The resurgence and continued spread of once-controllable diseases such as measles, HIV, and mpox (previously monkeypox) is exposing critical vulnerabilities in public health systems already severely strained by re
For many clinicians and infectious disease experts, the concerns extend beyond any single outbreak. Instead, these events collectively highlight how quickly declining vaccination coverage, strained prevention infrastructure, uneven health care access, and gaps in interagency coordination may become more visible when health care systems are placed under pressure, particularly in safety-net and re
For Monica Gandhi, MD, MPH, professor of medicine in the division of HIV, infectious diseases, and global medicine at the University of California, San Francisco (UCSF), and medical director of the HIV Clinic at San Francisco General Hospital, the outbreaks reflect broader concerns regarding infectious disease preparedness and containment capacity
In an interview with Infectious Disease Advisor, Dr Gandhi noted that recent reductions in public health workforce capacity and international outbreak-response coordination may leave health care systems less prepared to respond to emerging infectious disease threats both within the United States and globally
Those concerns became increasingly visible earlier this year when San Francisco confirmed its first measles case since 2019, prompting health care systems across the city to rapidly shift into outbreak-response mode
Now more than ever, following the US withdrawal from the WHO, we are less equipped to respond to infectious disease outbreaks both within our own borders and globally
Measles Resurgence Raises Preparedness Concerns
The case involved an unvaccinated infant exposed during international travel before returning to San Francisco, prompting contact tracing efforts and renewed concerns regarding health care worker exposure
In guidance circulated to UCSF health care personnel, Dr Gandhi instructed staff to verify measles immunity documentation amid renewed emphasis on infection-control measures, exposure protocols, and rapid recognition of symptoms potentially consistent with measles infection (email communication, April 13, 2026). The communication also emphasized the exceptionally high infectivity of measles, noting that the virus may linger in the air even after an infectious individual has left the room
According to Dr Gandhi, the case reflected not only the resurgence of a vaccine-preventable disease, but also broader challenges that many clinicians may have limited experience managing in the current era. “Physicians treating in the current era may not be as familiar with measles or other diseases that we had formerly eliminated, so they may not recognize the symptoms and signs right away,” Dr Gandhi said
Delayed recognition may complicate efforts to isolate infected individuals, quarantine exposed contacts, and administer post-exposure prophylaxis during highly transmissible outbreaks. “This is problematic for the patient if they need to be isolated and their contacts quarantined and given measles immunoglobulin and/or a booster or first shot of the measles vaccine,” Dr Gandhi said
She also expressed concern regarding the ability of health care systems and public health agencies to maintain effective containment measures requiring rapid isolation and coordinated public health action. “I am worried about our ability to control diseases that require isolation and quarantine in the current era of reduced public health funding as well,” Dr Gandhi said
The resurgence has emerged alongside declining vaccination coverage nationwide and growing concern among infectious disease clinicians regarding the durability of prevention systems once thought to have brought vaccine-preventable diseases largely under control. According to the Centers for Disease Control and Prevention (CDC) data updated July 9, 2026, 2231 confirmed measles cases had already been reported across 42 US jurisdictions and among international visitors during 2026, with 93% associated with outbreaks. Vaccination coverage among US kindergarteners declined from 95.2% during the 2019-2020 school year to 92.5% during the 2024-2025 school year, leaving approximately 286,000 kindergarteners at risk during the 2024-2025 school year, according to the CDC.1
Dr Gandhi also pointed to broader concerns surrounding reductions in domestic and international public health response capacity, including diminished federal workforce support and reduced global outbreak-response coordination following the US withdrawal from the World Health Organization (WHO)
Together, the rising case counts and declining vaccination coverage have heightened concern among infectious disease clinicians that health care systems may increasingly encounter outbreaks requiring rapid recognition, isolation protocols, and containment measures that many frontline providers have limited experience managing in routine practice, especially in communities where health care access and prevention re
Maine HIV Outbreak Highlights Containment Challenges
The pressures exposed by these outbreaks may become especially visible in communities already facing barriers to health care access, housing instability, and prevention services
In Maine, an ongoing HIV outbreak in Penobscot County has emerged as another example of the challenges surrounding disease containment in vulnerable populations, particularly individuals experiencing housing instability and people who inject drugs. According to updated Maine CDC data posted July 2, 2026, the outbreak had reached 44 confirmed cases between October 1, 2023 and June 26, 2026, with 91% of affected individuals reporting injection drug use within 1 year of diagnosis and 91% experiencing homelessness within the same timeframe.2
The outbreak has also highlighted how HIV transmission may intersect with housing instability, substance use disorders, and disruptions in continuity of care. Maine CDC data additionally showed that 89% of affected individuals had hepatitis C coinfection, while only 60% of individuals currently living in Maine had achieved viral suppression at their last recorded test.2
The concerns stand in contrast to the goals outlined in the 2019 “Ending the HIV Epidemic” initiative, launched during President Donald J Trump’s first administration, which aimed to end the HIV epidemic in the US within 10 years. The initiative was built around 4 pillars: diagnosing HIV as early as possible, rapidly achieving sustained viral suppression through treatment, expanding HIV prevention efforts including pre-exposure prophylaxis (PrEP), and quickly detecting and responding to emerging HIV clusters.3
