In early 2025, as measles began to spread across West Texas, Katherine Wells knew she needed money.
Although the outbreak was concentrated in Gaines County, a community an hour away, Wells, who heads the Lubbock Public Health Department, needed more staff to respond to numerous exposures at local pediatricians’ offices, urgent care centers, restaurants and daycares.
“We were really relying on a staff that doesn’t work on the hour, because I can work them 80 hours if I have to, which is horrible,” Wells said. In emergency planning meetings with the Texas Department of State Health Services, she advocated for about $100,000 to hire temporary workers to help her exhausted staff.
“I was wondering: Can I just have some money so that if I need a few hours of work from a retired school nurse that we’ve worked with before, I can just pay her? Wells said.
The answer, she said, was consistently “no.” The state sent some travel nurses from other areas to help, but without additional funding.
To prevent a measles outbreak from getting out of control, public health workers must act immediately, contacting anyone exposed to the virus as quickly as possible, determining their vaccination status or health risk, and then trying to convince them to get vaccinated or stay home for three weeks in quarantine.
Wells has mobilized at least half of its staff to work on the outbreak response in addition to their other daily duties.
What is the real cost of a measles epidemic?Wells could not estimate how much it cost the Lubbock Health Department to contain the virus before the outbreak, which began in a mostly unvaccinated Mennonite community in late January last year, ended months later.
Since 2019, more than two-thirds of counties and jurisdictions have reported notable declines in vaccination ratesan NBC News/Stanford University investigation found. Among states that track MMR rates, more than half of their counties – 67% – are below the level needed to stop a measles outbreak.
An alarming new report calculates the price the United States will pay if these rates continue to fall.
If measles vaccination rates continue to decline by just 1% per year over the next five years, the cost to the United States could reach $1.5 billion per year, according to a new report from the Yale School of Public Health.
Armed with existing county-level vaccination coverage data, Yale researchers used mathematical models to calculate projected increases in measles cases, hospitalizations, and associated medical and societal costs.
According to their projections, $41.1 million would be needed each year to cover patients’ basic medical needs, including health insurance, and $947 million for public health response efforts such as surveillance and contact tracing. According to the report, lost labor productivity could reach $510.4 million each year.
Dr. Dave Chokshi, president of Common Health Coalition, a nonpartisan, nonprofit public health group that partnered with Yale on the project, said a measles outbreak reverberates throughout all parts of the “health ecosystem.”
The human consequences of measles outbreaks “are important for us to address very clearly,” said Chokshi, who previously served as New York City’s health commissioner. “But we also wanted to make clear that there are economic consequences, including employees absorbing lost work, public health departments being overstretched to respond, and health systems straining to shoulder the burden of emergency response.”
Measles was declared eliminated in the United States in 2000. Since then, outbreaks here and there have generally been stopped quickly. But falling vaccination rates have increased the risk of mass outbreaks and now threaten the country’s measles-eliminated status.
In late January 2025, as President Donald Trump took his second oath of office, measles cases began to spread in West Texas. Under his presidency, following the advice of Health Secretary Robert F. Kennedy Jr., the administration did not strongly support vaccines as a way to end such outbreaks.
Instead, messages about childhood vaccination have focused on “personal choice” rather than public health necessity.
During the first two months of 2026, there were more than 1,000 confirmed cases of measlesalmost half of the 2,281 in all of 2025. Ninety-four percent of those infected were unvaccinated.
According to a recent analysis from the Johns Hopkins Bloomberg School of Public Health, the initial financial cost of a measles outbreak to a community is approximately $244,480. That’s the money local and state public health departments can expect to pay for resources such as vaccination clinics and staffing until the outbreak ends, said study author Bryan Patenaude, an associate professor of health economics.
“We know the ingredients needed to deal with a measles outbreak, how many cases end up becoming serious and requiring care, because they need to be very well traced and documented,” Patenaude said.
