In early 2025, as measles began to tear through West Texas, Katherine Wells knew she needed money.

Though the outbreak was concentrated in Gaines County, a community an hour away, Wells, who heads Lubbock’s public health department, needed more staff to respond to numerous exposures at local pediatricians’ offices, urgent care centers, restaurants and day cares.

“We were really relying on staff that aren’t hourly, because I can work them for 80 hours if I have to, which is horrible,” Wells said. In emergency planning meetings with the Texas Department of State Health Services, she pleaded for roughly $100,000 to hire temporary workers to help her exhausted staff.

“I was like, can I just have money so that if I need a few hours of work from a retired school nurse who we’ve worked with before, I can just pay them?” Wells said.

The answer, she said, was consistently “no.” The state did send a few travel nurses from other areas to help, but no extra funding.

To stop a measles outbreak from escalating out of control, public health workers have to snap into action, contacting every person exposed to the virus as fast as possible, determining their vaccination status or health risk, and then try to woo them into either getting vaccinated or staying home for three weeks in quarantine.

Wells pulled at least half of her staff to work the outbreak response on top of their other daily duties.

What’s the real cost of a measles outbreak?

Wells couldn’t estimate what it cost the Lubbock Health Department to contain the virus before the outbreak, which began in a mostly unvaccinated Mennonite community in late January of last year, ended months later.

Since 2019, more than two-thirds of counties and jurisdictions have reported notable drops in vaccination rates, an NBC News/Stanford University investigation found. Among states that track MMR rates, more than half their counties — 67% — fall below the level needed to stop a measles outbreak.

An alarming new report calculates the price tag for the U.S. if those rates continue to fall.

If measles vaccination rates continue to drop just 1% annually for the next five years, the cost to the U.S. could reach $1.5 billion a year, according to a new report from the Yale School of Public Health.

Armed with existing county-level vaccination coverage data, Yale researchers used mathematical models to calculate predicted increases in measles cases, hospitalizations and their associated medical and societal costs.

Based on their projections, $41.1 million would be needed each year to cover patients’ basic medical needs, including health insurance, and $947 million for public health response efforts such as surveillance and contact tracing. Lost productivity in the workforce, the report found, could reach $510.4 million each year.

Dr. Dave Chokshi, chair of Common Health Coalition, a nonprofit, nonpartisan public health group that partnered with Yale for the project, said a measles outbreak reverberates through all parts of “the health ecosystem.”

The human consequences of measles outbreaks “are important for us to face very squarely,” said Chokshi, who was previously health commissioner of New York City. “But we also wanted to make it clear that there are economic consequences, including employees absorbing lost work, public health departments that are stretched too thin to respond, and health care systems straining to shoulder the burden of emergency response.”

Measles was declared eliminated in the U.S. in 2000. Since then, outbreaks here and there have generally been stopped quickly. But backsliding vaccination rates have increased the risk of massive eruptions and now threaten the nation’s measles elimination status.

In late January 2025, as President Donald Trump was taking his second oath of office, measles cases were beginning to spread in West Texas. Under his presidency, following the guidance of Health Secretary Robert F. Kennedy Jr., the administration has not strongly endorsed vaccines as a way to end such outbreaks.

Instead, the messaging on childhood vaccination has focused on “personal choice” rather than public health necessity.

In the first two months of 2026, there have been more than 1,000 confirmed cases of measles, nearly half of the 2,281 in all of 2025. Ninety-four percent of the people infected were unvaccinated.

According to a recent analysis from Johns Hopkins Bloomberg School of Public Health, the initial financial hit to a community from a measles outbreak is about $244,480. That’s the money local and state public health departments can expect to pay for resources like vaccine clinics and staffing until the outbreak is over, said study author Bryan Patenaude, an associate professor of health economics.

“We know the ingredients that go into dealing with a measles outbreak, how many cases wind up becoming severe and seeking care, because they have to be really well-traced and documented,” Patenaude said.

