# A health and economic evaluation of the spatial spillover effect from measles resurgence

## TL;DR

This study evaluates how reduced MMR vaccination rates in Virginia lead to measles outbreaks and economic costs, emphasizing the importance of region-wide policies.

## Contribution

The integration of epidemiological modeling with spatial econometrics to quantify health and economic spillover effects of measles outbreaks.

## Key findings

- Reduced MMR vaccination rates are linked to increased measles cases and economic costs.
- Urban areas experience significant spillover effects from vaccination declines, while rural areas show negligible impacts.
- Spatial interdependencies highlight the need for region-wide policy responses to vaccination rate fluctuations.

## Abstract

The administration of the Measles, Mumps, and Rubella (MMR) vaccination has had a substantial impact on controlling the spread of measles on a global scale. Nevertheless, the COVID-19 pandemic caused major disruptions to normal immunization schedules, causing the omission or delay of routine immunizations. Expanding on previous research that simulated measles outbreaks using a detailed agent-based model, this study integrates epidemiological forecasts with spatial econometrics analysis. Our objective is to quantify the household-level direct and indirect health and economic impact of measles outbreaks caused by reduction in MMR vaccine uptake. A network-based SEIR (susceptible-exposed-infected-recovered) model is used to simulate the transmission of measles over a synthetic social contact network of Virginia, under various scenarios. Household-level costs of measles outbreak, encompassing MMR vaccine expenses, treatment costs, and productivity losses, are estimated from the simulation results. A Generalized Spatial Autoregressive (GSAR) model is used to estimate the spatial ‘spillover effect’ on neighboring counties. Our findings indicate that reduced MMR vaccination rates are associated with increased measles cases and related economic costs, which are intensified by disease transmissibility and moderated by home quarantine. The GSAR model, with spatial lag coefficients, shows significant spatial interdependencies. A small decrease in vaccination rate in an urban region like Richmond, Virginia, has significant economic and epidemiological spillover effect, while similar reductions in rural regions like Highland County, Virginia, have a negligible impact. A decline in MMR vaccination rate has ramifications for both disease incidence and the economy, presenting diverse consequences influenced by regional disparities. Policymakers should acknowledge the interconnectedness of health and economic outcomes across regions. This research underscores the necessity of implementing broad, region-wide policy measures in response to fluctuations in vaccination rates, prioritizing overarching strategies over localized interventions.

The online version contains supplementary material available at 10.1038/s41598-025-21097-0.