A new non–peer-reviewed study estimates that measles outbreaks in the United States cost more than $244 million in 2025 alone and warns that even modest declines in childhood measles, mumps, and rubella (MMR) vaccination could trigger billions of dollars in additional losses over the next five years.
MMR vaccine coverage among US kindergarteners has fallen steadily since the 2019–20 school year, alongside a national resurgence of measles. In 2025, the United States recorded its highest annual measles count since 1992, at 2,280 cases.
For the study, published on the preprint server medRxiv, researchers lead by a team from the Yale School of Public Health used county-level MMR coverage data and mathematical models that predict disease spread to quantify the economic burden of measles under current conditions and amid continued declines in vaccine uptake.
If 2025 vaccination rates remain unchanged, the model estimated 2,181 measles cases (50% high-density interval [HDI], 719 to 8,176), 554 hospitalizations (50% HDI, 196 to 1,927), and five deaths (50% HDI, 2 to 17) in 2025, corresponding to an estimated cost per case of $104,629 and an overall economic burden of $244.2 million.
Outbreak response activities, including contact tracing, testing, and post-exposure vaccination, accounted for roughly two-thirds of total costs (65.2%; 50% HDI, 62.5% to 66.9%), followed by productivity losses from missed work and school (32.1%; 50% HDI, 30.1% to 34.8%). Direct medical expenses represented a much smaller share (3.0%; 50% HDI: 2.7% to 3.2%).
Annual costs could climb to $1.5 billion in 2030
The researchers found that economic impact varied substantially by geographic region. Median county-level cost per case was $85,637, and costs were strongly and inversely correlated with population immunity. Counties with lower MMR coverage not only faced higher outbreak risk but also higher per-case costs.
To examine the consequences of declining vaccination rates, the team modeled scenarios in which MMR coverage among children ages 0 to 6 years drops by up to 1 percentage point annually over 5 years.
In the 1% annual-decline scenario, cases were projected to rise more than sevenfold by 2030, reaching 17,232 (50% HDI, 9,177 to 26,428), with 4,085 hospitalizations (50% HDI, 2,184 to 6,210) and 36 deaths (50% HDI, 19 to 54). Annual costs would climb to an estimated $1.5 billion in 2030, with cumulative costs totaling $7.8 billion over five years. Even smaller annual declines of 0.25% to 0.5% produced steadily increasing burdens, the authors report.
The authors caution that their results likely underestimate the true economic and societal burden of measles outbreaks, because they did not account for rare long-term complications after acute infection or fully capture the risks for vulnerable populations, including infants, young children, and older adults.
Vaccine prevented an estimated 85,000 deaths in 3 decades
The researchers conclude that continued erosion of MMR coverage threatens to reverse decades of progress against measles and will impose rapidly escalating health and economic costs if not reversed.
“Between 1994 and 2023, measles vaccination prevented an estimated 104 million cases and 85,000 deaths in the US,” they write.
“Continued erosion of MMR coverage threatens to reverse these gains, imposing substantial and rapidly escalating health and economic costs. Sustained investment in vaccination policy, public health infrastructure, and global immunization efforts is therefore paramount to protect population health and alleviate the socioeconomic impact of measles.”
