Episode 13: Un-Vaccinated - the Global Measles Emergency

Today's episode is about the state of global measles outbreaks at least in so far as I can cover in one episode. For a deep dive into measles, including symptoms, transmission, pathogenesis, and exactly what's in the vaccine and how we know it's safe, check out my episode on measles.

Summary

In 2024, measles surged across Europe, Asia, and Africa in outbreaks so large and fast-moving that the World Health Organization called it a global emergency. But this crisis didn’t come out of nowhere. In this episode, we trace how a nearly eradicated virus made its comeback—from misinformation campaigns to missed vaccinations during COVID-19—and why the U.S. may not be as safe as we think. With a blend of history, virology, and public health insight, Un-vaccinated explores how measles returned, why it spreads so fast, and what we must do to stop it.

Listen here or scroll down to read full episode.

Full Episode

Imagine a map of the world, lit up not with the bright glow of progress, but with red warnings of an old enemy: measles. By May 2025, that map showed that 60 countries—across every region, from Africa to Asia to the Americas—had reported large and disruptive measles outbreaks. It’s a surge that health experts have been dreading, a testament to the fragile state of vaccine coverage in many communities.

The map in blues, is from WHO's most recent update on global measles and shows all measles outbreaks from last November to May 2025. Here's the report:

WHO_global-mr-update.pdf

Download PDF • 13.23MB

Now before we get into the details about the various 2025 measles outbreaks, let's make sure we're on the same page when it come to how we refer to different areas of the globe.

The World Health Organization (WHO) divides the world into six regions for organizational and administrative purposes. They are:

African Region (AFRO):

This region includes countries across the continent of Africa.

Region of the Americas (AMRO):

This region encompasses all countries in North, Central, and South America, as well as some Caribbean islands.

Eastern Mediterranean Region (EMRO):

This region includes countries in the Middle East, North Africa, and parts of Central Asia.

European Region (EURO):

This region includes most countries in Europe, as well as some countries in the Caucasus and parts of Russia.

South-East Asia Region (SEARO):

This region includes countries in South Asia, Southeast Asia, and some parts of East Asia.

Western Pacific Region (WPRO):

This region includes countries in the Pacific Ocean, East Asia, and some parts of Southeast Asia.

Global Outbreaks

According to the World Health Organization, there were an estimated 9 million cases of measles worldwide in 2024, resulting in 136,000 deaths. These numbers are tragic but, unfortunately, not surprising. The COVID-19 pandemic disrupted immunization campaigns across many countries, leaving millions of children without protection.

As of May 28, 2025, the U.S. CDC maintains a global Watch-Level 1, Practice Usual Precautions, Travel Health Notice, identifying measles outbreaks in too many countries to list so here's a screenshot:

Here are some current measles outbreak hotspots facing outbreaks due to gaps in routine immunization from either lack of resources, lack of peace, or lack of intelligence.

• Sub-Saharan Africa (AFRO): Countries like Ethiopia, Nigeria, and the Democratic Republic of the Congo have faced sustained outbreaks due to gaps in routine immunization.

• Eastern Mediterranean (EMRO): Morocco

• Eastern Europe (EURO): Ukraine and Romania have reported surges in cases amid conflict and health system strain.

• South Asia (SEARO): India and Pakistan have experienced periodic outbreaks in under-immunized communities.

• Western Pacific (WPRO): Papua New Guinea and the Philippines continue to report significant transmission.

• Americas (AMRO): The US, Canada, and Mexico among others

In Africa, the virus has become a relentless tide. Countries like Nigeria, the Democratic Republic of the Congo, and Ethiopia—already battling other health crises including cholera and Mpox—have seen thousands of children and adults infected. In places where health systems are stretched to the breaking point, measles finds easy targets: children whose immune systems are weakened by hunger, and families who live hours from the nearest clinic.

Now let’s dive deeper into the outbreaks in Ethiopia, Nigeria, and Morocco.

In Ethiopia, the outbreak has become a major challenge in both urban and rural areas. By mid-October of last year, nearly 30,000 confirmed measles cases had been reported, a staggering number that underscored the scale of the crisis.

Consider the story of a young mother in Ethiopia, who walked for hours carrying her feverish child to the nearest health center—only to find that measles had already claimed the lives of three other children in her village.

In the northern Tigray region, the situation grew especially dire in early January 2025, when four suspected cases emerged at Suhul Hospital in Shire. The International Medical Corps immediately stepped in, working hand-in-hand with local health offices and the Tigray Regional Health Bureau to trace infections and facilitate treatment.

The outbreak was officially declared on March 17, and in response, surge teams and mobile health and nutrition units were deployed to hard-hit districts like Asgede. These teams not only re-established the Rapid Response Team to coordinate efforts but also trained healthcare workers, strengthened routine immunization, and reached over 21,000 children under five with critical vaccinations. Community leaders, religious figures, and educators were engaged to help combat misinformation and encourage parents to vaccinate their children. As of early May, 305 cases and four deaths had been reported in northwestern Tigray, with active surveillance and community engagement ongoing to curb the virus’s spread.

Meanwhile, in Nigeria, measles has persisted as a serious threat since 2023, especially in the northern states where vaccination rates are perilously low. Health workers there have been battling not only the virus itself but also deep-seated misinformation and logistical barriers that make vaccination campaigns a daunting challenge.

NigeriaMeasles2025.pdf

Download PDF • 958KB

In March 2025 alone, Nigeria reported more than 1,000 suspected cases, with seven states—including Akwa Ibom, Ogun, and Katsina—accounting for nearly half of them. While no deaths were recorded among the confirmed cases that month, the first quarter of the year saw nearly 4,700 suspected infections and about 1,400 confirmed cases. Over 70% of those confirmed infections were in children who had never received a single dose of the measles vaccine—children whose lives could have been protected by this simple shot. By March’s end, 356 local government areas across 37 states were grappling with active outbreaks, but there were some bright spots, too: 15 LGAs across 12 states managed to end their outbreaks, proving that with coordinated efforts, progress is possible.

