Measles Outbreaks Cause Financial, Public Health Burden in US – The American Journal of Managed Care® (AJMC®)

Report on the Economic and Public Health Impact of Measles Outbreaks in the United States

Introduction: A Challenge to Sustainable Development Goal 3

A 2025 review indicates a significant resurgence of measles in the United States, presenting a direct challenge to the achievement of Sustainable Development Goal 3 (Good Health and Well-being). The increase in outbreaks, driven by declining vaccination rates, reverses previous public health successes and undermines SDG Target 3.3, which aims to end the epidemics of communicable diseases. This report summarizes a systematic review assessing the financial and public health costs associated with measles outbreaks in the U.S. over the past 25 years, highlighting the economic and societal burdens that impede sustainable development.

Systematic Review Methodology

A systematic review was conducted to quantify the costs of measles outbreaks. The methodology involved:

• A search of the PubMed database for studies published between January 1, 2000, and October 7, 2025.
• Inclusion of English-language studies containing data on measles cases, outbreak response, and associated costs within the 50 U.S. states.
• Separate examination of publicly available government records (gray literature).
• Extraction of data points including the number of cases, total costs, cost per case, and cost per contact. All costs were adjusted to 2024 U.S. dollars for inflation.

Key Findings: The Economic Burden of Communicable Disease

The review identified 18 studies and 51 additional data points, revealing a substantial number of cases and significant economic consequences. As of October 7, 2025, a total of 1,563 measles cases were reported across 41 states. The financial burden of managing these outbreaks directly impacts resources that could otherwise be allocated to strengthening health systems, a core component of SDG 3.

Notable outbreak costs include:

• Texas: The largest outbreak with 802 cases, incurring an estimated cost of $10 million.
• New York City (2018-2019): An outbreak of 649 cases cost an estimated $10.6 million.
• Clark County, Washington: An outbreak of 71 cases resulted in costs of $4.3 million.

These figures demonstrate that preventable disease outbreaks divert significant financial resources, affecting economic stability and progress toward SDG 8 (Decent Work and Economic Growth).

Analysis of Costs and Impact on Health Systems

The financial impact of measles outbreaks is multifaceted, imposing high fixed and incremental costs on government, healthcare providers, and society. This strain compromises the ability to achieve SDG Target 3.8 (Universal Health Coverage) by consuming essential budgetary resources.

1. Cost Per Case: The mean cost per case was estimated at $43,203.65, with a wide range from $6,973.10 to $243,614.79, depending on the outbreak’s scale and location.
2. Cost Per Contact: The mean cost for contact tracing and management was significantly lower at $443.46 per contact.
3. Productivity Loss: Societal costs, such as lost productivity, are substantial but understudied. A single study from Clark County estimated productivity losses at over $1.3 million, or $18,065.61 per case.
4. Public Health and Provider Costs: The mean cost for outbreak response and healthcare provider expenses was estimated at $556,583.01 per outbreak.

Vulnerable Populations and Health Equity

Measles poses a heightened risk to vulnerable populations, including infants, children under 5, pregnant women, and individuals with weakened immune systems. The disproportionate impact on these groups highlights inequities in health outcomes, a critical concern for SDG 10 (Reduced Inequalities). Ensuring high vaccination coverage is essential to protect these individuals and uphold the principle of leaving no one behind.

Study Limitations

The review noted several limitations that affect the complete quantification of the burden of measles:

• Heterogeneous reporting of costs across different studies.
• Insufficient detail in cost breakdowns.
• Underrepresentation of societal costs, such as productivity loss.
• The preliminary nature of the 2025 case data.

Conclusion and Recommendations for SDG Alignment

Measles outbreaks impose a significant and preventable financial and public health burden on the United States. These costs directly hinder progress toward key Sustainable Development Goals, particularly SDG 3. The findings underscore that widespread measles vaccination is not only a critical public health intervention but also a cost-effective strategy for protecting economic stability and ensuring sustainable development. Enhanced data collection on the full economic impact of outbreaks is necessary for improved budgetary planning and to demonstrate the value of investing in vaccination programs to achieve global health and development targets.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: This is the primary SDG addressed. The article focuses on the resurgence of measles, a communicable disease, and its impact on public health. It discusses the importance of vaccinations for prevention, the complications of the disease, and the strain it places on healthcare systems. The core theme is about ensuring healthy lives and promoting well-being by combating a preventable disease.
• SDG 8: Decent Work and Economic Growth: This SDG is connected through the economic consequences of the measles outbreaks. The article explicitly mentions the financial burden on the government and healthcare providers. It also quantifies “productivity loss” in one of the cited studies, directly linking the public health crisis to economic impact and the ability of individuals to work.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
     
     Explanation: The article directly addresses this target by focusing on outbreaks of measles, which is a highly contagious communicable disease. The text states that the US had previously “declared that measles was eliminated in the country in 2000, but outbreaks have been appearing,” highlighting the challenge of controlling and ending the spread of such diseases.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
     
     Explanation: The article’s emphasis on the “widespread use of measles vaccinations” points to the access to vaccines component of this target. Furthermore, the extensive discussion of the “financial and public health strain” and the high “cost per case” (ranging from $6,973.10 to $243,614.79) underscores the issue of financial risk protection, as these costs are borne by the government, healthcare systems, and society.
   • Target 3.b: Support the research and development of vaccines and medicines for the communicable and non-communicable diseases… provide access to affordable essential medicines and vaccines…
     
     Explanation: The entire premise of the article revolves around a vaccine-preventable disease. The problem described—an uptick in measles outbreaks—is a direct result of a “decrease in vaccination rates.” This connects directly to the goal of ensuring access to and utilization of essential vaccines.

2. SDG 8: Decent Work and Economic Growth

   • Target 8.5: By 2030, achieve full and productive employment and decent work for all women and men…
     
     Explanation: This target is relevant due to the article’s mention of the economic impact of the disease. The article specifically notes that “Productivity loss was only estimated in 1 study, where the estimated productivity loss in Clark County totaled $1,300,716.21.” This loss of productivity directly impacts the achievement of full and productive employment.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for SDG 3 Targets

   • Indicator for Target 3.3: The number of measles cases. The article provides specific data points that can be used as a direct measure of the incidence of a communicable disease. For example, it states, “A total of 1563 measles cases had been reported through October 7, 2025.” This serves as a direct indicator of the scale of the outbreak.
   • Indicator for Target 3.8: The financial cost of outbreaks. The article provides detailed financial data, such as the “mean cost per case was estimated at $43,203.65” and the total cost in Texas was “$10 million.” These figures act as indicators of the financial burden on the health system, which is a key component of universal health coverage and financial risk protection.
   • Indicator for Target 3.b: Vaccination rates. Although the article does not provide specific percentages, it explicitly states that the cause of the outbreaks is a “decrease in vaccination rates.” Therefore, the vaccination rate is a crucial implied indicator for measuring access to and use of essential vaccines.

2. Indicator for SDG 8 Target

   • Indicator for Target 8.5: Productivity loss due to illness. The article explicitly mentions this as a measured outcome in one study: “the estimated productivity loss in Clark County totaled $1,300,716.21, or $18,065.61 per case.” This is a direct economic indicator of how disease outbreaks affect productive employment.

4. Summary Table of SDGs, Targets, and Indicators

Source: ajmc.com