to 20% of children in the U.S. had missed at least one measles vaccine, more than at any point over the past two decades (Pandey and Galvani, 2023).

2.1.5 Worldwide Epidemics

Worldwide, concern about measles is growing. In 2022, the CDC called for “urgent global action,” saying that since 2016, ten countries that had previously eliminated the illness were seeing outbreaks. At the height of the COVID-19 pandemic in 2021, close to 61 million measles vaccines were postponed or missed in 18 countries, placing nearly 40 million children worldwide at risk. That year, there were an estimated 9 million cases and 128,000 deaths from measles worldwide (UN News, 2022).

In 2023, twenty-two million of the world’s children missed their first dose of the vaccine. Cases rose to 10.3 million, with an estimated 107,500 deaths (WHO, 2024).

War, displacement, and poverty hinder the access that children have to measles vaccinations. In the U.S., much of the hesitancy is found in tight-knit communities where mistrust of vaccines is a social norm and there are high numbers of non-medical exemptions to vaccines (Novilla, et, 2023).

The Measles and Rubella Partnership is a global effort to deliver vaccines worldwide. Founded in 2012, it has saved more than 56 million lives. Between 2000 and 2021, the yearly numbers of measles deaths dropped by 83%. The Measles and Rubella Partnership and its partners have launched another global initiative, Immunization Agenda 2030, which aims to save another 50 million lives by providing access to essential vaccines by the end of 2030 (WHO, 2023).

Unfortunately, progress in global measles vaccinations has stalled, with first-dose coverage yet to recover from pre-pandemic levels. Sustained investments to strengthen primary health care, improvements in routine immunizations, and timely, high-quality immunization campaigns can effectively address these important issues (M&RP, 2024).

Ten countries, led by Nigeria, the Democratic Republic of Congo, and India, account for more than half the children in the world without a measles vaccination. The majority of unvaccinated children live in countries that are politically and economically unstable, in conflict, and subject to humanitarian crises and protracted emergencies. The countries with the most measles zero-dose children often have a high birth rate and weak healthcare systems (M&RP, 2024).

2.1.6 Simplified Delivery

Because the current delivery of the measles vaccine is via injection, it requires administration by skilled personnel. Vaccines must be kept both sterile and cold. This makes it a challenge to store, transport, and deliver them, especially in developing countries that have unstable electricity and refrigeration.

Once a vaccine vial is opened and the powdered vaccine is mixed with a diluent, the vial and its vaccine must be used within six hours. Often vaccinators at sparsely populated clinics are reluctant to open a new vial when there are not enough children present to use up all the vaccine. Sometimes they ask parents to bring them back another time, which doesn’t always happen in places where traveling to a clinic is a day-long undertaking.

Failing to adhere to a strict protocol can be disastrous. For example, when vaccines are stored improperly or needles are reused, recipients can go into anaphylactic shock or be infected with bloodborne pathogens*. This reduces trust in vaccine programs.

*Bloodborne pathogens: infectious organisms in blood and other body fluids that can cause chronic and life-threatening disease in humans. Measles is not a bloodborne pathogen.

New microneedle, or microarray patches (MAPs) are a source of much optimism among immunization advocates. These are small adhesive patches that insert micro-projections of vaccine into the body when they are applied to the skin. MAPs are less cumbersome (and less frightening, especially for small children) and do not require cold storage. They can be administered by community volunteers who have not undergone extensive medical training (Goodson and Rota, 2022).

2.1.7 Alarming Costs of Non-Vaccination

Measles outbreaks are expensive. In 2019, Clark County, in Washington State, reported 72 confirmed cases of measles, which cost nearly $50,000 per case for treatment. Vaccination rates in Clark County were lower than the state and national averages. Only 81% of 1–5-year-olds had received their first dose, and only 78% of 6–18-year-olds had received both doses of the vaccine. Eighty-six percent of the infected patients were unvaccinated (Pike et al., 2021).

Public health costs include the need to trace contacts, test suspected cases, establish quarantine, and compensate healthcare workers for overtime. And, as has been made all too clear by the COVID-19 pandemic, allocating every available resource to a crisis means that other health programs are de-prioritized and public health infrastructure is weakened.

Did You Know. . .

One of the unique aspects of measles is that it causes immune amnesia, wiping out the immune system’s memory of other illnesses. This means the body becomes more vulnerable to other pathogens after recovering from measles. This can occur because the measles virus is able to invade immune system cells in addition to cells with the respiratory system.

2.2 Responding to Vaccine Resistance

There are many reasons given by people who are skeptical of or hostile to vaccines. Some believe there is a connection with autism. Others have religious concerns, while some argue that mandatory vaccine programs are a threat to individual freedom. Many people distrust western medicine or fear that vaccines pose a threat to their health.

