*Article Originally Published in the May issue of the Great Plains Tribal Health Magazine
Measles was pronounced “eliminated” in the United States twenty-five years ago. Yet immunity gaps on the Northern Plains have welcomed the virus back, threatening elders, disrupting clinics, and exposing cracks in our public health shield. How did we beat measles once? Why is it resurging now? What will it take to stamp it out again?
On a frigid February afternoon in 1757, Scottish physician Francis Home drew blood from a feverish child and, decades before germs had a name, proved that measles travels in the bloodstream. Fast‑forward two and a half centuries, and that same virus has slipped back into the United States, fueling its largest surge since 2019.
Over the past 12 months, the country has logged 1,085 confirmed infections across 25 states: 285 cases in calendar year 2024 and another 800 between January 1 and April 17, 2025. Most of this acceleration stems from a single multi-state outbreak rooted in low vaccination enclaves of New Mexico, Oklahoma, and Texas, which together account for 82 percent of 2025’s cases. Roughly one in eight patients has required hospitalization and at least two people have died.
While nearly every index infection arrived with an international traveler, the virus has flourished wherever local MMR coverage falls below the 95 percent herd immunity threshold—especially inside tightknit rural and faith-based communities whose “immunity valleys” give it room to run.
Herd immunity (also called community immunity) is reached when enough people are protected—through vaccination, prior infection, or both—that a virus struggles to find new hosts and transmission fizzles. Because measles boasts a basic reproduction number (R₀) of 12–18, roughly 95 percent of the population must carry two dose MMR immunity to create this protective firewall. Viruses with lower R₀ values, such as seasonal influenza, require far less coverage to stall.
If the pattern holds, the Great Plains could be next. Vaccination rates in many reservation schools hover well below the 95 percent mark—and in some classrooms dip below 50 percent—setting the stage for a single imported case to erupt into a community‑wide emergency.
For Native nations, the stakes are painfully familiar. In the pre-vaccine era, measles was a leading killer of Native children: during one bitter stretch in southwestern Alaska (1960–62), it contributed to nearly half of all post-neonatal deaths. Reservation epidemics rippled through the Dakotas during the 1970s, a stubborn outbreak lingered on a Montana reservation in the 1980s, and a 1991 surge on the Navajo Nation forced the evacuation of overcrowded IHS wards. Even during the 1989–91 nationwide resurgence, American Indian infants were hospitalized at markedly higher rates than their non-Native peers.
“EVERY CHILD BY FIFTEEN” – LIFE BEFORE THE SHOT
When measles became a nationally notifiable disease in 1912 it killed an average of 6,000 Americans every year. By mid-century, it was a near-universal childhood rite; CDC historians estimate that in the late 1950s, the virus infected 3–4 million people annually, hospitalizing 48,000 and leaving 400–500 dead. Lakota elders still recall the “red‑rash winters” of the 1940s, when cough and conjunctivitis raced through snow-locked communities before the roads reopened.
Relief arrived in 1954, when virologists John Enders and Thomas Peebles isolated the pathogen from 13-year-old David Edmonston. A first-generation attenuated vaccine was licensed in 1963; an improved strain followed in 1968, and the combined measles–mumps–rubella (MMR) shot debuted in 1971. Vaccination rewrote the epidemiology textbooks: U.S. cases fell 99 percent within a decade, and by 1983, measles deaths dropped to fewer than one per million citizens.
On March 27, 2000, the CDC declared measles “eliminated” in the United States—meaning the virus no longer circulated continuously. Yet elimination was never eradication; imported sparks could still ignite outbreaks wherever community immunity had thinned.
MEASLES & CONGENITAL SYPHILIS: PARALLEL CRISES
Today, the Great Plains Tribal Epidemiology Center is responding to two fronts at once. Syphilis—especially its congenital form—has risen sharply across Indian Country, prompting an urgent parallel alert. Measles and syphilis are biologically different (viral versus bacterial), yet their modern surges share root drivers: under-resourced clinics, stigma, and uneven prevention infrastructure. The same toolkit that contains measles—rapid contact tracing, pop-up vaccination or testing clinics, and culturally grounded education—can blunt congenital syphilis as well.
LOOKING AHEAD: FRAGILE VICTORIES, SHARED RESPONSIBILITY
As this edition goes to press (May 5, 2025), the nation stands one traveler—and one under-vaccinated community—away from eclipsing the 2019 measles record. For the tribes of the Great Plains, the stakes are higher still: a single case can shutter clinics, divert scarce staff, and endanger elders who carry language and ceremony.
The measles vaccine is an elder in its own right—62 years old this spring. Its power rests, as ever, on the collective embrace. The virus is unforgiving yet predictable; our defense was engineered in 1963, refined in 1968, and tested by generations. All that remains is the will to use it.