The report, which was posted in October on medRxiv, a site that releases research before it’s gone through peer review, tracked measles outbreaks in 18 states since 2004 (not including the 2025 cases in Texas, Utah and Arizona).

On top of the upfront cost, each additional case of measles averages $16,000 a pop for contact tracing, medical expenses and quarantine monitoring. Five measles cases could reach $324,480, while an outbreak of 50 might cost $1 million, the Johns Hopkins report estimated.

In 2019, Clark County, Washington, experienced an outbreak of 72 measles cases. Health officials spent hours making certain that people adhered to quarantines.

“We brought in staff from the state, the CDC, even from other jurisdictions as far away as Idaho to help us with the case investigation and contact tracing,” said Dr. Alan Melnick, the public health director for Clark County. The team contacted people who were quarantined every day. Ultimately, 87% of subsequent measles cases occurred among people who’d been quarantined, Melnick said.

An assessment found that productivity losses from the relatively small outbreak in Clark County soared to over a million dollars.

The measles vaccine is free in the U.S.

“The public should be aware of what a good deal vaccines are,” Melnick said, “because they save a lot of money in addition to saving lives.”

As a former California legislator, pediatrician Dr. Richard Pan helped strengthen state vaccine requirements following a 2015 measles outbreak linked to Disneyland. “People need to recognize that there’s a tremendous cost to these outbreaks,” he said. “That cost, by the way, is being borne by American families.”

South Carolina is wrestling to contain the country’s largest single outbreak in more than a generation. Spartanburg County has been on high alert since fall, with at least 1,000 cases and possible exposures in fast food restaurants, stores, medical clinics and a government office.

The South Carolina Department of Public Health wouldn’t divulge how much contact tracing, mobile vaccine clinics and increased staffing have cost.

A department official said the Centers for Disease Control and Prevention had approved a request to redirect several hundred thousand dollars previously allocated for emergencies.

“Additionally, South Carolina requested and received $100k from CDC available for vaccine-preventable disease responses,” Louis Eubank, deputy incident commander for the South Carolina Department of Public Health, said in a statement to NBC News. “South Carolina and the CDC continue to discuss additional funding needs and resource support.”

A senior official at the U.S. Department of Health and Human Services said the CDC sent $8.5 million to seven areas of the country experiencing measles outbreaks over the past year, but declined to say where or give additional details.

“Amounts were awarded based on requests from the state or local health agency and availability of funding at CDC,” the person said.

As the South Carolina outbreak spilled over into North Carolina, Dr. David Wohl, a global health and infectious disease specialist at the University of North Carolina at Chapel Hill, has scrambled to prevent a surge beyond the 23 cases already confirmed.

“There’s so many people working on this in my health care system,” Wohl said. “I can’t tell you how many calls, how many hours, how stretched people are.”

Intangible, indirect costs

The potential economic burden of measles outbreaks is easily calculated. The personal cost of having children unprotected against the world’s most contagious virus is impossible to measure.

Hundreds of people infected with measles over the past year — more than 1 in 10, according to the CDC — have been hospitalized with dangerously high fever, pneumonia, trouble breathing and dehydration.

Mothers and fathers have spent countless, blurry hours by their child’s bedside. Most recovered. Some are left with the long-term consequences of encephalitis — inflammation of the brain that can lead to seizures, blindness, deafness and learning disabilities.

Rarely, measles can hide in the body for a decade before re-emerging by attacking the brain and nervous system. The condition, called subacute sclerosing panencephalitis, is almost always fatal.

Two little girls in Texas, ages 6 and 8, died of measles much sooner, within weeks of their diagnosis.

While the economic consequences of measles outbreaks are real, the human impact cannot be ignored, Chokshi said. “Behind every number is a child struggling with a devastating illness, or a family reckoning with an unexpected hospitalization, and, in the worst circumstances, a death or a long-term consequence from what is a preventable disease.”