Further northwest in Morocco, the story began quietly in late 2023, when a handful of cases emerged in the Souss Massa region. But by early 2024, the virus had spread across the entire country. Between October 2023 and April 2025, more than 25,000 suspected cases were reported nationwide, with over 13,700 confirmed and 184 tragic deaths. The virus showed no mercy, affecting children and adults alike. Nearly 70% of infections were in people under 18, and almost half had never been vaccinated.

In response, the Ministry of Health and Social Protection joined forces with other sectors to activate the National Center for Public Health Emergency Operations. Urgent catch-up vaccination campaigns were launched, while surveillance, case management, and risk communication and community engagement efforts were strengthened to control the outbreak and protect communities at risk.

Yet even here, amidst the heartbreak, there are signs of hope. Morocco reached its national peak in late January 2025, and for ten weeks since then, the number of cases has steadily declined. Genomic sequencing has revealed that the B3 genotype, a strain linked to outbreaks across Africa, has been the primary culprit—yet a single case of genotype D8 serves as a reminder that measles knows no borders.

These three outbreaks—across Ethiopia, Nigeria, and Morocco—tell a shared story of how measles takes root in communities where vaccine coverage falters. But they also show the power of local health workers, international partnerships, and community leaders who are working tirelessly to close immunity gaps and protect children. As these countries continue to fight back against measles, the message is clear: vaccines work, and they save lives. In the fight against this preventable disease, every dose counts.

In Asia, the virus has stalked crowded cities and remote villages alike. In India, where routine immunization efforts have faltered, tens of thousands of children have fallen ill, and the virus has spilled across borders into Pakistan and Afghanistan, places already struggling with political instability and conflict. To address persistent immunization inequities in conflict-affected areas, global and national policy and planning must prioritize the specific service delivery needs of these populations, while also increasing investment in health system support and fostering partnerships with civil society.

Across East Asia and the Pacific, vaccine-preventable diseases are surging back with a vengeance—and measles is leading this dangerous comeback. In the first months of 2025, countries like Cambodia, Mongolia, the Philippines, and Viet Nam have seen a sharp rise in measles cases compared to the same period last year. This spike signals that far too many children are missing out on lifesaving vaccines.

Since January, Viet Nam alone has recorded nearly 82,000 suspected measles cases across all 63 provinces and cities. Mongolia has confirmed more than 2,600 cases, while Cambodia has reported over 2,100 cases so far this year. In the Philippines, the toll has reached more than 2,000 measles cases as of mid-May. These figures mark the highest levels of measles in the region since 2020, according to the World Health Organization.

“The alarming rise in measles cases is a wake-up call,” said Dr. Saia Ma’u Piukala, WHO’s Regional Director for the Western Pacific. “It shows us exactly which children are being left behind—those in underserved communities who haven’t received even a single dose of vaccine. These children are missed by routine immunization and vaccination campaigns, and that gap puts everyone at risk.”

Meanwhile, Papua New Guinea has declared a national public health emergency after confirming a polio outbreak. Although the country was declared polio-free 25 years ago, low routine immunization coverage has left many children vulnerable to this paralyzing disease. The risk of polio spreading within the country—and beyond its borders—is real.

These outbreaks underscore a bigger problem: the systems meant to protect children are failing. Measles can cause pneumonia, brain damage, and lifelong disability. Polio can leave children with permanent paralysis. And the youngest children, especially those in poverty, conflict zones, or remote areas, are most at risk and least likely to recover.

“We’re not just seeing a spike in disease—we’re seeing a signal that the systems meant to protect children are faltering,” said June Kunugi, UNICEF’s Regional Director for East Asia and the Pacific. “Measles and polio are highly infectious, and children are paying the price for gaps in coverage, delayed care, and misinformation. No child should suffer or die from diseases we know how to prevent.”

Even in wealthier countries, the story is not so different. In the UK, the EU, Australia, and in the region of the Americas, Canada, Mexico, and the US are once again facing outbreaks.

The UK

The UK in western Europe has been one of the countries hardest hit by the measles resurgence. In 2024 there were 2,911 laboratory confirmed measles cases in England, the highest number of cases recorded annually, since 2012. This was initially driven by an outbreak in Birmingham but was soon overtaken by a large outbreak in London, with small clusters in other regions.

Vaccination rates have slipped below 90% for the two-dose MMR vaccine, leaving many communities vulnerable. This is a stark reversal from 2017, when the WHO recognized the UK as measles-free after recording only 284 cases that year.

Since 1 January 2025, there have been 320 laboratory confirmed measles cases reported in England. 33% (102 of 320) of these cases have been in London, 17% (53 of 320) in the South West, and 16% (50 of 320) in East of England. 71 out of 152 upper tier local authorities (UTLAs) have reported at least one confirmed case with symptom onset since January 2025, with the highest numbers reported in Bristol (42 of 320, 13%), Leeds (32 of 320, 10%) and Essex (22 of 320, 7%). 2025 data for Northern Ireland, and Scotland show that they have some cases but not in the triple digits so far this year. I couldn't find data for measles cases in Wales. Even on their public health measles surveillance page, there's nothing for 2025 so if you have insight into where to get their data let me know! The WHO report shows the UK as a whole so that doesn't help either.

And not in the UK, but really close, it looks like Ireland isn't doing too bad with regard to measles. According to the Health Protection Surveillance Centre (HPSC) website, measles increased last year but they don't have a concerning number of measles cases in 2025 that I could find. They seem to be watching for norovirus, bird flu, COVID-19 and Meningococcal disease.

Looks like that's not the case in the EU. In 2024, a total of 35,212 measles cases were reported across the EU/EEA, a ten-fold increase from the 3,973 cases in 2023.

EU_MEAS-AER-2024-Report.pdf

Download PDF • 1.21MB

So far in 2025, measles has been on the rise across Europe, with around 4,500 cases reported in the European Union according to the European Centre for Disease Prevention and Control. Romania has been hardest hit, accounting for more than 3,200 of these cases as of late March and recording four tragic deaths—so far the only measles-related fatalities in the EU this year.

