Two peer-reviewed research reports published in quick succession reach the same sobering conclusion about why some measles outbreaks are so difficult to control — and what it means for the outbreaks still active across the United States right now.
A CDC-led Notes from the Field report in the Morbidity and Mortality Weekly Report examining the 2025 West Texas measles outbreak and a paper published in the journal Vaccine on the 2025–2026 South Carolina school-based outbreak both identify community distrust of outside institutions as a significant obstacle to effective outbreak response — one that low vaccination rates alone do not fully explain. Both reports also conclude that maintaining high vaccination coverage remains the most effective intervention for preventing measles and limiting its spread.
Why This Matters
Vaccination rates are the most widely discussed variable in measles outbreak coverage — and they matter enormously. The mathematical reality is clear: two-dose MMR vaccination coverage above approximately 95 percent prevents sustained outbreaks by removing enough susceptible people that transmission chains reliably die out.
But the new reports identify a more granular problem: standard vaccination outreach and public health response approaches assume a baseline of institutional trust that is absent in some specific communities. When vaccination campaigns, door-to-door outreach, quarantine orders, and health department communications are perceived as threatening rather than protective — as they often are in communities with histories of government-related trauma, religious resistance to outside authority, or strong misinformation ecosystems — the standard public health playbook may produce resistance rather than cooperation.
That finding is directly relevant to understanding why the South Carolina 997-case outbreak (now resolved), the ongoing Virginia outbreak in Buckingham and Cumberland Counties, and the ongoing Pennsylvania outbreak in Lancaster and Lebanon Counties have been so difficult to contain despite significant resource investment.
What the Reports Found
The MMWR West Texas Analysis: The CDC-led MMWR Notes from the Field report examined why the 2025 West Texas outbreak — which ultimately seeded outbreaks in multiple other states and contributed to the national case surge — was so difficult to contain once established in the Mennonite community where it originated. The outbreak ultimately sickened 762 people, hospitalized 99, and killed two, with nearly all patients (97%) either unvaccinated or of unknown vaccination status. Local kindergarten MMR vaccination rates ranged from 77.3% to 94.6%.
The researchers found that standard health department outreach reached only a fraction of the potentially exposed population. As the authors write, "Many community members described their lack of trust in outside institutions and their reluctance to engage with public health and health care systems overall, based on an ethos within the community that prioritized maintaining independence from outside institutions and seeking solutions from within the community." This perspective, the researchers note, "complicated implementation of standard measles control measures and hampered epidemiologic investigations," leading investigators to believe the true case count was substantially higher than reported.
Despite 33 vaccination clinics and 16 testing clinics, only about 275 MMR doses were administered. The researchers conclude that early collaboration with trusted community members could help support more effective public health interventions.
The Vaccine Journal South Carolina Paper: The Vaccine journal paper, produced by Cornell University researchers, examined the 2025–2026 school-based outbreak in Spartanburg County, which saw 997 cases across 32 schools before being declared over in April 2026. Average two-dose MMR coverage at schools with measles exposures was 82.5%, compared with 91.0% at schools without exposures. Schools that required multiple rounds of quarantine had average vaccination rates of 77% versus 86% at schools needing only a single quarantine.
The paper found this pattern of repeated quarantines clustered in low-coverage schools to be especially concerning. Twenty-nine cases were also connected to a church, which the researchers note "mirrors dynamics observed in other US outbreaks" — faith communities with shared vaccine attitudes sustaining and amplifying transmission. The authors argue that quarantine should be viewed as buying time for vaccination rather than a mitigation strategy in itself. "Maintaining high vaccination coverage," they write, "is not only an infection control measure but a prerequisite for uninterrupted schooling, sustainable public health capacity, and the prevention of severe neurological complications."
Both papers specifically note that community-trusted messengers — local religious leaders, community health workers from within the affected group, and trusted primary care physicians already embedded in the community — were more effective at driving vaccination uptake than external health department campaigns, even well-resourced ones.