Let’s examine each of these arguments and evaluate them in terms of the common good.

2.2.1 Hoax of Connection with Autism

Vaccine misinformation can be traced to a 1998 article in The Lancet by a team led by Andrew Wakefield, who claimed that heavy metals in vaccines caused autism and Crohn’s disease. In 2011, a series of articles in The British Medical Journal by journalist Brian Deer found that Wakefield had falsified the medical data of all 12 children included in his “study.” Wakefield was also being paid by the attorney for an anti-vaccine activist group to further a lawsuit against a vaccine manufacturer.

Andrew Wakefield’s article in The Lancet was retracted, and Britain’s General Medical Council found him guilty of serious professional misconduct and for subjecting the developmentally disabled children in his study to unnecessary invasive medical procedures, including ileocolonoscopies, lumbar punctures, and other investigations, most of which had to be done under sedation. Wakefield and his fellow authors were stripped of their registration, meaning they could no longer practice medicine (Lindsay, 2021).

The fallout from Wakefield’s fraudulent research lingers. According to a 2023 survey by the Annenberg Public Policy Center, up to 30% of American adults either believe that the MMR vaccine causes autism or do not know if the claim is false (Rozansky, 2024). A recent review of published literature found that, “Fear of autism was the most cited reason for MMR vaccine hesitancy…clustered in middle to high income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information” (Novilla, et al., 2023).

Dr. Paul Offitt, a pediatrician and virologist who serves as director of the Center for Vaccine Education at Children’s Hospital of Philadelphia, has written extensively about the need to counter misinformation about vaccines. He worries that the upsurge in MMR vaccine hesitancy will lead to lower overall immunization rates, which he predicts will lead to a resurgence in other easily preventable diseases as well.

2.2.2 Against Religious Values

One researcher has classified religious opposition to vaccines into five categories: (1) a worldview clash, in which vaccines do not make sense as a health intervention; (2) divine will, which represents a form of passive fatalism; (3) immorality, which considers some vaccines unethical because of their production or effect; (4) impurity, pointing to ingredients that will defile the body; and (5) conspiracy, in which a vaccine plot is targeting a religious group (Trangerud, 2023).

Objection to vaccines arises from a variety of religious beliefs among diverse groups including Protestants, Catholics, Jewish groups, Muslims, Christians, Amish, Hindus and Sikhs. A major barrier among Muslims involves the use of non-halal ingredients like gelatin derived from pigs to stabilize live vaccine. A similar concern may arise for Hindus, who believe that cows are sacred, about the use of bovine ingredients in vaccines. A study in Guinea found that 46% of Muslims and 80% of religious leaders believed that vaccines are inappropriate during Ramadan, because nothing should enter the body during the fasting period.

Members of some religious groups, including Muslims, Protestants, Catholics and Jews, also believe that vaccines interfere with “divine will” regarding protection from illness. Amish and Catholic leaders have raised objections about the use of cells from aborted fetuses in vaccines (Violet, et al., 2022).

Some studies have found that one particular variety of religious belief is a powerful predictor of vaccine hesitancy, at least regarding the COVID-19 vaccine: that of Christian nationalism, defined as “a U.S. cultural ideology that wants civic life to be permeated by their particular form of nationalist Christianity” (Corcoran, et al., 2021).

Sociologists Andrew Whitehead and Samuel Perry estimate that close to a quarter of the American population “strongly embrace Christian nationalism,” a demographic they claim is much more likely than others to abstain from vaccination. This trait, they believe, predicts skepticism about doctors and pharmaceutical companies, as well as a greater faith in conspiracies, individualism, and hierarchical thinking (Whitehead and Perry, 2020).

People are prepared to fight for what they perceive to be their religious rights. Title VII of the Civil Rights Acts requires employers to accommodate an employee’s sincerely held religious beliefs and practices, as long as the accommodation does not create an undue burden for the business. In 2022, during the COVID-19 pandemic, complaints about religious discrimination filed with the Equal Employment Opportunity Commission were six times higher than they were the previous year (Mello and Parmet, 2023).

2.2.3 Threat to Individual Freedom

The debate between individual freedoms and protection of society has grown more heated in recent years. It is estimated that 90% of people exposed to the measles virus who are not vaccinated will be infected—and the majority of these are very young children. 

The chaos of the COVID-19 response, including shuttered schools and businesses, hotly debated mask mandates, and a rapidly developed vaccine, led to further mistrust. People already frightened by a deadly novel virus were forced to make a decision about a new vaccine amid changing and conflicting information. Anxiety and paranoia likely played a role as people based their decisions on whether they were more worried about the virus or the safety of the vaccine.