In France, 345 cases have been reported, fueled in part by a sharp increase in imported infections. At least 41 of these cases have been linked to travelers returning from Morocco, up from 26 such cases last year. Even though France has a high national vaccination rate—93% of people were fully vaccinated in 2023—pockets of unvaccinated people have created fertile ground for the virus to spread.

Italy, too, has seen a worrying number of cases—227 so far this year, second only to Romania in the EU. With a vaccination rate of 85% in 2023, Italy has struggled to maintain herd immunity. Years of anti-vaccine sentiment, conflicting health guidance, and an overstretched medical system have kept the country vulnerable to ongoing outbreaks.

In the Netherlands, 204 cases were reported in the first three months of 2025. More than two dozen infections were linked to travelers returning from Morocco and Romania, and the virus has found footholds in local clusters—particularly in primary schools and childcare centers. Most of the cases have been among children under ten. Despite the outbreaks, Dutch health authorities say there is no national-level crisis. Still, with a vaccination rate of just 81%—the lowest in the EU outside of Romania and Cyprus—the Netherlands remains at risk.

Even Spain, with a high national vaccination rate of 92%, is seeing outbreaks. By early spring, Spain had already reported over 200 measles infections, including several cases brought in from outside the country.

And, of course, Ukraine has seen a troubling rise in measles cases, largely due to the ongoing invasion that has disrupted health services. Many families have been displaced, making it difficult to ensure children receive routine vaccinations. Health authorities in Ukraine are working with humanitarian organizations to offer mobile vaccination clinics in areas affected by fighting, though these efforts are constantly hampered by security concerns.

Across Europe, these outbreaks are a sobering reminder that measles remains a global threat. Even in countries where overall vaccination rates are high, gaps in coverage and international travel can quickly reignite the spread of this highly contagious virus. It’s another stark warning that maintaining high vaccination coverage everywhere—and closing those immunity gaps—is essential to keeping measles from taking hold.

So now let's take a look down under. Australia officially eliminated measles in March 2014, yet this year has seen the disease return in several states and territories. From January 1 to May 27, 2025, there have been 77 confirmed measles cases across the country. The majority of these cases have been in young adults aged 20 to 49, many of whom were either unvaccinated or uncertain about their immunization status, and most of these infections have been linked to international travel. The Australian Health Protection Committee's (AHPC) web page on measles is one of the best I've seen. it's concise, accurate, and gives good information on who should get vaccinated.

The Region of the Americas

And then there's the region of the Americas. Like in other regions, it began quietly, almost unnoticed—a few scattered cases in January, a ripple that seemed small. But by mid-April 2025, that ripple had become a tidal wave of disease sweeping across the region. In just over three months, more than 2300 people across six countries had fallen ill with measles, and three had died. It was an 11-fold increase compared to the previous year—a chilling reminder of how quickly measles can surge when immunity falters.

In Argentina, the story started with a single child who had returned from abroad. This child, unvaccinated, developed a rash in Buenos Aires at the end of January. From that one case, measles spread like wildfire in the close-knit neighborhoods of the capital and Buenos Aires Province. By April, there were 21 confirmed cases, some of them children too young to be vaccinated, others adults who had never received their shots. Two children ended up in the hospital with pneumonia, fighting for breath in a country that had once thought itself safe from this disease.

Genetic analysis has shown that twelve of the confirmed cases involve the B3 genotype, which is common in measles outbreaks worldwide. Notably, one imported case has been traced to genotype D8, the genotype I mentioned earlier found in a Morocco case, that is also associated with travel to Thailand.

As of late April, the regional risk for measles remains high, while the global risk is considered moderate. Interestingly, the Argentine Republic is not listed in the U.S. CDC’s current Global Measles Travel Advisory, as you can see in the image further up, which identified countries with active outbreaks. This discrepancy underscores the fast-changing landscape of measles transmission and the need for constant vigilance.

In Belize, a country that hadn’t seen measles since 1991, two teenage boys brought the virus home after traveling to a religious gathering in Chihuahua, Mexico. Their journey, meant to strengthen their faith, instead ended with fever, cough, and the telltale rash of measles. Health workers scrambled to track down their close contacts and vaccinate those at risk, racing against the clock to stop the virus from taking root in Belize’s vulnerable communities.

Brazil’s story was a patchwork—five confirmed cases in four cities, from the bustling streets of Rio de Janeiro to the quiet corners of the Federal District and São Paulo. Two babies in Rio de Janeiro were struck hardest, both unvaccinated, both hospitalized as the virus spread in the air around them. In São Paulo, an adult with no known travel history became infected, raising fears of hidden chains of transmission.

But it was in Canada that the outbreak took on the scale of an epidemic. A total of 2,515 measles cases have been reported by 9 jurisdictions, as of May 17, 2025—more cases than Canada has seen in decades. The spark was lit months earlier at a large gathering in New Brunswick, where an imported case spread the virus among unvaccinated communities. From there, the outbreak rippled across the country, from the icy prairies of Saskatchewan to the crowded streets of Quebec. Most of the cases were in children and adults who had never received a single dose of the MMR vaccine—communities where mistrust of vaccines had quietly smoldered for years. The hardest hit is Ontario with 1848 out of the 2515 cases so far.

In Mexico, the numbers are also sobering. More than 400 people have been sickened, with Chihuahua at the epicenter. The first known case was an unvaccinated child returning from abroad, and from there, measles tore through families and neighborhoods. One child died, a tragic loss in a country that has fought so hard to keep measles at bay. The majority of those infected were adults between 25 and 44—young parents, workers, breadwinners—many of whom had never received their shots.

And then there was the United States. By end of May, 1088 cases had been confirmed across 32 states (33 jurisdictions), from Alaska to Florida. Two children died in Texas, victims of a disease that’s almost entirely preventable. In New Mexico and Oklahoma, outbreaks linked to undervaccinated communities accounted for most of the cases and there's been one death in New Mexico, both states first infected via the Texas outbreak. Nearly every child who has ended up in the hospital in the US had never been vaccinated, or no one could say if they had. It’s a sobering number, and behind it lie the stories of children and families who have paid the price for lapses in vaccination.