What This Means for Active Outbreaks
The finding is directly applicable to the active outbreaks still underway as of July 1, 2026.
Virginia's Buckingham and Cumberland Counties: The Virginia Department of Health expanded its measles outbreak to include Cumberland County on June 25, 2026, with 106 outbreak-associated cases reported in the Piedmont Health District and 129 statewide. The Texas and South Carolina research suggests that communities with below-threshold vaccination rates may require tailored trust-based outreach rather than additional amplification of standard public health messaging to reach the populations most at risk.
Pennsylvania's Lancaster and Lebanon Counties: Lancaster County's kindergarten MMR coverage of approximately 88.5 percent reflects a concentration of vaccine hesitancy within specific communities that have longstanding patterns of limited engagement with state health authorities. Pennsylvania DOH has confirmed 87 cases statewide in 2026, with 72 linked to the Lancaster-Lebanon outbreak. The new research suggests that local Mennonite and Amish community leaders may be more effective vaccination advocates than additional health department campaigns in these communities.
What Doctors and Experts Say
Public health researchers responding to the publications have emphasized that these findings do not suggest abandoning standard outbreak response — case isolation, contact tracing, and emergency vaccination campaigns remain essential. What the research suggests is that these tools work differently in low-trust communities and that community-embedded approaches need to be scaled up as rapidly as traditional methods.
Building trust in communities with longstanding institutional distrust is not a short-term project. Both papers acknowledge that the outbreak response window — often measured in weeks — is simply too short to build the relationship infrastructure needed. The implication for longer-term public health is that trust-building needs to happen before outbreaks begin, not during them.
What the Evidence Shows — and What It Does Not
MedicalDaily Evidence Check
- Reports: CDC-led MMWR Notes from the Field on the 2025 West Texas measles outbreak ; Vaccine journal paper on the 2025–2026 South Carolina school-based outbreak
- Central finding: Community distrust of outside institutions complicates outbreak control in specific communities — independent of whether those communities are uniformly opposed to vaccination in principle
- Primary conclusion of both reports: High vaccination coverage remains the most effective intervention for preventing measles
- What this does not claim: That vaccination rates are irrelevant; that standard outbreak response should be abandoned; that all communities share these dynamics
- What this adds: Systematic, peer-reviewed evidence that some communities require tailored trust-based approaches that standard public health frameworks do not currently provide at scale
What You Can Do Now
If you live in or near a community currently experiencing an active measles outbreak, the most direct action you can take is confirming your own and your family's MMR vaccination status and getting vaccinated if you are not up to date.
If you are a community leader, faith leader, or trusted local figure in an area with low vaccination rates, the research finding is directly addressed to you: conversations about vaccination from trusted community sources are demonstrably more effective than external public health campaigns in low-trust environments.
Follow your state health department's outbreak guidance — the Virginia Department of Health and Pennsylvania Department of Health have region-specific resources, including community vaccination clinic locations.
What Happens Next
Both research papers are now in the published literature and available for public health practitioners to incorporate into outbreak response planning. Whether their findings will be formally integrated into CDC outbreak response protocols in time to affect the current active outbreaks depends on how quickly state health departments adopt the trust-based supplementary approaches the research validates. The CDC's Measles Cases and Outbreaks page — which as of June 25, 2026 shows 2,134 confirmed U.S. cases this year, 93% outbreak-associated — is updated weekly. MedicalDaily will report on any CDC guidance updates that incorporate this research.
The Bottom Line
Two simultaneously published peer-reviewed reports reach the same finding: measles outbreaks in certain communities are being sustained not merely by insufficient vaccination rates but by structural community distrust of the institutions deploying standard outbreak response tools. Vaccination rates remain the primary target and the most powerful intervention — but the research validates what frontline responders in West Texas and South Carolina observed firsthand: that trust-based, community-embedded engagement is essential to reaching the populations most at risk, and that standard public health campaigns often cannot access those communities alone.
