In early November, the South Carolina Department of Public Health opened a pop-up mobile vaccine clinic in a library parking lot in Boiling Springs. Dozens of people in South Carolina’s Upstate region have been diagnosed with measles this fall. (Photo by Lauren Sausser/KFF Health News)

This article first appeared on KFF Health News.

BOILING SPRINGS, S.C. — Near the back corner of the local library’s parking lot, largely out of view 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 fighting a measles outbreak since early October, with more than 50 cases identified. Health officials have encouraged people who are unvaccinated to get a shot by visiting its mobile vaccine clinic at any of its several stops throughout the county.

But on a Monday afternoon in Boiling Springs, only one person showed up.

“It’s progress. That progress is slow,” Linda Bell, the state epidemiologist with the Department of Public Health, said during a recent press briefing. “We had hoped to see a more robust uptake than that in our mobile health units.”

As South Carolina tries to contain its measles outbreak, public health officials across the nation are concerned that the highly contagious virus is making a major comeback. The federal Centers for Disease Control and Prevention has tallied more than 1,700 measles cases and 45 outbreaks in 2025. The largest started 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 poised to lose its measles elimination status, a designation indicating that outbreaks are rare and rapidly contained.

South Carolina’s measles outbreak isn’t yet as large as those in other states, such as New Mexico, Arizona and Kansas. But it shows how a confluence of larger national trends — including historically low vaccination rates, skepticism fueled by the pandemic, misinformation and “health freedom” ideologies promoted by conservative politicians — have put some communities at risk for the reemergence of a preventable, potentially deadly virus.

“Everyone talks about it being the canary in the coal mine because it’s the most contagious infectious disease out there,” said Josh Michaud, associate director for global and public health policy at KFF, a health information nonprofit that includes KFF Health News. “The logic is indisputable that we’re likely to see more outbreaks.”

Schools and ‘small brush fires’

Spartanburg’s vaccination rate is among the lowest of South Carolina’s 46 counties. And that was true “even before COVID,” said Chris Lombardozzi, a senior vice president with the Spartanburg Regional Healthcare 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 published by the state.

Lombardozzi said the county’s low vaccination rate is tied to misinformation not only published on social media but also spread by “a variety of nonmedical leaders over the years.”

The pandemic made things worse. Michaud said that fear and misinformation surrounding COVID-19 vaccines “threw gasoline on the fire of people’s vaccine skepticism.” In some cases, that skepticism transferred to childhood vaccines, which historically have been less controversial, he said.

This made communities like Spartanburg County with low vaccination rates more vulnerable. “Which is why we’re seeing constant, small brush fires of measles outbreaks,” Michaud said.

In Spartanburg, the overall percentage of students with required immunizations fell from 95.1% to 90% between the 2020-21 and 2024-25 academic years. Public health officials say a minimum of 95% is required to prevent significant spread of measles.

Children who attend public and private schools in South Carolina are required to show that they’ve received some vaccinations, including the measles, mumps and rubella vaccine, 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 about the family’s religious beliefs.

The number of students in South Carolina who have been granted religious exemptions has increased dramatically over the past decade. That’s particularly true in the Upstate region, where religious exemptions have increased sixfold from a decade ago. During the 2013-14 school year, 2,044 students in the Upstate were granted a religious exemption to the vaccine requirements, according to data published by The Post and Courier. By fall 2024, that number had jumped to more than 13,000.

Some schools are more exposed than others. The beginning of the South Carolina outbreak was largely linked to one public charter school, Global Academy of South Carolina, where only 17% of the 605 students enrolled during the 2024-25 school year provided documentation showing they had received their required vaccinations, according to data published 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 from measles, U.S. 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 stand at odds with other statements Kennedy has made that cast doubt on vaccine safety and have falsely linked vaccines with autism. The CDC, under his authority, now claims such links “have been ignored by health authorities.”

“What would I do if I could go back in time and I could avoid giving my children the vaccines that 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 has made other misleading or unsupported statements. During a congressional hearing in September, Kennedy defended his past claims that he was not anti-vaccine but affirmed his stated position that no vaccines are safe or effective.

Emily Hilliard, a spokesperson for the Department of Health and Human Services, told KFF Health News that Kennedy is “pro-safety, pro-transparency and pro-accountability.” Hilliard said HHS is working with “state and local partners in South Carolina” and in other states to provide support during the measles outbreaks.

