In early 2025, when measles began to sweep through West Texas, Katherine Wells knew she needed money.
Although the outbreak is centered in Gaines County, a community an hour away, Wells, who heads Lubbock’s public health department, needs more staff to respond to numerous exposures at local pediatricians’ offices, urgent care centers, restaurants and day cares.
“We really rely on non-hourly staff, because if I had to I could work 80 hours, which is scary,” Wells said. In emergency planning meetings with the Texas Department of State Health Services, he pleaded for about $100,000 to hire temporary workers to help his exhausted staff.
“If I need a few hours of work from a retired school nurse we worked with before, can I pay her?” Wells said.
The answer, she said, is a consistent “no.” The state has sent some travel nurses from other areas to help, but there is no additional funding.
To prevent measles outbreaks from getting out of control, public health workers must spring into action, contact each person exposed to the virus as quickly as possible, determine their vaccination status or health risk, and then try to get them vaccinated or quarantined at home for three weeks.
Wells pulled half of his staff to work on the outbreak response on top of their other daily duties.
What is the true cost of a measles outbreak?
Wells could not estimate how much it would cost the Lubbock Health Department to contain the virus before the outbreak, which began in the largely unvaccinated Mennonite community in late January of last year, ended months later.
An NBC News/Stanford University investigation found that since 2019, two-thirds of counties and jurisdictions reported significant declines in vaccination rates. Among states that track MMR rates, more than half of their counties — 67% — are below the level needed to stop measles outbreaks.
An alarming new report calculates the price tag for the US if those rates continue to fall.
If measles vaccination rates continue to decline by just 1% annually for the next five years, the cost to the US could reach $1.5 billion a 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 predicted increases in measles cases, hospitalizations, and their associated medical and social costs.
Based on their projections, $41.1 million is needed each year to meet patients’ basic medical needs, including health insurance, and $947 million for public health response efforts such as surveillance and contact tracing. Lost productivity among employees, the report found, can reach $510.4 million each year.
Dr. Dave Chokshi, president of the Common Health Coalition, a nonprofit, nonpartisan public health group that partnered with Yale for the project, said the measles outbreak reverberates through all parts of the “health ecosystem.”
The human consequences of measles outbreaks are “important for us to deal with very smartly,” said Chokshi, a former New York City health commissioner. “But we want to be clear that there are economic implications, including employees absorbing lost work, public health departments stretched too thin to respond, and health care systems shouldering the burden of emergency response.”
Measles was declared eliminated in the US in 2000. Since then, outbreaks here and there have generally stopped quickly. But backsliding vaccination rates have increased the risk of massive outbreaks and now threaten the nation’s measles eradication 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 chairmanship, Health Secretary Robert F. Following Kennedy Jr.’s lead, the administration has not strongly endorsed vaccines as a way to end such outbreaks.
Instead, the message of childhood vaccination focused on “personal choice” rather than public health need.
In the first two months of 2026, more than 1,000 measles cases were confirmed, half of the 2,281 in 2025. Ninety-four percent of those infected were not vaccinated.
According to a recent analysis by the Johns Hopkins Bloomberg School of Public Health, the initial economic hit to a community from a measles outbreak is about $244,480. Local and state public health departments can expect to pay for resources such as vaccine clinics and staff until the outbreak is over, said study author Brian Patenaud, assistant professor of health economics.
“We know the ingredients that deal with measles outbreaks, how many cases become severe and require care, because they have to be really well detected and documented,” Patenaud said.
The report, posted in October on medRxiv, a site that releases research before it goes through peer review, tracked measles outbreaks in 18 states since 2004 (not including 2025 cases in Texas, Utah and Arizona).
On top of the upfront cost, each additional case of measles costs an average of $16,000 a pop for contact tracing, medical costs and quarantine monitoring. A Johns Hopkins report estimated that five measles cases could reach $324,480, while 50 outbreaks could cost $1 million.
In 2019, there were 72 measles outbreaks in Clark County, Washington. Health officials spent hours making sure people adhered to quarantine.
“We’ve brought in personnel from the state, CDC, other jurisdictions, even as far away as Idaho to help us with case investigation and contact tracing,” said Clark County Public Health Director Dr. Alan Melnick said. The team contacted people in quarantine every day. Ultimately, 87% of subsequent measles cases occurred among people who were quarantined, Melnyk said.
The assessment found that productivity losses from relatively small outbreaks in Clark County ran into the millions of dollars.
The measles vaccine is free in the US
“The public needs to know that vaccines are good, because they save lives as well as a lot of money,” Melnyk said.
As a former California legislator, pediatrician Dr. Richard Pan helped strengthen the state’s vaccine requirements after the 2015 measles outbreak linked to Disneyland. “People need to recognize that there is a huge cost to this outbreak,” he said. “That cost is being borne by American families.”
South Carolina is wrestling with the nation’s largest outbreak in more than a generation. Spartanburg County has been on high alert since the fall, with at least 1,000 cases and possible exposures at fast food restaurants, stores, medical clinics and government offices.
The South Carolina Department of Public Health would not disclose how much the contact tracing, mobile vaccination clinics and increased staffing cost.
The Centers for Disease Control and Prevention has previously approved requests to redirect several hundred thousand dollars for emergencies, a department official said.
“Additionally, South Carolina requested and received $100k from the CDC for vaccine-preventable disease responses,” Louise Eubank, deputy incident commander for the South Carolina Department of Public Health, said in a statement to NBC News. “South Carolina and CDC continue to discuss additional funding needs and resource support.”
A senior official at the US Department of Health and Human Services said the CDC has sent $8.5 million to seven areas of the country experiencing measles outbreaks over the past year, but declined to provide where or additional details.
“Amounts are awarded based on requests from the state or local health agency and the availability of funds at CDC,” the person said.
As the South Carolina outbreak spread to North Carolina, Dr. David Wohl is scrambling to prevent a surge beyond the 23 cases already confirmed.
“A lot of people in my health care system are doing this,” Voll said. “I can’t tell you how many calls, how many hours, how stretched people are.”
Intangible, indirect costs
The potential economic burden of a measles outbreak is easily calculated. The personal cost of having children unprotected from the world’s most contagious virus is impossible to measure.
Hundreds of people infected with measles in the past year — more than 1 in 10, according to the CDC — have been hospitalized with dangerously high fever, pneumonia, difficulty breathing and dehydration.
Mothers and fathers have spent countless, bleak hours at their child’s bedside. Most have recovered. Some are left with the long-term effects of encephalitis — inflammation of the brain that can lead to seizures, blindness, deafness and learning disabilities.
Rarely, measles can hide in the body for up to a decade before reemerging by attacking the brain and nervous system. This condition, called subacute sclerosing panencephalitis, is almost always fatal.
Two little girls in Texas, ages 6 and 8, died of measles within weeks of their diagnosis.
Chokshi said that while the economic impact of measles outbreaks is real, the human impact cannot be ignored. “Behind every number is a child battling a devastating illness, or a family facing an unexpected hospitalization, and in the worst cases, a death or long-term consequence from a preventable disease.”
