America’s Measles Crisis: How Staffing Cuts and Weakened Surveillance Are Hiding the True Scale of the Outbreak
And Remember...it is only October. Peak transmission is winter and early spring.
This article originally appeared in Powell’s Linkedin Newsletter. You can connect with Josh on Linkedin here.
By Josh Powell
The United States is experiencing its worst measles outbreak in over three decades, with 1,596 confirmed cases reported as of mid-October 2025—a staggering increase from just 285 cases in all of 2024. But public health experts warn that these official numbers may represent only a fraction of the true toll, with some estimates suggesting the actual case count could be three times higher.
This alarming discrepancy comes at a critical moment when the nation’s public health infrastructure has been systematically dismantled through unprecedented staffing cuts and funding reductions at both federal and local levels—decisions made by the Trump administration and the Department of Government Efficiency (DOGE) without fully understanding the consequences.
Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, has sounded the alarm about what he believes is severe underreporting. “If you talk to people on the ground, including not only in Texas, but other states, they all say the same thing, which is that the numbers are much worse than that. Probably closer to 5,000 cases,” Offit told NPR in October. His estimate isn’t conjecture—it’s based on patterns in death rates, doubling rates, and hospitalization data that don’t align with official case counts.
The CDC itself has acknowledged this problem. In an April report, the agency noted that “outbreak-related cases were likely underreported because certain persons in affected communities might not engage with the health care and public health systems.” South Carolina’s state epidemiologist Dr. Linda Bell put it even more bluntly when her state reported its eighth case in late September: “What this new case tells us is that there is active, unrecognized community transmission of measles occurring.”
Evidence of hidden spread continues to emerge across the country. In Utah, wastewater testing revealed that the measles virus was far more widespread than confirmed case counts suggested, prompting health officials to warn that surveillance was missing substantial transmission. It’s a pattern that public health officials find deeply troubling—not just because cases are going undetected, but because the infrastructure that would normally catch them has been systematically dismantled.
The capacity to track, respond to, and contain measles outbreaks has been severely compromised by a series of devastating cuts to the nation’s public health infrastructure. The Centers for Disease Control and Prevention, America’s primary disease surveillance and response agency, has been gutted by multiple waves of layoffs throughout 2025. In February, approximately 1,300 employees—10% of the workforce—were terminated. Among those let go were first-year Epidemic Intelligence Service officers, the “disease detectives” who investigate outbreaks. These cuts eliminated critical capacity in the National Center for Immunization and Respiratory Diseases, which oversees measles response.
Then, in October, another round of terminations targeted approximately 600 more employees during a government shutdown. The positions eliminated weren’t redundant bureaucrats, as administration officials suggested. They included two senior officials responsible for overseeing the CDC’s measles response team—Athalia Christie, who served as incident commander of the measles response, and Maureen Bartee, a senior infectious disease expert. Staff who brief Congress on disease outbreaks were terminated. Health statistics analysts who track disease trends lost their jobs. Support staff who arrange travel and security for scientists working on international outbreaks were let go. Congressional liaison officers who coordinate federal response efforts were dismissed.
An agency official, speaking anonymously for fear of retaliation, described the rationale behind the cuts: “The administration did not like that CDC data did not support their narrative, so they got rid of them. They didn’t like that CDC policy groups would not rubber stamp their unscientific ideas, so they got rid of them.”
The impact has been immediate and tangible. “If we lose these people we lose important capacity and in a very real sense we lose our CDC future,” one current CDC employee told NPR. Dr. Georges Benjamin, executive director of the American Public Health Association, was unequivocal in his assessment: “This is a nonsensical rearrangement of the agencies under their charge and an excuse to devastate the workforce for financial reasons. It will increase the morbidity and mortality of our population, increase health costs and undermine our economy.”