Meanwhile, Kennedy has frequently championed the idea of health freedom, or freedom of choice, regarding vaccines, a talking point that has taken root among Republicans.

That has had a “chilling effect all the way down through state and local lawmakers,” Michaud said, making some leaders hesitant to talk about the threat that the ongoing measles outbreaks poses or the effectiveness and safety of the MMR vaccine.

Brandon Charochak, a spokesperson for South Carolina Gov. Henry McMaster, said the governor was not available to be interviewed for this article but referenced McMaster’s comment from October that measles “is a dangerous disease, but in terms of diseases, it’s not one that we should panic about.”

On a separate occasion that month, the Republican governor said he does not support vaccine mandates. “We’re not going to have mandates,” he said, “and I think we are responding properly.”

Even though the South Carolina Department of Public Health has repeatedly encouraged measles vaccines, the push has been notably quieter than the agency’s COVID-19 vaccine outreach efforts.

In 2021, for example, the agency partnered with breweries throughout the state for a campaign called “Shot and a Chaser,” which rewarded people who got a COVID-19 vaccine with a free beer or soda. By contrast, the pop-up measles vaccine clinic at the Boiling Springs Library featured no flashy signage, no freebies, and wasn’t visible from the library’s main entrance.

Edward Simmer, interim director of the Department of Public Health, would not speak to KFF Health News about the measles outbreak. During a legislative hearing in April, Republican state lawmakers voted against his permanent confirmation because of his past support for COVID-19 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 also have been blocked from new roles because of their COVID-19 response. In Missouri, where MMR vaccine 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 appointment.

In South Carolina, Simmer, lacking lawmakers’ confirmation, leads the public health agency in an interim capacity.

South Carolina Sen. Tom Davis of Beaufort was the only Republican on the Senate Medical Affairs Committee who voted to confirm Simmer in April. He told KFF Health News that his Republican colleagues raised valid questions about Simmer’s past support for COVID-19 vaccines.

But, Davis said, it would be “tremendously unfortunate and not beneficial from a public health perspective” if the Republican Party just took a stance against vaccines “as a matter of policy.”

The Department of Public Health had administered 44 doses of the MMR vaccine through its mobile health unit from October to mid-November. The last mobile vaccine clinic was scheduled for Nov. 24. But health officials are encouraged that patients are seeking vaccines elsewhere. The agency’s tracking system shows that providers across Spartanburg County administered more than twice as many measles vaccines in October as they did a year ago.

As of mid-November, more than 130 people remained in quarantine, most of them students at local elementary and middle schools. Cases have also been linked to a church and Greenville-Spartanburg International Airport.

“We’re reminding people that travel for the upcoming holidays increases the risk of exposures greatly,” said Bell, the state epidemiologist. “Due to that risk, we’re encouraging people to consider getting vaccinated now.”

KFF Health News correspondent Amy Maxmen contributed to this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. Learn more about KFF.

Health and Human Services Secretary Robert F. Kennedy Jr., joined by President Donald Trump, delivers an announcement on “significant medical and scientific findings for America’s children” in the Roosevelt Room of the White House on Sept. 22, 2025 in Washington, D.C. Federal health officials suggested a link between the use of acetaminophen during pregnancy as a risk for autism, although many health agencies have noted inconclusive results in the research. (Photo by Andrew Harnik/Getty Images)

WASHINGTON — A majority of Americans disapprove of Health and Human Services Secretary Robert F. Kennedy Jr.’s job performance and the federal government’s evolving vaccine policy, according to a poll released Thursday by the nonpartisan health organization KFF.

In addition, the vast majority of those surveyed have heard the unproven claims made by President Donald Trump, Kennedy and others in late September that taking acetaminophen, also known as Tylenol, during pregnancy could be one possible environmental factor in a child later being diagnosed with autism.

A total of 77% of the people KFF polled said they knew of the statements, though whether people believe the claims, which have yet to be established by the medical community, varied.

Only 4% of those surveyed said it is “definitely true” that taking Tylenol during pregnancy increases the risk of the child developing autism, and 35% said the claim is “definitely false.” Thirty percent said it is “probably true” and 30% said it is “probably false.”

Combined, 65% said it’s either probably or definitely false to say that taking acetaminophen during pregnancy increases the chance of a child developing autism, a complex disorder that experts believe is the result of both genetic and environmental factors.

When broken down by political party, 86% of Democrats, 67% of independents and 43% of Republicans said the claims were either probably or definitely false.