The outbreak has touched nearly every corner of the country, from the snow-covered mountains of Montana to the humid streets of Florida. Fourteen separate outbreaks have been reported so far this year—and together they account for more than 90% of all cases. What’s striking is that these outbreaks aren’t confined to any one region. They’ve swept across big cities and rural communities alike, a reminder that measles respects no borders.

The US map in blues here is a screenshot of CDC's interactive map. The more blue, the more measles. Click on the link in this sentence then scroll down to check out the CDCs interactive version with measles cases for each state. And here are links to state health departments providing real-time updates: Texas, New Mexico, Ohio, Kansas, Indiana, Michigan, Illinois, North Dakota, Arkansas, and Montana,

In the US, among those infected, children under five make up nearly a third of the cases—311 little ones, some too young for their second dose of the MMR vaccine, others whose parents chose not to vaccinate at all. In this group, the disease has taken an especially harsh toll: almost one in four has ended up in the hospital, battling pneumonia or struggling to breathe as the virus courses through their tiny bodies.

School-aged children—kids between five and nineteen—make up the largest share of infections, 37% of all cases. Many of these children are old enough to have received both recommended doses of the MMR vaccine, but the data tell a chilling truth: 96% of those infected were either unvaccinated or their vaccination status was unknown. Only a tiny fraction—less than 3%—had received even one or two doses of the vaccine.

Adults haven’t been spared, either. Over 330 adults have fallen ill, some of them infected after decades of assuming they were safe. In the older age group, hospitalizations are less frequent, but still, 25 adults have been admitted with severe complications. Three people in the US have died—lives lost to a disease that, in many cases, could have been prevented with a simple vaccine.

Texas has the worst of it. The largest outbreak began in Gaines County, Texas, in January 2025, a place with a close-knit, undervaccinated Mennonite community. So far this outbreak accounts for most of the cases reported. Health officials are grappling with the serious outbreak, primarily centered in the western part of the state. Which is not surprising considering Andrew Wakefield's presence in TX when he fled the UK in disgrace. He still spends a lot of time and effort spreading his antivax propaganda in the Lone Star state along with his buddy and founder of the antivax Children's Health Defense, RFKjr.

Since late January, the Texas Department of State Health Services has confirmed 742 cases, an increase of 4 cases since the last update in late May 30.

So far, 94 people have been hospitalized throughout the course of this outbreak and two school-aged children have died from the disease. Both were unvaccinated and had no underlying health conditions. RFKjr congratulated their parents at their funeral for not vaccinating their kids.

Given how contagious measles is, health officials warn that more cases are likely in the outbreak area and nearby communities. As of now, measles transmission continues in Cochran, Dawson, Gaines, Lamar, Lubbock, Terry, and Yoakum counties. The Texas Department of State Health Services is collaborating closely with local health departments to investigate and contain the outbreak.

The source of the west Texas outbreak remains unknown and it has spilled over to other states and into Mexico. New Mexico has had 81 cases so far with one death in an unvaccinated adult. They are working hard to get people vaccinated. Thirty-seven confirmed cases in Kansas are suspected to be linked to this outbreak. In addition, an expanding outbreak in Chihuahua, Mexico*** began in late February after a Mexican resident became infected after reported travel to Gaines County, Texas. All specimens obtained from measles patients in Kansas, New Mexico, and Texas were genotype D8, 196 (94%) of which had identical N-450 sequences; 12 differed by one nucleotide, which can be expected in prolonged outbreaks. In other words, they were all the result of a single source in Texas.

Behind these US numbers are stories of heartbreak and resilience. In Texas, a baby girl under one year old spent days in a pediatric ICU, hooked up to oxygen after contracting measles in a community with low vaccination rates. In Ohio, a teenager developed encephalitis, a rare but devastating complication, after attending a gathering where the virus spread unchecked. In a small town in Montana, a 7-year-old who had never been vaccinated became the first measles case in the county in decades—he recovered, but not before infecting his baby brother, who was too young to be vaccinated and spent a week in the hospital.

These stories are a stark reminder that measles is more than a rash and a fever. It can literally steal breath, cause brain swelling, and take lives—especially among the most vulnerable.

So what should you do if you find yourself in the middle of, or traveling to, an area with an outbreak?

Well...you're here so you're halfway there! The next step, if you haven't already done it, is get yourself and your kids vaccinated. The MMR vaccine has been use safely for 50 years. Nobody, not even one person has ever died from the MMR vaccine. Not one. But we've lost 3 people in America to measles and it's only beginning of June. Measles kills more children, worldwide, than any other vaccine-preventable disease. So get them vaccinated. If you want to know exactly what is in the MMR vaccine and how it was developed, check out my measles episode.

And also pay attention to notices on the news about measles exposures. If you find that you were exposed, isolate yourself at home for 10-14 days until you know you don't have it. If you end up getting sick, let your doctor know and stay home! Don't spread it!

So that's what you can do.

Lots of others are working hard to help despite the antivax admin's insistence on letting it burn through. Public health workers and pediatricians are working around the clock to contain these outbreaks. They’re knocking on doors, holding emergency vaccination clinics, and sitting down with worried parents to answer questions and dispel myths. Their message is simple, but powerful: Vaccines save lives. But the antivax message of the idiot in charge of HHS is louder as he tells parents good job for letting your kid die rather than get the vaccine. All why he and his kids are safely vaccinated.

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And now, because the head of HHS is pushing antivax bullshit, we have to do this: It's time for my WTF-RFK! the segment in which I debunk his lies. So today we'll address the lies he tells about measles.

And they are legion. Gotta start somewhere so how about his claim that measles outbreaks like the ones in TX and Ontario happen “every year”

• Well that's not true is it. We know this because we have the data for the last 60 years. As per his own CDC: "Before 1963, approximately 500,000 cases and 500 measles deaths were reported annually, with epidemic cycles every 2 to 3 years. In the years following licensure of vaccine in 1963, the incidence of measles decreased by more than 95%, and 2- to 3-year epidemic cycles no longer occurred. In fact, we were so good at not having measles outbreaks that it was declared eliminated in 2000. But since then, RFKjr and his buddy Andrew Wakefield have pushed their antivax agenda further and further, running the antivax movement together and grifting off parents. Listen to my Andrew Wakefield episode. You will be horrified and you will understand how we got here.