The report, published in October on medRxiva site that publishes research before it is peer-reviewed, has tracked measles outbreaks in 18 states since 2004 (not including 2,025 cases in Texas, Utah and Arizona).
In addition to the initial cost, each additional case of measles costs an average of $16,000 per person for contact tracing, medical costs and quarantine monitoring. Five cases of measles could cost $324,480, while an outbreak of 50 cases could cost $1 million, according to the Johns Hopkins report.
In 2019, Clark County, Washington, experienced an outbreak of 72 cases of measles. Health officials spent hours making sure people complied with quarantines.
“We have brought in personnel from the state, the CDC, and even other jurisdictions as far away as Idaho, to assist us with case investigation and contact tracing,” said Dr. Alan Melnick, Clark County Public Health Director. The team contacted those quarantined daily. Ultimately, 87% of subsequent measles cases occurred among people who were quarantined, Melnick said.
An evaluation found that productivity losses from the relatively small outbreak in Clark County climbed to more than $1 million.
Measles vaccine is free in the United States
“The public should be aware of the importance of vaccines,” Melnick said, “because they save a lot of money in addition to saving lives.”
As a former California lawmaker, pediatrician Dr. Richard Pan helped strengthen the state’s vaccine requirements following a 2015 measles outbreak linked to Disneyland. “People need to recognize that these outbreaks come at a huge cost,” he said. “This cost, by the way, is borne by American families. »
South Carolina is struggling to contain the nation’s largest outbreak in more than a generation. Spartanburg County has been on alert since the fall, with at least 1,000 cases and possible exposures at fast food restaurants, stores, medical clinics and a government office.
A mobile health unit in Spartanburg, South Carolina.Patrick Martin / NBC NewsThe South Carolina Department of Public Health would not disclose how much contact tracing, mobile vaccination clinics and increased staffing cost.
A department official said the Centers for Disease Control and Prevention approved a request to redirect several hundred thousand dollars previously allocated to emergencies.
“Additionally, South Carolina requested and received $100,000 from the CDC to combat vaccine-preventable diseases,” Louis Eubank, deputy incident commander for the South Carolina Department of Public Health, said in a statement to NBC News. “South Carolina and the CDC continue to discuss additional funding needs and resource support.”
A senior official at the U.S. Department of Health and Human Services said the CDC sent $8.5 million to seven areas of the country with measles outbreaks over the past year, but declined to specify where or give additional details.
“Amounts were awarded based on requests from the state or local health agency and the availability of funding at the CDC,” the person said.
As South Carolina’s outbreak spread to North Carolina, Dr. David Wohl, a global health and infectious disease specialist at the University of North Carolina at Chapel Hill, worked to prevent an increase beyond the 23 already confirmed cases.
“There are so many people working on this in my health system,” Wohl said. “I can’t tell you how many calls, how many hours, how overwhelmed people are.”
Intangible and indirect costsThe potential economic burden of measles outbreaks is easy to calculate. The personal cost of having children unprotected from the world’s most contagious virus is impossible to measure.
Hundreds of people infected with measles over the past year — more than 1 in 10 people, according to the CDC — have been hospitalized with dangerously high fevers, pneumonia, difficulty breathing and dehydration.
Mothers and fathers have spent countless blurry hours at their child’s bedside. Most have recovered. Some suffer the long-term consequences of encephalitis – inflammation of the brain that can lead to seizures, blindness, deafness and learning disabilities.
Rarely, measles can hide in the body for a decade before reappearing, attacking the brain and nervous system. The condition, called subacute sclerosing panencephalitisis almost always fatal.
In Texas, two little girls aged 6 and 8 died of measles much earlier, a few weeks after their diagnosis.
While the economic consequences of measles outbreaks are real, the human impact cannot be ignored, Chokshi said. “Behind every number is a child battling a devastating illness, or a family dealing with an unexpected hospitalization and, in the worst circumstances, death or a long-term consequence of a preventable illness. »
