Once declared eliminated in the U.S., measles has now reemerged with over 1,000 cases across 31 states, threatening the health infrastructure. The measles outbreak does not represent a health crisis but signals a flawed structure of governance in the Trump administration, especially his health policies. Once eliminated, the disease was revamped due to flawed administration and poor policy implementation, including declining vaccination rates, rising vaccine hesitancy, and fragmented public health governance. All of these flaws combined to create perfect conditions for the eradicated disease’s return. At the heart of this crisis is the Trump administration’s approach to public health, marked by funding cuts, institutional recalibration, and inconsistent management. This article looks into Trump-era health governance machinery through a policy lens to identify policy faultlines and bureaucratic failures that aided the return of measles in the U.S.
Understanding the Outbreak: From Elimination to Resurgence
Measles was declared eliminated in the U.S. in 2000, a milestone achieved due to high national vaccination rates, vaccine drives, and effective public health coordination. However, the year 2025 witnessed a decline in vaccination rates of MMR (Measles-Mumps-Rubella). MMR witnessed a national average of 91.5% in 2022 to 84.3% by early 2025, according to the National Immunization Survey, significant enough to compromise the herd immunity across the U.S. This drop was especially sharp in some states due to a lack of mandates.
As Dr. Anthony Fauci warned in 2019, “A drop below the herd immunity threshold for measles could easily trigger a national health crisis.” Moreover, the U.S. fell victim to vaccine hesitancy: people, influencers, and media questioned the safety of vaccine protocols and their effects on the human body. Fake media propaganda added fire to the fuel, with people refusing to get vaccinated and boycotting.
Many states allowed non-medical exemptions, both philosophical and religious, to vaccines, with no federal efforts to coordinate a rollback on such loopholes. As a result, measles came back as a national public health concern, with over 1,000 cases across 31 states being reported. Notably, many of these cases were concentrated in regions with strong anti-vaccination sentiments, including areas of Texas, California, and New York.
Policy Gaps and Federal Failures: Trump Administration’s Response
The Trump administration is responding to the outbreak in various ways, trying to justify its incompetence.
Weak Federal Oversight and Decentralized Management
Weak Federal Oversight and the decentralized response of the Trump administration played a major role in the outbreak of the disease. No vaccination mandates left states with widely varying rules and allowed exceptions for non-medical reasons. The trump administration refused to impose federal standards. The CDC guidelines exist but were not backed by federal enforcement, leading to vaccine gaps. In the absence of a binding federal framework, containment strategies varied wildly, with some states enforcing robust mandates while others allowed anti-vaccine sentiment to shape public health decisions.
The result was a patchwork of policies that failed to effectively contain the outbreak. Between 2023 and 2025, the CDC immunization program funding dropped by 17%, with the Vaccines for Children program alone losing over $380 million, according to the Congressional Budget Office’s 2025 Public Health Funding Review.
Absence of Proactive Communication
Absence of proactive communications further fueled the fire, with no nationwide campaigns to counter vaccine misinformation. Trump and his cabinet remained silent on the matter and did not address any anti-vaccination campaigns, losing the opportunity to build their trust in the marginalized community. Without credible voices at the federal level to counter misinformation, the administration left the field wide open for conspiracy theories and pseudoscience. In 2023, a Pew Research Center survey found that 28% of U.S. adults expressed skepticism about vaccine safety, up from 14% in 2016.
Public Health Funding Cuts
Trump’s second term was followed by large cuts to public health funding and is marked by a significant reduction in the CDC budgets, especially the immunization programs and Vaccines for Children (VFC) reach and support. These cuts in the public health sector led to understaffing, limited vaccine outreach, and almost no incentives for immunization programs. Public health institutions, already strained by the scale of the outbreak, were further hobbled by these financial constraints. The absence of federal support led to logistical breakdowns, especially in underserved areas, and delayed critical responses.
Institutional Recalibration Without Strategic Clarity
Institutional recalibration and proper administration contributed to the widespread outbreak of the disease. Trump dissolved major pandemic and vaccine advisory boards of the U.S. and replaced them with the “Administration for a Healthy America” to centralize health efforts and programs, but it seems to have failed due to a lack of a clear mandate, a flawed system of state-centered coordination, and a lack of top-tier scientific advisors.
