As millions of kids across the country prepare to head back to school — and many have already returned — the national count of measles cases continues to climb, reaching its highest number in 35 years. Utah and South Carolina, which both allow for various exemptions to school-based vaccine mandates, carry most of the disease burden, accounting for half of U.S. cases in 2026. In South Carolina, 50 school districts were back in session as of Aug. 5 and in Utah, a few districts open next week while most are clustered the following. Get stories like this delivered straight to your inbox. Sign up for The 74 Newsletter Though numbers in both states have slowed, experts warn of a potential resurgence as students re-enter classrooms and return to indoor spaces, especially amid falling vaccination rates and chaotically shifting federal policies. RelatedCDC Advisory Committee Votes to Overturn Decades-Old Hep B Vax Recommendations “I don’t want to fearmonger whatsoever, but we’re in a different position than we were as kids were headed back to school in years past,” warned Northe Saunders, president of the advocacy group American Families for Vaccines. Richard Hughes, a George Washington University law professor and leading vaccine expert, emphasized that “kids should not be going to school with children who aren’t vaccinated against measles. This is a serious public health threat … We need strong herd immunity and that means that every child that goes to school unvaccinated is diminishing that immunity.” This year alone, there have been 2,371 confirmed measles cases reported across 43 states and Washington, D.C., already outpacing the 2,289 cases recorded in all of 2025, according to the Centers for Disease Control and Prevention. The vast majority of those infected are unvaccinated or have an unknown vaccine status (93%) and are younger than 20 years old (69%). Ten percent of infected kids under 5 years old have been hospitalized. Ellie Brownstein is a pediatrician in Utah and president-elect of the state’s American Academy of Pediatrics chapter. (Ellie Brownstein) Ellie Brownstein is a pediatrician in Utah, where there have been at least 524 cases this year — 22% of the country’s entire share. Brownstein, who is also the president-elect of the state’s American Academy of Pediatrics chapter, serves a diverse range of patients just south of Salt Lake City and has been practicing medicine for three decades. Until recent years, she said she didn’t hear much, if any, pushback from parents about vaccinating their kids. But now, “it has become an everyday thing.” The state allows for medical, religious and personal exemptions to school vaccine requirements, which can be obtained after parents watch a 15-minute module on the state health department website and sign a form. Statewide, only 85.5% of students are adequately immunized, nearly 10 percentage points below the needed rate for herd immunity, making it one of the top 10 least vaccinated states in the country. The bulk of the state’s cases (266) have been concentrated in Southwest Utah, along the Arizona border, where 27% of students are exempt from vaccines, over double the rate in the same region in the 2021-22 school year. Some individual schools report even higher numbers; at one, Water Canyon, half of students had an approved exemption in the 2025-26 school year, leaving only 30% adequately immunized. August 13 is the first day of school for Water Canyon Elementary School’s roughly 275 students. Though Brownstein’s practice hasn’t seen any measles cases, and the associated urgent care has had just one confirmed case, the effects of the spread can still be felt by her patients, she said. This week, the parents of a 5 ½-month-old, who was having a medical episode, called her office, requesting help. Nurses recommended the infant be taken to the local emergency room, but Brownstein said the parents were too terrified to bring their child, who was too young to be vaccinated, to such a crowded and risky place amid the measles spread. Ultimately, the parents brought the baby to Brownstein’s office for treatment, where they told her they had avoided all indoor spaces because their baby hadn’t had the measles vaccine. Brownstein and other physicians emphasize the importance of vaccinating all eligible kids to protect those who can’t yet receive the shots or may be medically unable to take them. Though the spread of infection has recently tapered off, with four new cases over the past three weeks, the disease has still been detected in wastewater in six areas over the past week, which Brownstein says “tells me there’s more than we know out there.” This is particularly worrying to her as children flock back to school. “You take people from different areas, different places, and put them back in rooms together, anything airborne can find those folks who aren’t vaccinated,” she said, “and we will start increasing our numbers.” To reach herd immunity against measles, 95% of a community must be vaccinated, though vaccine coverage among kindergarteners nationally has decreased from 95.2% during the 2019–20 school year to 92.5% in 2024–25. Childhood vaccination rates have been steadily falling since the COVID pandemic, amid a backdrop of rising anti-vax sentiment and legislative pushes to weaken state laws mandating vaccines for school-aged children. South Carolina alone saw roughly 16 such bills this year, said Hafeezah Yates, director of South Carolina Families for Vaccines, even as it experienced the largest measles outbreak in the U.S. since 1991. This year, the state has reported 670 measles cases, or 30% of the country’s total. Yates said advocates had to mobilize against five of these bills, including one that would prevent any vaccine mandates for infants under 24 months. While none ultimately passed, she expects a number of them will be re-introduced in January. “Right away, we could tell this was going to be a long fight,” she said. Medical and religious exemptions are already allowed in the state — though unlike in Utah, religious exemptions must be notarized. Yates expects a bill proposing a third category of exemptions — personal ones — will be re-introduced in the next legislative session, along with one around school immunizations themselves. Utah’s legislature looked at a bill this winter which would remove any vaccine mandates for schools, and Florida Gov. Ron DeSantis and state Surgeon General Joseph Ladapo proposed a similar elimination. Since September 2025, there have been nearly 1,000 measles cases in South Carolina alone, with the vast majority among unvaccinated children in the northwest region of Spartanburg. The outbreak affected 33 schools and forced 874 students to quarantine. Spartanburg County, located within the Bible Belt, is the least vaccinated in the state, with a rate of just 88.9%, leaving over 6,300 students unprotected. Nearly 5,500 students, or 10% of all of the county’s roughly 57,500 students, have religious exemptions. Yates said the next two months will be key in determining how many families opt for religious exemption versus having their child vaccinated. “By the end of September, we will definitely start seeing those numbers come in and that will be telling if we are continuing to increase that number of religious exemptions, which again impacts the overall immunity of the school,” she said. Experts argue growing anti-vaccine attitudes have only worsened under the leadership of Health Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic who initially downplayed the 2025 measles spread and has been inconsistent in his support of the measles, mumps and rubella vaccine since. Last week, during a heated interview on CNN, he encouraged parents to vaccinate their children against measles, noting it is 97% effective, though only in response to a direct request from the show’s host. And throughout the conversation, he cited a number of false claims about the COVID pandemic and vaccines, including the incorrect assertion that their connection to autism hasn’t been studied. RelatedResearchers Find Strong Link Between Vax Hesitancy and ‘Fringe’ Right-Wing Media During his tenure as secretary, Kennedy has sown disruption, leading the charge to overturn a recommendation that all newborns receive the hepatitis B vaccine; changing policies surrounding the combination MMR and varicella (chickenpox) vaccine; rolling back recommendations around 2025’s COVID-19 booster; and overhauling the U.S. childhood vaccine schedule, significantly reducing the number of shots routinely recommended for all kids. A preliminary injunction in March temporarily halted some of these changes, though the future of the policies remains uncertain. In the lead-up to the midterms, White House political advisers have reportedly directed Kennedy to tone down his anti-vaccine rhetoric, though President Donald Trump has continued to push his health secretary to scale back the number of shots federally recommended for kids, including via a May 2026 executive order. Trump’s moves have surprised some top health officials, according to reporting from The Wall Street Journal, as he continues to cite disproven links between childhood vaccines and autism. Hughes, the law professor and vaccine expert, believes it will be “seriously hard” to undo the damage this administration has done to vaccine policies and said, “I hope this is the last school year that RFK Jr.(‘s) aura is hanging over back-to-school immunization.”
