Haunting memories of a child's measles death in rural Nepal take on new urgency as the disease surges across America with over 900 cases in just six weeks. A former immunization team leader warns that declining vaccination rates threaten to return the U.S. to an era of preventable childhood deaths.
The escalating number of measles infections in the U.S. brings haunting memories from the year I spent leading an immunization team in Nepal. I was trekking through a rural district without roads, electricity, or modern conveniences. We immunized kids under age five against diphtheria, tetanus, whooping cough, and tuberculosis, but a heat-stable measles vaccine was not yet available. Sadly, in those small villages the deadliest, most feared illness was measles. I wrote in my journal about a day I was called to see a child suffering from measles. We moved into the shadows of a low-slung house and stepped inside. An elderly woman sat on a mat, holding the now lifeless body of a small child, pale and still, in her arms. She was half-singing, half-crying an ancient sound of mourning, rocking him gently and fondling his face, arms, and legs. It was a painful sight, almost too difficult to witness. I took a deep breath, fighting back tears, an immense effort to keep my composure in the face of this tragic scene. “There’s the boy’s mother,” whispered the local health assistant, pointing with his chin to a younger woman weeping quietly next to the grandmother. In her arms was an older child, also suffering from measles. Other adults and children milled about the shadows of the room. Dust motes floated in the narrow beacon of sunlight streaming through one small window. We approached the two women with a deep namaste. “Kasto dukhha, Aama,” I said and bowed respectfully. So much pain. The child’s mother looked up with the saddest of eyes and nodded her acknowledgement. Before a vaccine was widely available, measles caused two to three million deaths around the world every year, most often among malnourished kids. The first measles vaccine required freezing and refrigeration at every point prior to injection, so it was years before a new formulation was available that could be used in areas without electricity. Even today, measles is still a leading cause of child death in poor countries, killing over 100,000 children annually. In pre-vaccine U.S., measles was an expected rite of passage for kids. “Just get it over with,” was the usual advice. During that era, around half a million U.S. kids came down with measles and roughly 500 of them died every year. When immunization programs were launched after 1963, the numbers gradually dropped to fewer than 100 cases a year by the late 1990s. But now -- it’s coming back. In 2025, more than 2200 cases were reported in the US, most in families with religious or other objections to immunizations. Three of them died. In only the first six weeks of 2026 over 900 cases have been reported, encompassing half the U.S. states. Among that group are many children of “anti-vaxxer” parents, who unknowingly put their children at risk by refusing the vaccine. Even college campuses are seeing a surge in infections because of generally lower immunization rates among incoming groups. Why such rapid spread? Measles is in fact one of the most infectious diseases we know: Just spending a few minutes in a room soon after a measles patient has left is enough exposure to lead to infection. Similarly, touching something contaminated by droplets from the sick person’s sneezing or coughing also will do it. We can combat deaths from measles with widespread vaccinations. “Herd immunity” for measles requires that 95% of susceptible people are vaccinated, and as coverage drops below that level, the risk of outbreaks increases. But the value of vaccines is apparently not understood by our Secretary of Health and Human Services, Robert F. Kennedy, Jr. Though without formal health training, Kennedy has expressed unverified concerns about the safety of many routine childhood immunizations. Before President Trump took office, the U.S. was a major supporter of organizations providing vaccines and other basic health interventions for children around the world. But funding for vaccines meant to save children’s lives was cut by the Trump administration, and other sources of support have been slow to emerge. The result: many families—some who live in the most impoverished places on earth—are on their own to provide for their children’s health. Vaccines prevent kids’ dying from measles and other infectious diseases. We must not return to the era of tragic, needless child deaths that I encountered in Nepal - which could return to this country, unless we safeguard the system that protects our most vulnerable.
About the author ~
Dr. Mary Anne Mercer is a University of Washington public health faculty member and author whose four-decade career has focused on maternal and child health in developing nations. Beginning with her transformative year providing immunizations in rural Nepal in 1978, she has developed health projects in 14 countries and authored books including Beyond the Next Village (2022) and Sickness and Wealth: The Corporate Assault on Global Health. Her recent work strengthening midwifery care through mobile technology in Timor-Leste has been adopted as a national program.
Dr. Mary Anne Mercer is a University of Washington public health faculty member and author whose four-decade career has focused on maternal and child health in developing nations. Beginning with her transformative year providing immunizations in rural Nepal in 1978, she has developed health projects in 14 countries and authored books including Beyond the Next Village (2022) and Sickness and Wealth: The Corporate Assault on Global Health. Her recent work strengthening midwifery care through mobile technology in Timor-Leste has been adopted as a national program.
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