| Last week, Taiwan reported three new cases, including two imported from Vietnam, where about 90,000 infections have occurred over the past year. The deadly surge there, like in many places, stems from a pandemic-era lapse in routine pediatric immunizations. In Mexico, new infections are being traced back to the US, as a spiraling outbreak in the Texas Panhandle spills across borders. And in Europe, countries like France, Belgium, and the Netherlands are seeing cases tied to a historically large outbreak in Morocco. While a widening outbreak in west Texas is capturing headlines in the US, measles is now sickening people in every region of the world. In the first quarter of 2025, more than 32,000 suspected and confirmed cases were reported across 132 countries, according to the World Health Organization. None of this surprises Walter Orenstein, a former US assistant surgeon general who led the national immunization program from 1988 to 2004 — including the period when the US officially declared measles eliminated. “The US was certified to have eliminated measles in 2000, meaning there was no sustained transmission for over a year,” Orenstein told me. “But over the years, we’ve had multiple importations, and our goal needs to be not getting the importations.” That means strengthening global surveillance and vaccination efforts, so countries can identify problems early and take action to prevent exportation. The threat isn’t limited to international visitors, either. “They were also from potentially unvaccinated or inadequately vaccinated US people who travelled to these countries and then come back,” he said. Since starting his career at the US Centers for Disease Control and Prevention in 1974, Orenstein has seen the same cycle repeat: outbreaks drive investment in immunization, cases decline, and then attention fades — until the next resurgence. In February, just weeks after Donald Trump returned to the White House and announced new cuts to foreign aid and a renewed withdrawal from the WHO, the Geneva-based agency warned that its global measles and rubella laboratory network — previously funded entirely by the US — was on the brink of collapse. The risk of losing such infrastructure is precisely what happens when prevention efforts become victims of their own success — quietly working until they’re no longer visible, or funded. “With a successful prevention program, you don’t see these diseases at all. You’re not really understanding what benefits you’re getting,” he said. “And that’s why there needs to be an investment not only in buying the vaccines, but in implementation science. How do we enhance uptake? My favorite line is vaccines don’t save lives. Vaccinations save lives.” “Vaccines don’t give themselves,” Orenstein added. “You need the right message delivered by the right messenger through the right communications channel, and we need to invest in that.” About 95% of a population needs to be immunized to prevent community transmission of measles, a virus that can linger in the air for up to two hours after an infected person breathes, coughs, or sneezes. Orenstein prefers the term “community protection” over “herd immunity,” which he believes is more relatable. “When you have high levels of immunity in the community, you can protect people who can’t be vaccinated — people with compromised immune systems that can’t make a protective response.” That, he said, is why it’s essential to overcome hesitancy through engagement and education. “We need to invest in the implementation science side. How do we effectively educate the public as to why getting vaccinated for themselves and their children is so important?” With importations on the rise and immunity gaps widening, experts warn that even countries like the US — once certified measles-free — risk losing their elimination status if complacency continues. — Jason Gale | 
