BOILING SPRINGS, S.C. — Near the back corner of the local library parking lot, largely out of sight from the main road, the South Carolina Department of Public Health opened a pop-up clinic in early November, offering free measles vaccines to adults and children.
Spartanburg County in South Carolina’s upstate region has been battling a measles outbreak since early October, with more than 50 cases identified. Health officials encouraged unvaccinated people to get vaccinated by visiting its mobile vaccination clinic at one of its many stops throughout the county.
But on a Monday afternoon in Boiling Springs, only one person showed up.
“This is progress. This progress is slow,” Linda Bell, state epidemiologist at the Department of Public Health, said during a recent press briefing. “We were hoping to see higher adoption than our mobile health units. »
As South Carolina attempts to contain the measles outbreak, public health officials across the country are concerned about the highly contagious virus making a comeback. The Centers for Disease Control and Prevention has documented more than 1,700 cases of measles and 45 outbreaks in 2025. The largest began in Texas, where hundreds of people were infected and two children died.
For the first time in more than two decades, the United States is on the verge of losing its measles elimination status, a designation indicating that outbreaks are rare and quickly contained.
South Carolina’s measles outbreak is not yet as large as other states, such as New Mexico, Arizona and Kansas. But it shows how a confluence of broader national trends — including historically low vaccination rates, pandemic-fueled skepticism, misinformation and “health freedom” ideologies proliferated by conservative politicians — have put some communities at risk from the re-emergence of a preventable and potentially deadly virus.
“Everyone talks about the canary in the coal mine because it’s the most contagious infectious disease,” said Josh Michaud, associate director for global and public health policy at KFF, a nonprofit health news organization that includes KFF Health News. “The logic is indisputable: we will likely see more outbreaks.”
Schools and “small bushfires”
Spartanburg’s vaccination rate is among the lowest in South Carolina’s 46 counties. And that was true “even before Covid,” said Chris Lombardozzi, senior vice president of Spartanburg Regional Health System.
Nearly 6,000 children in Spartanburg County schools last year — 10% of the total enrollment — either received an exemption allowing them to forgo required vaccinations or did not meet vaccine requirements, according to data released by the state.
Lombardozzi said the county’s low vaccination rate is linked to misinformation not only posted on social media but also spread by “a variety of non-medical leaders over the years.”
The pandemic has made the situation worse. Michaud said fear and misinformation surrounding covid vaccines “have added fuel to the fire of people’s skepticism about vaccines.” In some cases, that skepticism has transferred to childhood vaccines, which have historically been less controversial, he said.
This has left communities like Spartanburg County with low vaccination rates more vulnerable. “This is why we constantly see small bushfires caused by measles outbreaks,” Michaud said.
In Spartanburg, the overall percentage of students receiving required vaccinations decreased from 95.1% to 90% between the 2020-21 and 2024-25 academic years. Public health officials say a minimum of 95% is needed to prevent significant spread of measles.
Children attending public and private schools in South Carolina must prove they have received certain immunizations, including measles, mumps and rubella, but religious exemptions are relatively easy to obtain. The exemption form must be notarized, but it does not require a doctor’s note or any disclosure of the family’s religious beliefs.
The number of South Carolina students with religious exemptions has increased significantly over the past decade. This is especially true in the upstate region, where religious exemptions have increased sixfold compared to a decade ago. During the 2013-2014 school year, 2,044 upstate students received a religious exemption from vaccination requirements, according to data published by The Post and Courier. By fall 2024, that number had increased to more than 13,000.
Some schools are more exposed than others. The start of South Carolina’s outbreak was largely linked to a public charter school, Global Academy of South Carolina, where only 17% of the 605 students enrolled in the 2024-25 school year provided documentation showing they had received required vaccines, according to data released by the Department of Public Health.
No one from Global Academy responded to interview requests.
“Health Freedom”
In April, after visiting a Texas family whose daughter had died of measles, Health and Human Services Secretary Robert F. Kennedy Jr. wrote on social media that “the most effective way to prevent the spread of measles is the MMR vaccine.” He made a similar statement during an interview on “Dr. Phil” later that month.