He falsely claims that the MMR vaccine causes autism or other developmental disorders.

• This claim has been thoroughly debunked by extensive research; the original Wakefield study that linked the MMR vaccine to autism was retracted, and no credible evidence supports this connection. See my episode on vaccines and autism for all the data on that!

He has also lied that the measles vaccine causes “vaccine injury” at a scale not acknowledged by health authorities. In an interview with Sean Hannity that aired on Fox News on March 11: "There are adverse events from the vaccine. It does cause deaths every year. It causes -- all the illnesses that measles itself causes, encephalitis and blindness, etc. And so people ought to be able to make that choice for themselves."

• Yeah that's ridiculous bullshit. There are no deaths from MMR vaccine. Certainly not "deaths every year". I love how he spews this stuff with zero citations. He provides no sources. This is a red flag my friends. The truth? The measles vaccine is extremely safe! In fact, it carries fewer serious risks than even Tylenol—which is widely considered safe and commonly used. If you’re interested, check out my episode on the Vaccine Court for more on that.

• The bottom line? The risks from the MMR vaccine are far lower than the risks of measles itself. Yes, rare side effects can occur, but they’re extremely uncommon. The risk is one in a million. Risk of adverse events from Tylenol? Over 2000 in a million. The exact numbers are in my Vaccine Court episode. Most reactions are mild, like a sore arm, fever, mild rash, or brief joint pain in older teens or adults without rubella immunity. Febrile seizures are very rare, and by the way happen more often with infectious diseases. Febrile seizures are caused by a rapid increase in temperature. Severe allergic reactions can happen if someone is allergic to any vaccine components, but even those are also very rare. Now, Pregnant women are also not advised to get the vaccine but not because it's been shown to be unsafe, but because of an abundance of caution because of the rubella component.

Government and pharmaceutical conspiracies: 

• He has often framed vaccination campaigns as driven by corrupt alliances between government agencies and pharmaceutical companies, implying that the MMR vaccine is pushed primarily for profit rather than public health. In fact, vaccination campaigns are driven by overwhelming evidence of safety and effectiveness, and their primary aim is to prevent disease and save lives. This is RFKjr outing himself. His entire antivax industry is driven by corrupt alliances so this accusation is what we call projection or mirror politics, he accuses others of actions he engages in himself.

“The MMR vaccine that we currently use has millions of particles that were created from aborted fetal tissue, millions of DNA fragments,” RFK Jr. told Fox News host Bret Baier in a report aired on May 8th.

• The following is from my episode on What's In Vaccines:

  This one sounds dramatic but is a misrepresentation of how some vaccines are made. Here’s the truth: Fetal fibroblast cells (WI-38 and MRC-5) used to grow vaccine viruses were first obtained from elective termination of two pregnancies in the early 1960s. Crucially, these fetal cells were never used directly in vaccines. Instead, they were cultured and grown in labs to create cell lines—self-replicating populations of cells that have been maintained under controlled conditions for decades. These cell lines are not fetal tissue. They are generations removed from the original cells and behave like standard laboratory cell cultures. No ongoing supply of fetal tissue is needed to maintain them. The reason these cells are used is that they’re excellent at growing viruses—especially for viruses that only replicate well in human cells. After the virus is grown, it’s purified and the final vaccine contains no cells and no fetal tissue. This method is used in the development of vaccines like rubella, hepatitis A, and varicella.

• The Vatican, the U.S. Conference of Catholic Bishops, and other religious authorities have issued statements clarifying that receiving these vaccines is morally acceptable when no alternatives are available.

  "All vaccinations recognized as clinically safe and effective can be used in good conscience with the certain knowledge that the use of such vaccines does not constitute formal co-operation with the abortion from which the cells used in production of the vaccines derive.”

He claims through various arguments that measles isn't serious, including:

When he was a kid everyone got measles and was fine

• That's a lie. He was born in 1954. The vaccine was introduced in 1963. As I said a few minutes ago, before the introduction of the measles vaccine, so for the first 9 years of his life, the US reported around half a million measles cases and roughly 500 related deaths each year. Following the rollout of the vaccine, measles cases declined by more than 95%, and by the way, nobody died or got seriously injured by the vaccine. It was a medical breakthrough that people were incredibly grateful to have because they knew the real cost of uncontrolled measles.

Measles doesn't kill healthy people and only unhealthy kids should die from measles

• Well, his eugenics are on full display right there. No, RFKjr, unhealthy kids shouldn't die from measles either. No one should. In a CBS interview about the death of an 8-year-old in Texas, he claimed: “The thing that killed [her] was not the measles, but it was a bacteriological infection.” But the truth is that measles complications—like pneumonia—are how measles kills. And yes, healthy kids can and do die from them. According to the CDC, 1 to 3 out of every 1,000 kids infected with measles die. Plus, measles also suppresses the immune system for years, making kids more vulnerable to other serious infections long after they recover. It actually inhibits immune memory from other vaccines so it's bad. This actually significantly increases childhood mortality from other infectious diseases. So the measles vaccine not only saves kids from measles illness, complications and death, it reduces mortality from other infectious diseases.

Hospitalization is only for quarantining not because illness is severe

• He’s even gone so far as to downplay the need for hospitalization itself, falsely claiming that kids with measles in Texas were only hospitalized for quarantine. Dr. Lara Johnson, chief medical officer at Covenant hospital in Lubbock, shot that down in an interview, saying: “We don’t hospitalize patients for quarantine purposes.”

  The truth is that measles can lead to serious complications affecting nearly every major organ system. These include problems with the lungs, brain, eyes, skin, kidneys, blood, and even the gastrointestinal system. 1 in 5 unvaccinated people with measles will require hospitalization.

Easily treatable with homeopathic remedies like vitamin A and steroids

• There’s no cure for measles—it’s a virus that the body has to fight off on its own. While we have some antivirals for other infections, there’s nothing proven for measles yet, so the best protection is still vaccination.