While the CDC was being dismantled at the federal level, local and state health departments—the frontline responders to disease outbreaks—suffered their own catastrophic losses. In March 2025, the Trump administration clawed back $11.4 billion in COVID-era funding from state and local health departments, plus another $1 billion from the Substance Abuse and Mental Health Services Administration. This wasn’t money sitting idle in bank accounts. It was actively supporting respiratory virus testing and monitoring, including measles surveillance. It funded childhood vaccination programs, disease surveillance systems, laboratory capacity, wastewater monitoring for disease detection, and public health workforce development.
The cuts were sudden and came without warning, often after funds had already been allocated and programs launched. States were left scrambling. California lost over $1 billion in public health and mental health funding. Minnesota saw $226 million in grants terminated. Illinois had $125 million rescinded. Washington lost $160 million. In Virginia, community health workers, nurses, and epidemiologists began receiving termination notices within days of the announcement.
Dr. Céline Gounder, CBS News medical contributor, captured the chaos: “It will take time to figure out all of the impacts of this action, but these cuts are a tremendous loss—made worse by the uncertainty and chaos that our federal partners have introduced into this process.” Brian Castrucci, president of the de Beaumont Foundation, which studies public health infrastructure, explained the cascading effects: “The funds may not have been spent yet, but local health organizations would already have had plans for it. People will lose jobs, programs will be reduced or cut, communities will be less safe.”
State and local health departments have traditionally relied on the CDC for expert assistance during outbreaks—help that is increasingly unavailable. Dr. Karen Remley, former CDC official and former Virginia health commissioner, described what’s been lost: “Sometimes that help might be we’re going to send some people to help you investigate this. Sometimes that might be talking to somebody who’s the world’s expert on a specific type of infection or exposure.” Now, health officials report a different reality. “There’s nobody to answer the phone,” one local health official described their attempts to reach CDC experts for outbreak assistance.
Dr. Susan Kansagra, chief medical officer for the Association of State and Territorial Health Officials, documented the cascading effects throughout the country: “Public health departments have been laying off staff, cutting lab capacity and reducing immunization clinics.” The infrastructure built over decades to prevent exactly this kind of epidemic was crumbling in real time.
The 2025 measles epidemic differs from previous outbreaks in several concerning ways that reflect this weakened surveillance and response infrastructure. One in eight measles cases has required hospitalization—a rate that public health experts find alarming. Through mid-October, approximately 200 people had been hospitalized. The CDC reported that among hospitalized cases through early April, 42 were children under 5 and 19 were children ages 5-19. “Although many people think of measles as a mild illness and for the most part it is, it can also cause severe illness,” Dr. Caitlin Rivers of Johns Hopkins University told NPR, noting the concerning hospitalization rates.
Even more shocking are the three confirmed deaths—the first measles fatalities in the United States in ten years. Two unvaccinated school-aged children in Texas died, with one succumbing to what doctors described as “measles pulmonary failure.” An unvaccinated adult in New Mexico tested positive for measles after death, never having sought medical care. These deaths have shaken public health officials who had come to view measles as largely controlled in the modern United States.
The largest outbreak began in Gaines County, Texas—where vaccination rates were among the lowest in the nation—and exploded to 654 linked cases across three states: Texas, New Mexico, and Oklahoma. At its peak, Texas was reporting 15 to 20 new cases daily. The outbreak has since spawned 44 separate outbreaks across 41 states, with 86% of all cases being outbreak-associated. This represents a dramatic increase from 2024, when only 16 outbreaks occurred and 69% of cases were outbreak-associated.
Active outbreaks continue spreading across the country. In South Carolina, 139 schoolchildren remain under 21-day quarantine after exposure to measles. Along the border region of Utah and Arizona, 56 and 77 cases have been reported respectively. Minnesota has seen 20 cases in a recent surge. In Colorado, multiple cases were traced to a single infectious traveler on a commercial flight, illustrating how quickly the disease can spread in our interconnected world.
The West Texas outbreak didn’t respect international borders either. It triggered a major epidemic in Chihuahua, Mexico, with 3,911 cases reported, predominantly affecting indigenous communities with a case-fatality rate 20 times higher than the general population. Fourteen deaths were reported in Mexico. The outbreak also spread to Canada, which has reported 4,548 cases and one death—a fatal congenital measles infection in a newborn.