But these endorsements conflict with other statements made by Kennedy that cast doubt on the safety of vaccines and falsely link vaccines to autism. The CDC, under its authority, now claims that such links “were ignored by health authorities.”
“What would I do if I could go back in time and avoid giving my children the vaccines I gave them? he said on a podcast in 2020. “I would do anything for that. I would pay anything to be able to do that.”
Throughout 2025, he made other misleading or unsubstantiated statements. At a congressional hearing in September, Kennedy defended his past claims that he was not anti-vaccine, but affirmed his stated position that no vaccine is safe or effective.
Emily Hilliard, a spokesperson for the Department of Health and Human Services, told KFF Health News that Kennedy is “in favor of safety, transparency and accountability.” Hilliard said HHS works with “state and local partners in South Carolina” and other states to provide support during measles outbreaks.
During this time, Kennedy frequently championed the idea of health freedom, or freedom of choice, when it comes to vaccines, a talking point that has taken root among Republicans.
That had a “chilling effect all the way down to state and local lawmakers,” Michaud said, making some leaders hesitant to talk about the threat posed by ongoing measles outbreaks or the effectiveness and safety of the MMR vaccine.
Brandon Charochak, a spokesman for South Carolina Gov. Henry McMaster, said the governor was not available to be interviewed for this article, but referred to McMaster’s October comment that measles “is a dangerous disease, but in terms of diseases, it’s not a disease that we should panic about.”
On another occasion that month, the Republican governor said he did not support vaccination mandates. “We will not have mandates,” he said, “and I think we are responding correctly.”
Although the South Carolina Department of Public Health has repeatedly promoted measles vaccines, the push has been significantly more muted than the agency’s Covid vaccine outreach efforts.
In 2021, for example, the agency partnered with breweries across the state for a campaign called “Shot and a Chaser,” which rewarded people who received a covid vaccine with a free beer or soda. In contrast, the Boiling Springs Library’s measles vaccination pop-up clinic had no flashy signage, no giveaways, and was not visible from the library’s main entrance.
Edward Simmer, acting director of the Department of Public Health, would not talk to KFF Health News about the measles outbreak. At a legislative hearing in April, Republican state lawmakers voted against his permanent confirmation because of his past support for Covid vaccines and masking. One lawmaker specifically criticized the agency during that hearing for the Shot and a Chaser campaign.
Public health officials in other states have also been blocked from taking on new roles because of their response to Covid. In Missouri, where MMR vaccination rates have declined among kindergartners since 2020 and measles cases have been reported this year, Republican lawmakers rejected a public health director in 2022 after vaccine opponents protested his nomination.
In South Carolina, Simmer, without confirmation from lawmakers, is leading the public health agency in an interim capacity.
South Carolina Sen. Tom Davis, of Beaufort, was the only Republican member of the Senate Medical Affairs Committee to vote in favor of Simmer’s confirmation in April. He told KFF Health News that his Republican colleagues have raised valid questions about Simmer’s past support for Covid vaccines.
But, Davis said, it would be “extremely unfortunate and not beneficial from a public health perspective” if the Republican Party simply took a position against vaccines “as a matter of policy.”
The Ministry of Public Health administered 44 doses of the MMR vaccine through its mobile health unit from October to mid-November. The last mobile vaccination clinic was scheduled for November 24. But health officials are encouraged that patients are seeking vaccinations elsewhere. The agency’s tracking system shows Spartanburg County providers administered more than twice as many measles vaccines in October as a year ago.
As of mid-November, more than 130 people remained in quarantine, mostly students from local primary and secondary schools. Cases have also been linked to a church and the Greenville-Spartanburg International Airport.
“We remind people that traveling for the upcoming vacation significantly increases the risk of exposure,” said Bell, the state epidemiologist. “Because of this risk, we encourage people to consider getting vaccinated now. »
KFF Health News correspondent Amy Maxmen contributed to this report.
