Six months ago, I wrote about why measles outbreaks matter to everyone. At that time, Lancaster County had recently diagnosed 5 people with measles, the first cases in Pennsylvania this year. As of today, the state Department of Health has recorded 296 cases of measles in 2026. Of those, 61 cases were confirmed in the past 7 days, most of these in Lancaster County. 52 patients became sick enough to be hospitalized; fortunately, no one has died. I am now practicing at the center of an outbreak that is threatening to become a full-blown epidemic, the likes of which we haven't seen since Covid.
It's not all Robert F. Kennedy, Jr.'s fault - but he certainly fanned the flames of anti-vaccine sentiment that brought us to this point.
The costs of a measles outbreak are not limited to patients' direct medical expenses, or even the indirect costs of missed school or work. Public health workers (Lancaster County, inexplicably, has no public health department, so we are relying on assistance from the state) are mobilized to track down contacts of ill persons and contain the spread. Vaccination clinics are organized and deployed throughout affected communities, requiring additional staff and medical resources. From February to August 2025, the New Mexico Department of Health responded to a 9-county measles outbreak that totaled 99 cases - fewer than the number we've already seen in Lancaster County this year. The estimated cost of the public health response was a staggering $5.4 million, or about $53,500 per case. Those dollars weren't just sitting in a government account waiting to be used - they had to be diverted from education, policing, highway maintenance, and other essential services.
In an incisive commentary on the "hidden costs" of a measles outbreak, Dr. Katherine Wells, the public health director of Lubbock, Texas, wrote: "When people hear that Lubbock had 50 measles cases in 2025, they often picture something manageable: a handful of sick children, some telephone calls, a few weeks of extra work. That is not what 50 measles cases look like." Instead, she explained, it looked like this:
1. An outbreak is not an event but a cascade - "a case is the start of a cascade of exposures, responses, and system disruptions that unfold over time. ... What emerges is not a series of isolated incidents but a pattern: each exposure generates conditions for the rest. Each setting does not simply experience the outbreak. It amplifies its complexity."
2. When systems bend, people improvise - "Clinics expanded capacity, added hours, and brought in additional staff where possible. But these resources did not materialize from nowhere. They were pulled from other services, such as routine immunizations, chronic disease management, [and] sexual health care - that now had to function with less."
3. The hidden erosion of emergency capacity - "An ambulance transports a patient with suspected measles. After the transfer, it must be taken offline, decontaminated, and cleared. Then it happens again. And again. Each time, the delay is measured in hours, but the impact is cumulative."
4. Survival is not the end of the story - For the sickest children, "survival ... entails extended hospital stays, ongoing clinical needs, and the quiet displacement of other patients who depend on the same finite resources."
5. The costs we do not count - "The most consequential impact [of an outbreak] lies elsewhere: in the work that did not happen."
As vaccination coverage declines in young children across the U.S., outbreaks of measles and other preventable diseases will inevitably become more common and widespread. I'll give the last word to Dr. Noel Brewer, a public health professor at the University of North Carolina, who chairs a committee that is evaluating whether the U.S. should lose its hard-won measles elimination status dating back to the year 2000:
Measles is a brutal disease that has no medical cure. Parents of children made sickest must wait it out in the hospital, despairingly wondering whether their child will die. That level of risk is indefensible in 2026 — more than 25 years after the United States achieved measles elimination. Kids are suffering and dying from a disease we already know how to prevent, and that failure is entirely ours.