The initiative additionally emphasized coordinated partnerships between federal agencies, public health departments, health care systems, and community organizations to strengthen outbreak detection, prevention, and treatment infrastructure. At the time, federal officials, including Anthony Fauci, MD, and then-CDC Director Robert Redfield, MD, described the initiative as a practical and achievable strategy to interrupt HIV transmission in geographic and demographic hotspots through sustained prevention and treatment efforts.3
Yet the ongoing outbreak in Maine has highlighted how difficult sustaining those goals may become when HIV prevention efforts intersect with housing instability, substance use disorders, gaps in health care access, and strained public health infrastructure
Despite major advances in HIV treatment and prevention through PrEP, outbreaks continue to expose gaps in disease containment, particularly among populations facing barriers to health care and prevention services. The outbreak has also reinforced broader concerns regarding continuity of prevention services, coordination between health care and public health agencies, and access to health care infrastructure within communities already facing significant socioeconomic challenges
“Communicable diseases do not stay restricted to certain populations, they spread,” Dr Gandhi highlighted
Mpox Continues to Challenge Global Response Systems
Discussion surrounding mpox has similarly raised concerns regarding how quickly evolving infectious disease threats may expose weaknesses in containment infrastructure, particularly in lower-re
During the 2022 global mpox outbreak, clinicians and health officials mobilized large-scale vaccination, surveillance, and containment efforts after the virus spread rapidly outside historically endemic regions. According to the WHO data included in a global health presentation developed by Dr Gandhi, more than 97,000 mpox cases across 121 countries had been reported as of August 2024 following the initial declaration of a public health emergency of international concern in July 2022.4
Although many high-rece transmission during the 2022-2023 outbreak, Dr Gandhi’s presentation noted that vaccine access and sustained containment efforts remained limited in parts of Africa where mpox had remained endemic for years.4
Her presentation additionally highlighted that the WHO declared another public health emergency of international concern in August 2024 after the emergence and spread of clade Ib mpox in Central Africa. According to CDC data cited in the presentation, the Democratic Republic of the Congo alone had reported more than 27,000 suspected mpox cases and more than 1300 deaths since January 2023.4
In a recent commentary published in the Journal of Clinical Microbiology, researchers noted that the evolution of mpox virus has begun to outpace parts of the current diagnostic infrastructure, potentially complicating surveillance and containment efforts in some settings.5
The researchers additionally highlighted reliance on centralized laboratory infrastructure and limited access to rapid point-of-care testing in many regions experiencing active outbreaks. Delayed diagnostic confirmation may hinder timely epidemiologic investigation, vaccination efforts, and early containment measures, particularly in areas with limited laboratory and health care capacity.5
Dr Gandhi also highlighted how the overlap between HIV and mpox during the 2022 outbreak reinforced how quickly emerging infectious diseases may concentrate within communities already experiencing fragmented health care access, social vulnerability, and uneven prevention infrastructure. Her presentation noted that 41% of patients included in an early multinational mpox case series had HIV, while US surveillance data from 2022 similarly demonstrated high rates of HIV coinfection among reported mpox cases.4
For clinicians and infectious disease experts, the continued emergence of new mpox clades despite prior containment efforts has reinforced broader concerns regarding how quickly evolving pathogens may expose gaps in diagnostic capacity, vaccine access, and coordinated response efforts, particularly in communities already facing health care inequities
Implications for Clinicians and Public Health Systems
Although measles, HIV, and mpox differ substantially in transmission patterns and epidemiology, the outbreaks collectively illustrate how quickly gaps in prevention and response capacity may emerge once health care infrastructure is placed under sustained strain
Across the outbreaks, clinicians and infectious disease experts have pointed to recurring challenges involving delayed recognition, uneven health care access, workforce limitations, housing instability, diagnostic barriers, and disruptions in prevention continuity, particularly within vulnerable populations and re
For many health care systems, the outbreaks have also served as a reminder that operational preparedness may become most difficult to sustain after years of perceived disease control, when familiarity with containment protocols, public health coordination, and prevention infrastructure may gradually erode over time
Dr Gandhi said, “Now more than ever, following the US withdrawal from the WHO, we are less equipped to respond to infectious disease outbreaks both within our own borders and globally.” She added, “Continued reductions in global health funding will further weaken preparedness for emerging pathogens and future pandemics.”
As infectious disease threats continue to evolve, Dr Gandhi emphasized that maintaining durable prevention systems, coordinated response capacity, and sustained public health investment will remain critical not only for future outbreak control, but also for protecting communities most vulnerable to disruptions in health care access and preventive services
- Centers for Disease Control and Prevention. Measles cases and outbreaks. Updated July 10, 2026. Accessed July 15, 2026.https://www.cdc.gov/measles/data-research/index.html
- Maine Center for Disease Control and Prevention. HIV/AIDS (Human immunodeficiency virus). Updated July 2, 2026. Accessed July 15, 2026.https://www.maine.gov/dhhs/mecdc/diseases-conditions/sexually-transmitted-diseases/hiv-aids
- Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP.Ending the HIV epidemic: a plan for the United States.JAMA. 2019;321(9):844-845. doi:10.1001/jama.2019.1343
- Gandhi M. Presentation on HIV, mpox and COVID-Updates in Global Health. Presented on October 8, 2024.
- Liu BM, Yang Z.An urgent need for diagnostic tools to address global mpox public health emergencies.J Clin Microbiol. 2025;63(7):e0132124. doi:10.1128/jcm.01321-24