• In a Fox News article and interview in March, RFKjr said vitamin A could treat measles and his dangerous claims have already caused real harm. OK, so Cod liver oil is a source of vitamin A. In West Texas, some kids were getting really, really sick with measles, as always happens, and because of RFKjrs lies, parents of these kids bought up all the cod liver oil and gave enough to their kids to be toxic to their livers. They eventually took their kids to the hospital where they had to get supportive care for serious measles AND get treated for vitamin A toxicity. “Some patients reported using vitamin A for both treatment and prevention of measles,” said Dr. Lara Johnson, chief medical officer of the Covenant Health-Lubbock service area in a statement on March 27.

• Kennedy has also spread other reckless lies, like saying two Texas doctors “healed” 300 Mennonite children using aerosolized budesonide (a steroid) and clarithromycin (an antibiotic). Not true! Neither of these drugs is effective against measles, and can do more harm. Dr. Sean O’Leary, MD, MPH, chair of the American Academy of Pediatrics Committee on Infectious Diseases, put it bluntly: “There are no miracle cures for measles.”

"Natural” infection is preferable to vaccination

• Natural infection does often lead to lifelong immunity, but let’s be clear: measles is a serious disease that can lead to pneumonia, brain swelling, and even death, especially in young children and those with weakened immune systems. There is no predicting which healthy kids end up in the hospital or dead from measles.

• Kennedy has no medical background, and in fact, a two-dose MMR vaccination provides lifelong protection for many people, and when vaccinated individuals do get measles, it’s usually much milder and less likely to lead to complications.

  • I need to let you know here that we are learning—and it's becoming relevant because of the loss of elimination status in many places like the US—that in elimination settings (like the US used to be), immunity can wane over time. So if you're old like me get boosted. If you're really old like me, get the two dose series again. You can get your antibody titer checked to see if you're immune, but if you don't want to go through that or it's not covered by insurance, you can get the vaccine again if you can get it e.g., you're not allergic and there's no other reason your doctor tells you you can't get it. And the two doses can be given 4 weeks apart so you don't need to wait years between doses if you need the vaccine as an adult.

    The risks of measles far outweigh the mild side effects of the vaccine. Bottom line? Vaccines work. Kennedy’s claims about “natural immunity” aren’t just wrong—they’re dangerous, especially for kids who are most at risk.

And the claim he's made about measles that is most dangerous in my opinion is that treatment is better than prevention through vaccination.

• He really does recommend literally everything under the sun before vaccination. Because of all the things I've talked about: the risk of dangerous and lifelong complications and death, especially in children; the immune suppression measles causes that makes you more susceptible to severe measles but also more susceptible to other infectious diseases including those you're vaccinated against; and the fact that there are no treatments for measles, just supportive care in a hospital that will be ridiculously expensive in the US and may or may not save your life or prevent long-term consequences, the idea that you should treat measles instead of prevent it is literal insanity. There is absolutely no reason anyone would suggest that except someone who is so invested in his antivax agenda that he cannot and will not ever admit he is wrong. And that's if he's wrong and not intentionally deceiving parents to advance his antivax eugenics agenda.

If RFKjrs lips are moving he's lying about vaccines. These misleading claims are harmful because they erode trust in vaccines and in evidence-based medicine—leaving children and communities at greater risk when measles spreads. RFKjr and his kids are vaccinated. He has said so. He has no problem with you offering up your kids as sacrifices to his agenda. The question is, do you? Vaccines offer safe, effective protection without the severe risks of natural infection. Don't let RFKjr take them from you.

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Now that we've tackled those lies, let's get back to tackling measles.

Global Efforts to Get Ahead of Measles

Measles continues to be a significant contributor to illness and death around the world. and as one of the most contagious viruses, preventing outbreaks depends on maintaining high levels of immunity within the population. Measles outbreaks, then, often highlight deeper health inequities, acting as a warning sign for gaps in immunization efforts and weaknesses in primary health care systems.

Rubella also remains endemic in many parts of the world. Cases of congenital rubella syndrome (CRS), which can lead to lifelong disabilities, are still being reported.

The Global Measles and Rubella Strategic Plan, launched in 2012 and spanning through 2020, was a monumental effort to protect children around the world by controlling measles and rubella. Over that decade, the plan achieved some remarkable milestones and is estimated to have averted 23 million deaths due to measles—an extraordinary testament to the power of vaccines.

Yet despite these advances, there were significant challenges along the way. Changing circumstances and implementation obstacles led to a troubling trend: a resurgence of measles outbreaks and a rise in cases worldwide. It’s a stark reminder that even as we celebrate progress, the fight against vaccine-preventable diseases like measles is far from over.

So in 2020, WHO published a new Measles and rubella strategic framework: 2021-2030:

Measles_and_rubella_strategic_framework_2021-2030.pdf

Download PDF • 7.08MB

The strategies outlined in the Global Measles and Rubella Strategic Plan 2012–2020 remain as relevant as ever. But looking ahead to the next decade, they make some key strategic shifts that are essential.

First, their approach to closing immunity gaps recognizes a need to move beyond a one-size-fits-all model. We need to use strategies that are better tailored to local challenges—like incorporating catch-up vaccination as part of a lifelong approach to immunization.

Another important shift is transitioning from disease-specific surveillance to a more integrated, sustainable system. Ministries of health and partner agencies must use surveillance data to drive decision-making and policy development.

Strengthening outbreak preparedness and response capacity at both the national and local levels will also be key. This means leveraging existing global health security resources and using real-time outbreak data to identify and close equity gaps, while informing long-term health system improvements.

Cross-border collaboration is another priority—sharing information and coordinating efforts to identify and close immunity gaps, and to quickly respond to new outbreaks wherever they emerge.

Finally, accelerating the development and use of innovative technologies will be crucial. Promising tools like microarray patches for vaccine delivery and rapid diagnostic tests have the potential to transform how we prevent and respond to measles and rubella, while improvements in surveillance systems will help ensure no case goes undetected.

