Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States
Open accessAbstract
Importance: Routine childhood vaccination is declining in some regions of the United States due to vaccine hesitancy, which risks the resurgence of many infectious diseases with public health and economic consequences. There are ongoing policy debates on the state and national level, including legislation around nonmedical (personal-belief) exemptions for childhood vaccination and possibly a special government commission on vaccine safety, which may affect vaccine coverage. Objective: To estimate the number of measles cases in US children and the associated economic costs under scenarios of different levels of vaccine hesitancy, using the case example of measles, mumps, and rubella (MMR) vaccination and measles. Design, Setting, and Participants: Publicly available data from the US Centers for Disease Control and Prevention were used to simulate county-level MMR vaccination coverage in children (age 2-11 years) in the United States. A stochastic mathematical model was adapted for infectious disease transmission that estimated a distribution for outbreak size as it relates to vaccine coverage. Economic costs per measles case were obtained from the literature. The predicted effects of increasing the prevalence of vaccine hesitancy as well as the removal of nonmedical exemptions were estimated. The model was calibrated to annual measles cases in US children over recent years, and the model prediction was validated using an independent data set from England and Wales. Main Outcomes and Measures: Annual measles cases in the United States and the associated public sector costs. Results: A 5% decline in MMR vaccine coverage in the United States would result in an estimated 3-fold increase in measles cases for children aged 2 to 11 years nationally every year, with an additional $2.1 million in public sector costs. The numbers would be substantially higher if unvaccinated infants, adolescents, and adult populations were also considered. There was variation around these estimates due to the stochastic elements of measles importation and sensitivity of some model inputs, although the trend was robust. Conclusions and Relevance: This analysis predicts that even minor reductions in childhood vaccination, driven by vaccine hesitancy (nonmedical and personal belief exemptions), will have substantial public health and economic consequences. The results support an urgent need to address vaccine hesitancy in policy dialogues at the state and national level, with consideration of removing personal belief exemptions of childhood vaccination.
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Reaching required vaccination levels should not be assumed given well-documented evidence of vaccine hesitancy across the world, which is often fuelled by online and offline misinformation.
“Reaching these required vaccination levels should not be assumed given well-documented evidence of vaccine hesitancy across the world 17 , which is often fuelled by online and offline misinformation surrounding the importance, safety or effectiveness of vaccines 18-20 .”
From Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA (2021) · cites this paper as [20]
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- Authors
- Lo, N. C., & Hotez, P. J.
- Affiliations
- Stanford Medicine (US)
- Baylor University (US)
- Corresponding author
- Lo, Nathan C.
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2017-09-01
- Volume
- 171
- Issue
- 9
- Pages
- 887
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC5710408
- OpenAlex
- W2739313217
- Cited by
- 355
- References
- 21
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 19 · 2023: 21 · 2022: 27 · 2021: 21 · 2020: 26 · 2019: 22 · 2018: 21 · 2017: 166
- FWCI
- 71.29
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mathematical and Theoretical Epidemiology and Ecology Models
- Keywords
- vaccine hesitancy, measles, MMR vaccination, childhood vaccination coverage, nonmedical exemptions, personal belief exemptions, measles resurgence, measles importation, infectious disease transmission models, public health policy
- MeSH terms
- Attitude to Health, Child, Child, Preschool, Female, Humans, Male, Measles, Models, Theoretical, Public Health, United States, Vaccination, Measles-Mumps-Rubella Vaccine
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