The United States declared measles a reportable disease in 1912, meaning that all healthcare providers, laboratories, and hospitals were required to report cases. Prior to the availability of a vaccine, the CDC estimates that 3–4 million people in the U.S. contracted the virus each year, resulting in 400–500 deaths annually.¹  The very first measles vaccination was trialed in the late 1950s and early 1960s. Early studies showed remarkable results, with reports of 100% efficacy.

By 1963, the first measles vaccine was licensed for use in the U.S., and just a few years later, in 1968, the combined Measles, Mumps, and Rubella (MMR) vaccine became available. That history leads us to a critical public health question: How many people in a community must be vaccinated—or “immune”—to stop diseases like measles or pertussis (whooping cough) from spreading?

When we put on our infectious disease and epidemiology hats, we know that measles and pertussis are among the most contagious illnesses. Their “R-naught (R₀)”—the average number of people infected by one sick individual—is estimated at 15–18 for measles and 12–17 for pertussis. Using these numbers, scientists calculate the “community immunity threshold.” For measles, 93–95% of the population must be immune to transmission. For pertussis, the threshold is 92–94%.

According to the CDC, nationwide vaccination coverage among children entering kindergarten declined during the 2024–2025 school year. Completion of the Measles, Mumps, and Rubella (MMR) series fell from 92.7% to 92.5%, while completion of the Diphtheria, Tetanus, and Acellular Pertussis (DTaP) series decreased from 92.3% to 92.1%.^2-4

Where does Michigan stand in terms of childhood immunization rates?

As the new school year begins, and with the country facing both measles and pertussis outbreaks, where does Michigan rank with childhood vaccination uptake?  The table below shows states with statistically significant gaps in child vaccination rates by race and ethnicity, 2019–2021.⁵ Michigan is among those with substantial gaps.

State	White	African American/Black	Hispanic/Latino	Other/Multiple Races
United States	75.50%	66.5%*	69.9%*	72.8%*
Dist. of Columbia	82.50%	68.1%*	62.1%*	70.80%
Georgia	75.20%	57.8%*	69.80%	70.80%
Illinois	79.30%	61.3%*	66.9%*	75.90%
Indiana	73.10%	66.00%	59.1%*	70.40%
Louisiana	70.10%	58.5%*	69.30%	71.90%
Maryland	84.50%	75.7%*	71.4%*	77.70%
Michigan	79.30%	49.8%*	76.70%	72.80%
Nevada	76.40%	55.8%*	73.20%	72.70%
New Jersey	76.10%	N/A	59.6%*	72.20%
New Mexico	76.60%	N/A	67.7%*	72.60%
New York	69.80%	69.00%	67.00%	79.5%*
North Dakota	80.10%	N/A	N/A	60.1%*
Oklahoma	75.20%	N/A	71.10%	59.5%*
Rhode Island	81.70%	N/A	70.6%*	83.10%
Tennessee	75.90%	49.4%*	59.9%*	76.60%
Texas	71.00%	61.7%*	72.20%	70.10%

Due to a number of factors—chief among them ample resources and robust vaccination standards in the U.S. and abroad—America declared measles eliminated in 2000, meaning no sustained transmission was reported for at least 12 months.³ Just eight years later, however, outbreaks reemerged as vaccination rates began to decline.⁶ To maintain “herd” or community immunity, an estimated 93–95% of the population must be immune to measles, with the threshold edging closer to 95% during active outbreaks.^7-9 As of September 2, 2025, 1,431 people in the U.S. had been infected with measles in the first nine months of the year—92% of them unvaccinated.³

In Michigan, the data show similar challenges. As of June 20, 2025, only 86.6% of children ages 13–17 had completed the MMR series, while just 76.3% had received a Tdap booster.¹⁰ These rates fall well below the levels needed to sustain herd immunity.

This “immunization report card” should sound the alarm for Michigan and beyond. Lower childhood vaccination rates leave babies too young to be immunized, immunocompromised individuals, and those with limited healthcare access especially vulnerable. If community immunity is lost, outbreaks are inevitable. The costs are also substantial: the 2019 measles outbreak that infected 71 individuals carried an average direct medical cost of $47,000 per case.¹¹ In Clark County, Washington, that same outbreak generated an estimated $3.4 million in total societal costs, including healthcare, productivity losses, and outbreak response.¹²

Public health agencies perform an essential surveillance role in detecting and reporting such outbreaks. Cases in Michigan have been known to originate in nearby locales (e.g., Chicago, Ontario) then spread once in-state. It is essential that professionals stay abreast of the latest national (through CDC) and state (through MDHHS) measles cases and outbreaks.^13,14 The MDHHS newsroom webpage is especially adept at reporting breaking Michigan county cases together with guiding information.^15,16

Exemptions compound the challenge of tracking and managing. Nationally, the percentage of kindergarteners with vaccination exemptions rose from 3.3% in 2023 to 3.6% in 2024.¹⁷ In Michigan, the waiver rate was nearly double—6.2% as of February 2025.¹⁷ While some children miss vaccines due to barriers such as lack of insurance or healthcare access, many exemptions are non-medical, driven by misinformation or vaccine hesitancy. Evidence is clear: states that eliminate non-medical exemptions report higher vaccination coverage and fewer vaccine-preventable diseases.¹⁸ In July 2025, the American Academy of Pediatrics (AAP) urged medical providers and policymakers to eliminate all non-medical school immunization exemptions to safeguard public health.¹⁹

As public health professionals, we must take action. We need to engage with vaccine-hesitant families respectfully, providing clear, evidence-based education and resources. We must build partnerships with policymakers, school boards, and community groups to reinforce the importance of vaccination. And we should support initiatives led by professional associations like the AAP, as well as grassroots advocacy groups such as Grandparents for Vaccines, to amplify our reach.²⁰

CALL TO ACTION

Public health professionals are at the frontlines of protecting communities from preventable diseases. With measles vaccination rates slipping below the critical threshold for herd immunity, the time to act is now. Strengthen outreach, build trust, and work collaboratively with schools, clinics, and local organizations to close immunization gaps. Every conversation matters—educate, advocate, and vaccinate. Together, we can prevent outbreaks, protect vulnerable populations, and reaffirm immunization as one of the most powerful tools of modern public health.

In Michigan, in line with American Academy of Pediatrics (AAP) recommendations, children entering kindergarten are required to have:

• Two doses of MMR (measles, mumps, rubella) and varicella (chickenpox) after 12 months of age
• Four doses of DTaP, with one given after age 4
• A three-dose hepatitis B series
• A polio immunization series

By age 11, or upon entering 7th grade, students must also receive:

• A Tdap booster (tetanus, diphtheria, pertussis)
• A meningococcal conjugate vaccine (meningitis)

CDC also publicizes the most recent nationally recommended vaccination schedules, the proviso being that the information appears on its Vaccines & Immunizations website with a 10-month lag following commission decision.²¹ In today’s political environment—indecisive at the very least and volatile at the most—it is essential to remain attentive to the ongoing changes, particularly as they pertain to vaccine policies.

NOTE: In today’s political environment—indecisive at the very least and volatile at the most—it is essential to remain attentive to the ongoing changes, particularly as they pertain to vaccine policies.

Resources:

• Click here to view tables of the Vaccine Schedules for Children by Age.
• Click here to view the ‘catch up’ schedule and minimal intervals between doses for children whose vaccinations have been delayed.

References

Updated 09/24/2025