Measles Cases Could Cost the U.S. Its Elimination Status. Here’s What That Means And How Close We Are.

The U.S. has reported more measles cases in the first half of this year than in any full year since 1992, raising concerns that the country could lose its measles elimination status and undo a 25-year public health victory amid declining vaccine rates.

But exactly what does that risk mean and how close is it to really happening?

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The World Health Organization sets the criteria for elimination status, requiring a country — or defined geographical area — to go at least 12 months without continuous domestic transmission of a virus. That means any new outbreaks during that time must come from people who contracted the virus from outside, not inside, the U.S.

Under that criteria, the U.S. has until January to eliminate the nation’s current outbreaks, which is a year after cases started domestically in Texas, according to epidemiology experts. If it doesn’t, the U.S.’s measles elimination status could be taken away.

“It could be more impactful than a lot of Americans think about since we have had measles elimination status for so long,” Brittany Kmush, associate professor and graduate director of Syracuse University’s Public Health Department, told HuffPost.

“It could affect U.S. citizens’ ability to travel to specific countries if they don’t want the risk of measles getting introduced to their country. It could affect other people’s ability to come visit the U.S. Other countries might require proof of measles vaccination before they can reenter their home country,” she said.

There could also be increased quarantine and isolation requirements, with potential economic fallout, she said.

On top of this, many more people could be at risk of contracting the virus, which is considered one of the most contagious in the world. If just one person has it, up to 9 out of 10 people nearby will become infected if they are not vaccinated, according to the Centers for Disease Control and Prevention.

“It’s not just a cold for a lot of people. It can lead to phenomena and in rare cases encephalitis and death,” said Kmush. Children younger than 5 years of age are especially vulnerable to severe illness and health complications.

Fortunately, there’s still time this year to fight outbreaks. Losing the elimination status is also purposely made challenging because, unless the virus is globally eradicated ― a feat only seen with smallpox ― there’s always going to be cases brought into the U.S. from outside, said William Moss, executive director of Johns Hopkins’ International Vaccine Access Center, who co-leads the school’s measles tracking project.

“As long as there’s measles virus circulating somewhere in the world, there’s always going to be these importations,” he told HuffPost. “It would be very hard to maintain measles elimination status if every time someone brought it in and there was another case, you would lose it.”

Whether or not outbreaks will stop before the deadline remains uncertain, however.

Measles cases in the U.S. have been dropping since their peak in March, giving hope that outbreaks may be petering out. But vaccination rates remain at their lowest in years in the U.S., reducing so-called “herd immunity” and opening the door for new outbreaks to ignite in communities that have low vaccination rates.

“It’s just a matter of if and when an infectious individual enters one of those communities and kind of invites an outbreak,” said Moss, while comparing the chances to a hot ember drifting from a wildfire.

“If it lands in a wet area, you’re not going to have an outbreak if there’s high vaccine coverage. But if it enters an area with really low vaccine coverage, you could have another really large outbreak,” he said.

With less than six months left in the year, Moss says it’s still too early to start a countdown or “really sweat about this.” He also said that even if elimination status is lost, cases are at least unlikely to return to the levels seen in the early 1990s, since vaccine levels do remain reasonably high.

Kmush, however, expressed more caution on the chances of elimination being a reality.

“I am definitely alarmed,” she said, while pointing out that the U.S. nearly lost its elimination status in 2019 when there were fewer cases than those seen this year. She credited a rise in vaccine coverage and public health advocacy toward the end of that year for sparing the U.S. from losing its status.

“We were able to get them vaccinated and do the quarantine and isolation,” she said of vulnerable communities. “Unfortunately, measles vaccination rates are even lower now than they were in 2019 and 99% of the cases that have been reported in this outbreak are either not vaccinated or have unknown vaccination status.”

She and Moss both also stressed that the U.S. getting its elimination status back after losing it is also no easy feat.

A country would have to show zero continuous transmission of the virus domestically for 36 months, as well as demonstrate a good virus surveillance system, which Moss said the U.S. does have.

As far as what can be done now, Kmush said more people need to get vaccinated, calling it “the greatest tool” in decreasing cases and protecting those who are unable to get vaccinated, such as babies younger than six months of age or people who are immunocompromised.

“You can do quarantine, isolation, similar to the idea with COVID, but measles is a lot more contagious than COVID,” she said. “And so we really need everyone who is eligible to get the vaccine.”

She also stressed that federal health officials need to do more to reduce vaccine hesitancy and skepticism.

“I think certain administrators and their views on vaccines have been fueling some of this vaccine hesitancy and people’s reluctance to receive a vaccine that’s been proven safe and effective for decades,” she said. “The policies and some of the vaccine hesitancy and skepticism rhetoric is definitely dangerous and going to make people who are unsure about vaccines even more unsure, when they really shouldn’t be.”

Health and Human Services Secretary Robert F. Kennedy Jr., who has no formal medical background and has a long record of anti-vaccine advocacy and other conspiracy theories, is among those who has offered inconsistent and tepid support for the measles, mumps and rubella (MMR) vaccine.

Earlier this year, he falsely claimed that the current vaccine administered, which was first distributed in 1968, hasn’t been safely tested and that its protection is short-lived. That’s despite widespread use of the vaccine being credited with achieving the nation’s elimination status in 2000 and saving hundreds of lives each year.

Before the measles vaccine was introduced, an estimated 48,000 people were hospitalized and 400–500 people died annually in the U.S., according to the CDC.

A HHS spokesperson, when recently contacted by HuffPost about the rise in cases, said that measles infection risks remain low for the overall U.S. population, “lower than peer developed countries including Canada, the United Kingdom, France, Spain, and Italy.”

“CDC continues to recommend MMR vaccines as the best way to protect against measles,” the spokesperson added, while calling the decision to vaccinate “a personal one.”

“People should consult with their healthcare provider to understand their options to get inoculated and should be informed about the potential risks and benefits associated with vaccines,” they said.