The difference between official case counts and real disease burden stems from multiple surveillance failures that compound one another. Local labs that once processed measles samples have been closed or had staff laid off, meaning that without accessible testing, cases go unconfirmed. The Epidemic Intelligence Service officers who would normally deploy to investigate outbreaks were among those terminated in February. These highly trained epidemiologists are essential for contact tracing and identifying transmission chains—work that simply isn’t happening at the scale it needs to be.
With CDC liaison positions eliminated and local health department staff reduced, the pathways by which cases are reported to federal authorities have been disrupted. The CDC acknowledged that people in affected communities, particularly those with low vaccination rates or undocumented residents, may not seek medical care or engage with public health systems, meaning their cases never get counted. The pandemic-era improvements to disease tracking systems—funded by the now-clawed-back grants—are being lost. Illinois officials noted that terminated funding was meant to support “technology to track the spread of diseases” including measles.
What makes this crisis particularly tragic is that it was entirely avoidable. The positions eliminated and programs cut were not duplicative or wasteful—they were the essential infrastructure that allowed the United States to maintain its measles elimination status for 25 years. “This happens when you do indiscriminate, poorly thought-out layoffs,” Dr. Georges Benjamin observed.
Many cuts were made without understanding what the affected employees actually did. Officials from the Department of Health and Human Services later attributed some layoffs to “data discrepancies and processing errors,” reinstating about 700 of 1,300 CDC workers after realizing the terminations were mistakes. But approximately 600 positions remain eliminated. Aryn Melton Backus, a health communication specialist who was terminated, captured the chaos: “We have no idea why certain programs were eliminated and others were saved. At this point, it seems like the chaos and lack of transparency is the point.”
The United States now faces a critical juncture. If measles transmission continues at current rates for 12 consecutive months, the country will officially lose its elimination status—a designation it achieved in 2000 after decades of vaccination efforts. Dr. Adam Ratner, a pediatric infectious disease specialist, warned: “We are in great danger of losing our measles elimination status, if not this year, then almost certainly in the coming years.”
The consequences extend far beyond measles itself. As public health experts note, measles serves as “the canary in the coalmine”—its resurgence exposes populations vulnerable to all vaccine-preventable diseases. With vaccination rates at 92.5% nationally, below the 95% threshold needed for community protection, and some communities far lower, the infrastructure to respond to other outbreaks has been critically weakened.
Former CDC official Dr. Umair Shah, now at Colby College, summarized the long-term impact with sobering clarity: “These cuts will mean that when the next health crisis comes along, precious days, weeks, months will be spent getting ready when we should have been ready.”
The true number of measles cases in America may never be known with certainty. What is certain is that the systems designed to track, contain, and prevent disease spread have been systematically dismantled, by officials who didn’t understand—or didn’t care to understand—what those systems did or why they mattered. The measles epidemic of 2025 is not just a public health crisis; it’s a monument to the dangers of governing through ideology rather than expertise, and making cuts without comprehending the consequences. As cases continue to climb and surveillance continues to fail, one thing is clear: the real numbers are worse than we know, and our ability to do anything about it has never been weaker.
Josh Powell is a healthcare writer, consultant, and former CEO of a leading multidisciplinary surgical center in New York. Most recently, he served as Project Manager for Columbia University’s NIH-funded HEALing Communities Study, addressing the opioid epidemic through evidence-based interventions.
His book, “AIDS and HIV Related Diseases,” published by Hachette Book Group, established him as an authoritative voice in healthcare. Powell’s insights have appeared in prestigious publications including Politico and The New England Journal of Medicine. As a recognized expert, he has been featured on major media outlets including CBS, NBC, NPR, and PBS.
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References
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Copyright Notice
Most people in the US have never experienced an epidemic outbreak other than COVID. They have never actually seen a case of chickenpox or measles. The current trend of questioning the importance of vaccines is quite troubling. My sister-in-law was exposed to anti-vaxers during the COVID-19 epidemic, so she decided not to get vaccinated. She got COVID and passed away--very sad but preventable.