These pivots are not just strategic plans on paper—they’re a roadmap for making sure that every child, everywhere, is protected against these preventable diseases. You may have noticed, these strategies involve cooperation. Cooperation between people, agencies, and countries. If the US remains on its current isolationist course, we will keep regressing in terms of public health, with measles for sure, but also for any new pathogens we run into as humans continue to invade habitats and exploit planetary resources.

The faces of this measles resurgence are heartbreakingly real: the teenage brothers in Belize who unknowingly brought the virus home, the infants in Rio de Janeiro fighting for their lives in intensive care, the grieving parents in Mexico who will never watch their child grow up. These aren’t just tragic anecdotes—they are glaring reminders that measles is not just a rash and fever. It can kill. And in communities where vaccination rates have slipped, it spreads fast.

As Nadia Lasri of the vaccine alliance, Gavi warns, we need urgent, coordinated action: emergency vaccination drives, stronger surveillance, and support for fragile health systems. But we also need something harder to rebuild—public trust. Because when communities stop believing in vaccines, children start dying from diseases we know how to prevent.

This resurgence points to a bigger truth: prevention is always better than crisis response. Emergency campaigns are costly and reactive. But routine immunization? It’s proactive, reliable, and life-saving.

UNICEF and WHO are calling for exactly that—investment in long-term solutions. That means vaccinating every child, building strong early warning systems, ensuring access to care, and fighting misinformation head-on.

Let’s not wait for more hospitalizations, more funerals, more “what ifs.” We know what works. Now we just have to act.

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As we wrap up, let’s introduce a new segment:

Hot Zone Hotline

Where I answer questions from listeners and readers:

Wendy B asked: How does measles spread so easily?

Measles is one of the most contagious viruses we know. It is airborne, meaning it spreads through the air when an infected person coughs, sneezes, or even talks. The virus can linger in the air and on surfaces for up to two hours after someone leaves the room—so you don’t even need direct contact to catch it.

To put it in perspective: if one person has measles, up to 9 out of 10 unvaccinated people around them will get infected. That’s why even a small drop in vaccination rates can lead to large outbreaks.

The only way to stop measles from spreading is through high levels of immunity in the community—what we call herd immunity. And that means keeping vaccination rates high.

Gracie V asked: What are the symptoms of measles, and when should people seek care?

Measles usually starts with a high fever, cough, runny nose, and red, watery eyes, followed a few days later by a rash that spreads from the face downward.

If someone—especially a child—shows these symptoms or has been exposed to measles, call your doctor immediately and tell them. Even if your child does not seem very sick because your doctor needs to know if there is measles in the community. So call. They will assess the situation and let you know whether or not you need to be seen. Because it's so contagious, it's better to avoid the doctor's office if it's not needed, so call first. Infants too young to be vaccinated have been infected in doctor office waiting rooms so it's really better to call first. As is indicated in the CDC flyer here, if the child/person has any of these symptoms, go to the ER: trouble breathing, pain when breathing or coughing, dehydration, a fever or headache that will not respond to over the counter medicines, confusion, decreased alertness or severe weakness, or if their skin starts to look blue.

Kate H asked: How can I talk to someone I care about who’s hesitant about vaccines?

I'm still working on this myself but a good place to start is with empathy, not arguments. Most people who are hesitant about vaccines aren’t anti-science—they’re just worried or confused. So listen first. Ask what concerns they have and really hear them out without judgment.

Once you understand where they’re coming from, share accurate information gently. You can talk about how vaccines are tested for safety, how they’ve saved millions of lives, or even your own decision to get vaccinated. Stories are powerful—sometimes more than facts.

And remember, you don’t have to convince someone in one conversation. Trust builds over time. Keep the dialogue open, be patient, and offer to help them find reliable sources, like a trusted doctor, public health website, or really great podcast (wink wink).

The goal isn’t to “win” the debate—it’s to support someone you care about in making an informed decision.

Caveat emptor: This is a viable strategy for those who are vaccine hesitant. My experience with those who are not hesitant but are antivax? Don't bother. I have given antivaxxers a lot of time and effort and it turns out they don't want the truth. They aren't interested in hearing you. They are hoping to catch you in a lie. It's the only reason they want you to talk. They will bait you. And when they don't catch you in a lie, they just ignore all the truth you've given them and try to find someone else they can catch in a lie, because we are all pharma shills. They are not there to learn. Don't give them your time.

Sam S. asked: What can individuals do to help prevent outbreaks?

The most important step is simple: make sure you and your children are fully vaccinated—on time and according to your country’s immunization schedule. If you're unsure about your status, check your records or talk to a healthcare provider. During outbreaks or before travel, infants may need an extra early dose for added protection. And don’t underestimate your voice—share accurate vaccine information, speak up against misinformation, and help others understand that protecting public health starts with each of us. And finally, VOTE for people who support evidence-based, science-backed information that will strengthen public health in the US.

Dr. Patrick P., infectious disease MD fellow asked: Does vaccination of infants prior to 12 months blunt overall vaccine effectiveness long term? And he linked a study seeming to show that might be the case.

OK, so, first, if you're not aware, the current recommended vaccine schedule in the US and by WHO for many countries, says to give young children their first MMR vaccine at 12 months with a second MMR between 4 and 6 years old, or before they enter kindergarten. It's the before kindergarten thing that's important here, not the age. However, infants are really susceptible to serious illness from measles so as I talk about in my first measles episode, if there is increased risk of exposure such as an outbreak where they live or they are traveling to someplace with continuous transmission, then pediatricians will recommend getting a measles vaccine as young as 6 months to help protect them from that immediate risk. In that case, WHO recognizes that early shot as an additional dose, not a replacement for one of the two normally scheduled doses. So the regular 2 dose series should still be given on schedule.

Here's the WHO recommended immunization schedule as of Jan this year. There is a chart on the first page but details for each vaccine are provided after that. The info for measles starts on page 6.

WHO_Recommended_Vaccine_Schedule_january_2025_english.pdf

Download PDF • 267KB

Now, not all countries give a two dose measles vaccine series. Check out this page on the WHO website that provides the measles vaccine schedule for all countries (what they do, not what WHO recommends, which is in the document above).