2.2.4 Mistrust of Western Medicine

Though measles vaccination rates have been declining for some time, the COVID-19 pandemic exposed the long-standing mistrust that some communities have for the western medical establishment. Some of this mistrust is based in conspiracy theories or a preference for non-expert advice. Some folk beliefs include faith in a strong-minded individual’s ability to cultivate a natural immune system that doesn’t need to be propped up with modern medicine.

However, it is a fact that medical authorities have not always followed the Hippocratic oath to do no harm. Instances of health professionals abusing their position of trust abound. Forced sterilizations, based on the now recognized junk science of eugenics, continued into the 1970s. Most of the victims of what may now be considered a crime were poor people and people of color, or people with unaddressed mental health issues.

And the fears of parents whose children suffer from mental and emotional disabilities do not exist in a vacuum. During the Cold War, children in institutions were subjected to experiments, including vaccine trials, that are now illegal. In 1972, a reporter uncovered abusive, squalid conditions at the Willowbrook State School on Staten Island. Disabled children were used to develop a vaccine for hepatitis, partly under the rationale that they would get the disease anyway, in conditions that then-Senator Robert F. Kennedy described as "less comfortable and cheerful than the cages in which we put animals in a zoo" (Rosenbaum, 2020).

The measles vaccine was also developed after testing it on disabled children both at Willowbrook State School and Fernald School, another institution. There, Dr. John Enders, leader of the team at Boston Children’s Hospital that began the work, made sure the children’s parents understood the trials and consented to them, and that the children were examined every day. And the vaccine worked. Though Maurice Hilleman, a top Merck scientist who worked on fully attenuating the vaccine, described it as “toxic as hell,” the children in the study were fully protected when an outbreak struck Fernald (Haelle, 2025).

2.2.5 Fear of Negative Effects on the Body

The MMR vaccine is a combination vaccine formulated with live attenuated (weakened) viruses, making it a harmless, less-virulent version of the infectious agents it targets. Though it is ordinarily inadvisable to vaccinate pregnant women, they may be vaccinated during an outbreak, since doctors believe the benefits outweigh the risk of disease to both the mother and her fetus. The MMR vaccine is safe during breastfeeding (Bailey, et al., 2024).

Like anything introduced into the body, there are potential side effects. When a foreign agent, or antigen, is introduced into the body, surveillance cells, known as dendritic cells, recognize it as foreign and communicate with specialized white blood cells, known as macrophages and neutrophils, to attack. B-Cells signal which cells are to be attacked and create specialized antibodies within the blood that carry memories of the attack.

The body responds with a general inflammatory response called vasodilation to help move killer cells more quickly to the offending pathogen. The clinical manifestations of heat and swelling come from vasodilation. Vasodilation pushes on nerve endings, causing pain. The side effects of vaccines reflect this natural immune response and indicate the body is responding correctly. When an arm or leg muscle hurts from the injection site, it is a demonstration of the vasodilation stage.

Developing immunity through memory cells takes several days. These memory cells remain in our system for years, but can degenerate over time, which is why a booster vaccine may be needed. Babies and young children don’t yet have the memory cells, which is why they seem to get ill so often. Their bodies haven’t responded to the plethora of pathogens yet, so their immune systems are immature.

Vaccines are a way of helping the body quickly develop protective antibodies against diseases. Inactivated vaccines, through an injection or oral liquid, introduce the shell or dead pieces of a pathogen. The body recognizes it as an enemy and quickly goes into action through the creation of antibodies. Live vaccines are synthetically altered real pathogens that initiate a strong response but cannot cause the actual disease.

Side effects from vaccines are real but generally not serious. There is a small risk that children under the age of 7 will have a febrile seizure within 6-14 days of receiving the MMR vaccine. This happens in about one in 3,000 to 4,000 children. Febrile seizures following MMR vaccination are rare and are not associated with any long-term effects.

Another rare side effect is immune thrombocytopenic purpura (ITP), a disorder that decreases the body's ability to stop bleeding. It can happen after both natural measles infection as well as after receiving the MMR vaccine. However, it is usually not life threatening. Treatment may include blood transfusion and medications. The risk of ITP has been shown to be increased in the six weeks following an MMR vaccination, with one study estimating 1 case per 40,000 vaccinated children.

A comparison of effects from the vaccine versus the actual measles disease is shown on the table below. Figures are based on a projection of 10,000,000 children; that is, if that number were in the study, these would be the results based on actual scientific evidence.