The survey shows 59% somewhat or strongly disapprove of how Kennedy is handling his new role at the top of the country’s public health infrastructure.

The level of support changes considerably depending on political party affiliation, with 86% of Democrats, 64% of independents and 26% of Republicans disapproving.

A slightly higher number, 62%, either somewhat or strongly disapprove of the United States’ vaccine policy.A similar trend emerged when those polled were broken up by political parties. Eighty-eight percent of Democrats, 67% of independents and 31% of Republicans somewhat or strongly disapproved of vaccine policy.

The survey shows a declining share of Americans have faith in the Centers for Disease Control and Prevention to provide trusted information about vaccines, compared with previous KFF polls in September 2023 and earlier this year.

A total of 63% of respondents two years ago trusted the CDC on vaccines, but that has declined to 50%.

Democrats’ faith in the CDC’s vaccine recommendations has dropped from 88% two years ago to 64%, independents have gone from 61% to 47% and Republicans have remained relatively steady, only going from 40% to 39%.

Across political parties, a person’s own doctor as well as the American Academy of Pediatrics and the American Medical Association remain broadly trusted for vaccine information.Eighty-three percent said they trust their doctor or health care provider, 69% believed information from the American Academy of Pediatrics and 64% had faith in the AMA.

The poll of 1,334 adults took place from Sept. 23 to Sept. 29 and had a margin of error of plus or minus 3 percentage points for the full survey. Questions broken down by a person’s political ideology had a margin of error of plus or minus 6 percentage points.

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The CDC says people age 65 and older should talk to their doctor about COVID 19 vaccines. (Photo by George Frey/Getty Images)

The Centers for Disease Control and Prevention on Monday updated its adult and child immunization schedules to to recommend COVID-19 shots for people 65 and older after they consult with their health care providers.

The CDC also is recommending in its updated immunization schedules that toddlers receive the chickenpox vaccines as a standalone immunization rather than in combination with measles, mumps, and rubella (MMR) shot.

The CDC announced what it called the return to “individual-based decision-making to COVID-19 vaccinations” in a press release on its website Monday morning.

The immunization schedules adopt recent recommendations by the Advisory Committee on Immunization Practices (ACIP), which has been overhauled by Health Secretary Robert F. Kennedy Jr., who fired  all 17 former members of the vaccine panel earlier this year and replaced them with his own appointees.

RFK Jr. fired everyone on a key vaccine panel. Here’s who he replaced them with.

“Informed consent is back,” said Acting Director of the CDC and Deputy Secretary of Health and Human Services Jim O’Neill. “CDC’s 2022 blanket recommendation for perpetual COVID-19 boosters deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent. That changes today,” he continued.

“I commend the doctors and public health experts of ACIP for educating Americans about important vaccine safety signals. I also thank President Trump for his leadership in making sure we protect children from unintended side effects during routine immunization.”

According to the CDC press release, individual-based decision-making “means that the clinical decision to vaccinate should be based on patient characteristics that, unlike age, are difficult to incorporate in recommendations, including risk factors for the underlying disease as well as characteristics of the vaccine itself and the best available evidence of who might benefit from vaccination.

“Individual-based-decision-making,” the release continues,” allows for immunization coverage through all payment mechanisms including entitlement programs such as the Medicare, Medicaid, Children’s Health Insurance Program, and the Vaccines for Children Program, as well as insurance plans regulated by the Affordable Care Act.”

Vaccines greatly reduce rates of death and disease around the world. The American Academy of Pediatrics, American Academy of Family Practitioners, American College of Obstetricians and Gynecologists, American Medical Association, American Nurses Association, American Pharmacists Association, National Academy of Medicine, and World Health Organization endorse the use of vaccines.

The health insurance trade group AHIP issued a statement last month saying health plans would continue to cover all ACIP-recommended vaccinations, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.

Health insurance group says vaccines in Florida still a covered benefit

The Florida Board of Pharmacy met briefly last month to affirm that Florida patients don’t need a prescription from their physician before receiving a vaccine. That’s because Florida law authorizes certain pharmacists who work in collaboration with physicians to administer vaccines.

Chickenpox

Meanwhile, the “new recommendation of standalone chickenpox vaccination for toddlers through age three follows evidence presented to ACIP by the CDC Immunization Safety Office’s that healthy 12–23 months old toddlers have increased risk of febrile seizure” from the combined chickenpox-MMR vaccine compared to those given immunization for chickenpox separately.