OK, so, when we vaccinate we are looking to get a robust immune response that will prime our immune systems for battle in case we see the virus in the wild. And one of the main things we are looking for is production of neutralizing antibodies, which, in this case, are protective against measles. They neutralize the virus. But they are not the only part of the immune response that is important. Cellular immunity - for example production of T cells, is also important for vaccine-induced immunity.

With his question, Dr. Patrick linked a small study out of the Netherlands published in April of this year. It's called Long-term Dynamics of Measles Virus–Specific Neutralizing Antibodies in Children Vaccinated Before 12 Months of Age and they looked at whether measles-virus-specific neutralizing antibodies hung around in children who were vaccinated before they were 12 months old.

• The authors of this study conclude that: "Routine vaccination of infants under 8.5 months of age may lead to blunted MeV-specific antibody responses to subsequent MMR vaccination."

So, based on what we know about vaccine-induced antibody production this doesn't seem like a good thing, right?

And this is where Dr. Patrick's question comes in:

"Does vaccination of infants prior to 12 months blunt overall vaccine effectiveness long term?"

Well, I want to first answer based on what we know aside from the study he linked, then I'll talk about that study.

So, my answer is, no. Vaccination of infants prior to 12 months will not blunt overall vaccine effectiveness long term. This is shown by data gathered over decades of using the vaccine.

This is not to say that there aren't variables that can impact strength, or length, of the neutralizing antibody response to the vaccine before 12 months in some children. This might even impact the immune response to the second shot in the series as shown in the Netherland's study. In fact, the reason we give the vaccine at 12 months and not sooner as we do other vaccines is that MMR is a live, weakened virus, and moms with immunity to measles pass on a little of their antibodies to their babies, in utero and in breast milk. And if a baby has it's mom's antibodies to measles, then when they get the vaccine, their antibodies will attack the weakened vaccine virus. This reduces effectiveness of the vaccine as you can imagine.

And this bears out in studies. We know that the infant immune response to a measles vaccine before they are 1, isn't long lasting. It's also not as strong. This is why we still need to give the regular two dose series at the recommended ages. But when we do that, decades of experience with this vaccine shows us that vaccinated infants don't die from measles, even when they get an extra shot before they are 1. So my answer is no, the early dose will not blunt long-term effectiveness of the vaccine. And there is a very thorough systematic review and meta-analysis into this very issue. In fact they found:

"...administering MCV1 to infants younger than 9 months followed by additional MCV doses results in high seropositivity, vaccine effectiveness, and T-cell responses, which are independent of the age at MCV1, supporting the vaccination of very young infants in high-risk settings. However, we also found some evidence that MCV1 administered to infants younger than 9 months resulted in lower antibody titres after one or two subsequent doses of MCV than when measles vaccination is started at age 9 months or older. They found "...no differences in seropositivity, cellular immunity, and antibody titres following an early three-dose MCV schedule"

So, that study found some reduction in antibody levels but it had zero impact on long term vaccine effectiveness when the early measles vaccine dose was followed by one or two additional doses.

And I don't think the Netherland's study can say it impacts long-term vaccine effectiveness either. Shall we dig into it?

This small Dutch study looked at measles immunity in two groups of children:

• 79 who received an early MMR dose (MMR-0) between 6 and 12 months and then MMR-1 at 14 months

• 44 who followed the standard Dutch schedule of MMR at 14 months and again at 9 years.

Researchers measured antibody levels before MMR-1 (at 14 months), then around 6 weeks, 1 year, and 3 years later, with follow-up at 6 years for some children.

Their Main Results:

• Seven children who got MMR-0 didn’t show protective antibody levels at 14 months.

• Almost all who received MMR-0 at 8.5 months or later, or who followed the standard schedule, had protective antibody levels at 5–6 years.

• In contrast, most vaccinated before 8.5 months had lower levels below the protective threshold.

• Antibody levels in all children decreased over time.

Some things to note cuz I'm nitpicky:

• This study only measured antibodies, not cellular immunity like T-cell responses and T-cell memory, which also provide protection. And because the second MMR dose in the Netherlands isn’t given until 9 years old (unlike the U.S. at 4–6 years), waning antibodies by age 6 wouldn't matter in countries following the WHO guidelines.

• I’m skeptical of the authors’ claim that seven children “did not seroconvert” after MMR-0. They didn’t measure antibodies until 14 months, likely on the same day as MMR-1, meaning they may have missed a brief antibody response. It’s more plausible that at least some of these children had a short-lived response that waned by 14 months, rather than no response at all.

• The authors also overreach when they say their research shows “age at first dose impacts MeV-specific antibody levels later in life.” Six years old isn’t “later in life,” and drawing that conclusion would require long-term tracking of antibody levels and more data on confounding factors.

• The statement: “age at first dose determines longevity of antibodies” is too strong. At best, they’ve shown that early vaccination affects or impacts antibody levels, but they haven’t accounted for other factors that likely play a role.

• The paper’s conclusion as stated by the authors, that: "Routine vaccination of infants under 8.5 months of age may lead to blunted MeV-specific antibody responses to subsequent MMR vaccination." is also an overstatement.

  • Antibody responses are complex physiological processes that involve several key steps, primarily in the adaptive immune system. This response is characterized by the production of antibodies by B cells, which are then recruited to the site of infection or antigen presence. Antibodies neutralize pathogens and mark them for destruction.

  • The only part of "antibody responses" they look at in this study is levels of neutralizing antibodies. And they looked after only one subsequent MMR dose in a very limited group of kids. More accurate would be: may lead to blunted MeV-specific neutralizing antibody levels after the 14-month dose. Because that's what they show.

So based on decades of data, and even with the decrease in antibody levels at 6 years old shown in the Netherland's study, I am confident that, a pre-12-month measles vaccine—even when given before 9 months—will not blunt the long term effectiveness of the measles vaccine.

All right then. I think that covers the rest of measles. I want to thank you all for your questions. Between this episode and my first measles episode I think we've got most things covered but feel free to find me on Bluesky or Twitter and ask me if I've missed something you'd like to know about measles!

Until next time, stay healthy, stay informed, and spread knowledge not diseases!