LANDRUM, SC — With baby Arthur too young for the measles vaccine and a sibling due in June, the Ottwells became nervous when the threat of the highly contagious virus began to impact their grocery store.
“We go to Costco that was kind of the hot spot,” said John Otwell, who was aware of state health department warnings about public exposure at the store. “A lot of people don’t understand it; they think it’s just a cold. It’s not.”
According to Arthur’s 9-month checkup, South Carolina’s outbreak had become the worst in the country in more than 35 years, surpassing that in Texas last year. This meant that under state guidance, Arthur could get his first dose of the MMR vaccine — for measles, mumps and rubella — earlier than the usual 12 to 15 months of age. Their newborn may not be able to get the vaccine for at least 6 months — a prospect that worries parents of infants wherever measles spreads.
Very young children are most vulnerable to vaccination in measles outbreaks. This disease can wreak havoc on their delicate bodies, causing them to become so ill that they stop eating and drinking. They may develop pneumonia or swelling of the brain and sometimes even die.
Infants are completely dependent on herd immunity – at least 95% of the community must be vaccinated to prevent measles outbreaks. But declining vaccination rates have reduced protections in South Carolina and across the country. In Spartanburg County, the epicenter of the outbreak, less than 90% of students have received the required vaccines.
“Children become sitting ducks,” said Deborah Greenhouse, MD, a pediatrician at Columbia University. “The burden for the safety of all of us rests on all of us.”
But increasingly, some policymakers and officials view vaccination to protect entire populations as an issue of personal liberties and parental rights rather than a matter of public health.
At the federal level, Health Secretary Robert F. Kennedy Jr., a longtime anti-vaccine crusader, has sought to rebuild vaccine policy and oversee billions in public health cuts. And although a temporary ruling by a federal judge has slowed their pace, several bills have been introduced in states, including South Carolina, that threaten to further reduce vaccination rates.
The measles outbreak in South Carolina, which totaled about 1,000 cases, has slowed. But measles is spreading in many states, with 17 outbreaks this year and 48 last year, and the US is on the verge of losing its status as the country that has eliminated measles.
Doctors work to protect the youngest children from measles
Jessica Early, MD, never thought she’d have to deal with measles, but when the disease surfaced in her Greer community the pediatrician feared for her patients and her child. She and other doctors started giving the infant the approved MMR dose at 6 months of age. Her practice also started giving the second MMR dose — usually around 4 to 6 years of age — sooner.
To the chagrin of many doctors, no one knows how many South Carolina infants have had measles or have been hospitalized because of it.
State officials would only disclose that 253 of the 997 cases were in children ages 4 and younger; They say they will not delve further into the matter for confidentiality reasons. It is not unusual to group data in this manner.
Officials also don’t know exactly how many infants were hospitalized with the virus because, unlike some other states, hospitals are not required to report measles-related admissions.
Across the state, doctors said they have many questions about whether it’s safe to bring infants to waiting rooms or day care.
Thomas Compton — regional director of Miss Tammy’s Little Learning Center, a child care network working throughout the outbreak area — said 18 parents pulled children out of their facilities, even though they had no confirmed cases. Some people left the deposit a few days before their children were to begin their studies, forcing the company to fire a teacher.
Although licensed day cares are required to have vaccines under state law, families can easily get religious exemptions. About a fifth of Miss Tammy’s 300 children are exempt from the vaccine.
When measles increased, Compton said state officials provided little guidance. His staff sanitized surfaces, as they did when COVID-19 was raging; Local measles cases tracked on Facebook; And depended on Google for information about the disease.
“A lot of parents were really stressed,” Compton said. “Whenever we had a little illness or something, they’d say, ‘Do you think it’s measles?'”
State legislation would ban vaccines for children under 2
Last year, a associated Press The investigation found that Trump administration officials were directing activists to push anti-science legislation in statehouses. Nearly 350 anti-vaccine bills were introduced nationally by the end of October, AP Including at least eight found in South Carolina.
This year, a state bill would ban requiring vaccines for children under age 2.
“In other words, it would get rid of those requirements in day care,” said Greenhouse, the pediatrician. “And for people like me, that’s a gut punch that’s terrifying.”
In a subcommittee discussion, Republican state Senator Carlisle Kennedy said his bill is aimed at protecting parents’ rights. Their child was born without a kidney in August and was given vaccinations on an individual schedule in coordination with doctors.
“We didn’t want to put vaccines into his body until his body was able to survive them,” he said.
Opponents counter that herd immunity protects children in these situations.
The Senate subcommittee advanced the legislation. Greenhouse fears it has momentum.
“In the environment we’re currently living in, I think any bill could potentially have legs,” he said. “It’s our job to do our best to make sure those feet don’t go anywhere.”
Even if the bill becomes law, doctors say such a law promotes skepticism and confusion about the vaccine. While the American Academy of Pediatrics recommends giving children all the vaccines they have been getting for years, some parents tell Greenhouse they know the government has called for fewer vaccines.
“They really don’t know who they can trust,” he said.
Like other states, South Carolina has made it easier to get non-medical vaccine exemptions, said Martha Edwards, MD, president of the state’s American Academy of Pediatrics chapter. At the center of the outbreak, religious exemptions have more than doubled since 2020. Statewide, 4% of school-age students have received such exemptions in 2025-26.
“Parental choice is a big topic of discussion in a lot of Southern states,” Edwards said. But the choice not to get vaccinated, he said, impacts the rights of other parents to keep their children safe.
Nationwide, protections ease as measles spreads
Doctors expect the situation to get worse.
In the first 3 months of 2026, 1,671 cases of measles were reported in the US. That’s 73% of the total for 2025, the worst year for the virus in more than three decades. In November, international health officials will determine whether measles is still considered eliminated in the Americas.
The national MMR vaccination rate — which fell to 92.5% among kindergartners in the 2024-25 school year, from 95.2% in 2019-20 — is unexplained by the very low rates in some communities. At one school in Spartanburg County, 21% of children received all required vaccinations.
Doctors worry that it is just a matter of time before vaccine-preventable diseases of all kinds will threaten lives as they did a century ago.
“The whole concept of vaccination is one of the best things that has ever happened to medicine,” Greenhouse said. “To see that we are actually going backwards is confusing.”
Helen Kaiser, who lives in the outbreak area, vaccinated her twin 2-year-old boys early to protect them and the community.
“I would never forgive myself,” she said, “if I had known that my son had made another child very sick and it was something I could have prevented.”