“The combination vaccine doubles the risk of febrile seizures without conferring additional protection from varicella compared to standalone vaccination,” the CDC statement says. Febrile seizures are brought on by high fevers.

A U.S. Department of Education employee leaves the building with their belongings on March 20, 2025 in Washington, D.C., amid mass layoffs.  (Photo by Win McNamee/Getty Images)

WASHINGTON — The Trump administration began posting plans over the weekend that detail how hundreds of thousands of federal workers will be furloughed during a government shutdown, while others will keep working without being paid. 

The updated guidance gives the clearest picture yet into how President Donald Trump and White House budget director Russ Vought hope to reduce the size and scope of government when given increased authority over the federal workforce during a funding lapse. 

A shutdown will begin Wednesday unless Republicans and Democrats in Congress reach agreement on a stopgap spending bill. Congressional leaders were set to meet Monday afternoon with Trump, but it was unclear if any agreement would result that would avert a shutdown.

The Defense Department’s plan shows it would keep about 406,500 of its 741,500 civilian employees working without pay during the shutdown, with the remaining going on furlough. 

The nearly 2.1 million military personnel housed within the department would continue to work throughout a shutdown but would not be paid until after it ends. 

The plan says the Defense Department believes operations to secure the U.S. southern border, Middle East operations, Golden Dome for America defense system, depot maintenance, shipbuilding and critical munitions are the “highest priorities” in the event of a shutdown. 

Medical and dental services, including private sector care under the TRICARE health care program, would largely continue at the Defense Department, though “(e)lective surgery and other routine/elective procedures in DoW medical and dental facilities are generally not excepted activities, unless the deferral or delay of such procedures would impact personnel readiness or deployability.”

Thousands of workers to be sent home from HHS

The Health and Human Services Department plans to furlough about 32,500 of its nearly 80,000 employees during a shutdown. 

The various components of HHS — including the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, Food and Drug Administration, and National Institutes of Health — have individual plans for a shutdown. 

The Centers for Medicare and Medicaid Services plans to retain 3,311, or 53%, of its employees during a shutdown and “will maintain the staff necessary to make payments to eligible states for the Children’s Health Insurance Program (CHIP).”

The CDC plans to have 4,891, or 35.88%, of its employees as well as those at the Agency for Toxic Substances and Disease Registry keep working. 

The contingency plans says that “(r)esponses to urgent disease outbreaks and continuing efforts to support the President’s Emergency Plan for AIDS Relief (PEPFAR), World Trade Center (WTC) Health Program, the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), and the Vaccines for Children (VFC) program” would continue during a shutdown. 

The CDC would not be able to undertake several other activities, including providing “guidance to state and local health departments implementing programs to protect the public’s health (e.g., opioid overdose prevention, HIV prevention, diabetes prevention).”

Departments with plans

Here is a list of the departments that have posted updated contingency plans in September:

• Defense Department contingency plan
• Education Department contingency plan
• Health and Human Services contingency plan
• Homeland Security Department contingency plan
• Labor Department contingency plan
• Justice Department contingency plan
• Social Security Administration contingency plan
• Treasury Department contingency plan

Here is a list of the departments that hadn’t posted updated contingency plans as of Monday afternoon:

• Agriculture Department contingency plan
• Commerce Department contingency plan
• Energy Department contingency plan
• Housing and Urban Development contingency plan
• Interior Department contingency plan
• State Department contingency plan
• Transportation Department contingency plan
• Veterans Affairs Department contingency plan

States Newsroom’s Washington, D.C. Bureau reached out to the  departments that didn’t have contingency plans posted to ask when those might become public.

A spokesperson for the USDA wrote in an email the department “is prepared for all contingencies regarding Department operations, including critical services and supports.” 

A State Department spokesperson said leadership “is undergoing all necessary planning efforts to sustain critical missions.”

Federal employees who work  without pay will be paid after the shutdown concludes. 

According to the Office of Personnel Management — the executive branch’s chief human resources agency — “after the lapse in appropriations has ended, employees who were furloughed as the result of the lapse will receive retroactive pay for those furlough periods.” 

The Government Employee Fair Treatment Act of 2019 requires furloughed government employees to receive back pay as a result of a government shutdown. 

That law does not apply to federal contractors, who face uncertainty in getting paid during a shutdown. 

Ashley Murray, Ariana Figueroa, Shauneen Miranda and Jacob Fischler contributed to this report.