On Tuesday at a press conference, Health and Human Services Secretary Robert F. Kennedy Jr. said his department’s handling of measles cases, including the outbreak in Texas should be a “model for the rest of the world.”
Kennedy said this is because cases have exploded more drastically in Europe — though he didn’t offer specifics on what he thinks has worked in the U.S. response.
“I would compare it to what’s happening in Europe,” he said. “They’ve had 127,000 cases and 37 deaths. And so what we’re doing here in the United States is a model for the rest of the world.”
While the numbers Kennedy cited are nearly accurate when looking at the vast European region in 2024, and much higher than the 285 cases in the U.S. last year, many factors make it difficult to compare that entire region to the U.S.
The U.S. currently has more than 600 cases so far this year, most of those linked to an ongoing outbreak in Texas, where two children have died from the virus.
“It’s misleading to compare the U.S. to the entire WHO European region, which spans 53 countries with wide disparities in health care access, vaccination coverage and surveillance systems,” said Dr. John Brownstein, an epidemiologist and chief innovation officer at Boston Children’s Hospital, and an ABC News contributor.
“The outbreaks in places like Romania and Kazakhstan are driving the regional numbers, but when you narrow the view to countries more comparable to the U.S., like those in the EU, the picture is much closer — and in some cases, better — than what we’re seeing in Texas right now,” Brownstein said.
Health Secretary Robert F. Kennedy Jr. speaks during a press conference while visiting the Osher Center for Integrative Health at the University of Utah in Salt Lake City, Utah, April 7, 2025.
Jim Urquhart/Reuters, FILE
How does Europe really compare?
The World Health Organization reports the European region, which includes 53 countries in Europe and central Asia, had 127,350 measles cases and 38 deaths in 2024, based on preliminary data received as of March 6 this year. This is twice the number reported cases in 2023. Romania reported the highest number of cases in the region for 2024, with 30,692 cases, followed by Kazakhstan with 28,147 cases.
This was the highest case count seen in the region since 1997. Romania reported the highest number of cases in the region for 2024, with 30,692 cases, followed by Kazakhstan with 28,147 cases.
From the 30 countries in the European Union and European Economic Area (EU/EAA) that are more comparable to the U.S., there were 3,973 measles cases in 2023 but that number grew steeply to 28,791 cases of measles from March 1, 2024 to Feb. 28, 2025, according to the European Centre for Disease and Control.
During this timeframe, Romania had 24,215 measles cases, followed by 1,064 in Italy, 591 in Germany, 572 in France and 556 in Belgium.
About 86% of measles cases in EU/EAA countries in Europe were among unvaccinated people, 45% of cases were in children under five years old and about 30% of cases were in people aged 15 and older.
“When you compare the U.S. to countries with similar health systems — like Germany or France — the scale of the current outbreak in Texas is not meaningfully better,” Brownstein said.
Experts have also been concerned about the number of measles deaths in the United States and ABC News has reported several have said they believe case counts are significantly higher than what’s being reported, despite RFK Jr. claiming “the growth rates for new cases and hospitalizations have flattened,” in a post on X.
“We think these cases are undercounted,” Dr. Amesh Adalja, an infectious disease doctor and senior scholar at Johns Hopkins Center for Health Security said at a Texas Department of State Health Services press conference on Tuesday. “When you’re hearing people on the ground say this is going to take a year to contain, that tells you that it’s doing the opposite of flattening.”
“We know that there’s really, on average, about one death for every around 1,000 cases,” Dr. Craig Spencer, an associate professor of the practice of health services, policy and practice at the Brown University School of Public Health, told ABC News. “We’ve already seen three deaths, which would make you suspect it’s probably more like 3,000 cases.”
“It feels very, very likely that the count is higher than 500,” he said, adding, “It’s not impossible for there to be three deaths among 500 cases, but statistically, one would expect more cases for that number of deaths.”
Now, more than 600 people in the U.S. have confirmed cases of measles this year and three people have died, which if accurate is about 0.5% of cases, according to data from the Centers for Disease Control and Prevention.
This would be much higher than what was seen in Romania last year, where 18 people died from measles out of more than 30,000 cases, or about 0.06%. When looking at the entire European region, only about 0.03% of people with measles died.
Boxes and vials of the Measles, Mumps, Rubella Virus Vaccine at a vaccine clinic put on by Lubbock Public Health Department, March 1, 2025, in Lubbock, Texas.
Jan Sonnenmair/Getty Images
Brownstein said this shows “that even smaller outbreaks can be deadlier when vaccination rates are low.”
Drivers of low vaccination rates are going to be variable across different regions and populations. Researchers have studied specific factors in Romania’s high case counts where WHO estimates vaccine coverage with two MMR doses to only be 62% in 2023.
They identified migratory patterns, growing vaccine hesitancy among parents and loss of health care providers as significant drivers of vaccination rates plummeting after 2010 due to lack of interest, access, supply and staff.
WHO data shows in Europe, measles vaccine rates and policies are variable by country and only four countries have a 95% vaccination rate or higher with two doses of the measles, mumps and rubella (MMR) vaccine: Hungary, Malta, Portugal and Slovakia.
On average across many European countries, rates for one dose of the MMR vaccine range from about 85% to 95% and 75% to 90% for two doses, but vary. In the U.S., about 91% of children have had one dose of the MMR vaccine by the time they turn two years old and 92% of teens have had the recommended two doses, according to the CDC.
Some countries in Europe including Germany, France and Italy have mandatory requirements for measles vaccination or immunity for school enrollment, but parents may be able to decline the vaccine in other countries where it is only recommended but not mandated such as Belgium, Romania and the Netherlands.
Jade A. Cobern, MD, MPH, is board-certified in pediatrics and general preventive medicine, and is a medical fellow of the ABC News Medical Unit. Cheyenne Haslett and Mary Kekatos also contributed to this report.