Politicization of Public Health
A major criticism of Trump is the politicization of the public health system, which left the health sector in the doldrums. A major mishandling is the appointment of Robert F. Kennedy Jr., widely known for anti-vaccine views, to the health sector. Public trust in the health sector eroded due to contradicting views of health officials. It further radicalized anti-vaccination campaigns all around the U.S. This controversial decision alienated scientific communities and further eroded public trust in official guidance.
A Reactive Administration
The Trump cabinet is marked as a reactive rather than a proactive government, with no proper statements from the government. Statements from federal leadership were sparse and vague, reflecting a broader trend of disengagement. Even after more than 1,000 reported cases, the administration refused to declare it a public health emergency, and states are forced to address this escalating situation alone. With no federal control, it is resulting in fragmented containment strategies.
Policy Alternatives: The Blueprint for Stability
Given the resurgence of measles and the evident gaps in the federal response, a set of well-structured, centralized policy reforms is imperative to restore public health resilience. The following steps must be taken to address the outbreak effectively:
- First and foremost, the federal government should launch a centralized vaccination plan with minimum immunization standards, strong federal funding tied to compliance, and outreach in low-coverage states and communities.
- To combat vaccine misinformation, the federal government must launch nationwide mandatory public campaigns through social media, TV, and radio to address the misinformation and public fears regarding the use of vaccines.
- There is a dire need for the trump administration to work on strengthening the CDC and Local health departments and restore the funding of the CDC’s immunization programs while investing in state-level vaccination tracking and distribution systems, along with mobile vaccination units.
- The center needs to tighten non-medical exemptions by revoking religious and philosophical exemptions. Moreover, the federal government must implement evidence-based exemption policies like California’s SB277 model, which successfully closed loopholes that enabled avoidable outbreaks.
- To streamline coordination and response, the Trump administration must focus on creating a federal outbreak task force under the HHS to monitor vaccine-preventable disease deaths, effectively coordinating with state/local health departments, and improving rapid response to regional outbreaks.
- Lastly, the “Administration for a Healthy America” must ensure that the public health leadership is science-driven, not politically motivated, to ensure that consistent and credible public health messaging comes from credible voices, not conflicting narratives. It will help rebuild public trust and prevent the fragmentation of health narratives that contributed to the current crisis.
Lessons for Governance and Policymaking
The outbreak of measles not only reflects faultlines in science or medicine but also uncovers a shameful structure of policy coordination, funding, and leadership. Lack of timely federal action leads to a fragmented and unequal response. The fragile health sector of the U.S. needs central support to thrive. The U.S. state autonomy requires federal guidance to ensure at least a minimum health standard, especially during this measles epidemic. Moreover, when individual ideology replaces scientific research, individual trust erodes as policy decisions must be evidence-based, with space for experts to lead. Similarly, effective communication between the states and the center is important in building trust; silence from the Trump administration has further fogged the situation.
Conclusion
In a nutshell, the measles resurgence in the U.S. was avoidable. It exposed the policy gaps, institutional derailment, and underinvestment in the public health sector. All this leads to a bigger picture that reiterates broader implications: if an eliminated disease can return, the system needs urgent reforms. The U.S. and other nations must learn that a nation’s health is not only dependent upon medical breakthroughs, but it requires strength from its key institutions to work properly. The health sector and its policies cannot be sustained for an extended period without effective administration. It demands resilient institutions, coherent policies, and proactive governance. Without these foundations, even the most advanced healthcare systems remain vulnerable. For the U.S. and the global community, this crisis must catalyze urgent and lasting reform.
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Areeba Imran is a third-year law student at Pakistan College of Law with a focused interest in constitutional law, environmental law, and the emerging field of space law. She serves as the general secretary of the Environment and Law Society and has interned at the Advocate General’s Office. Through her writing, Areeba aims to contribute to nuanced legal discourse on both national and global platforms.