What will the average number of measles cases be during Trump's term?
The market is severely mispriced because the average is already locked in at over 2,200 cases per year for the first two years of the term, making any 'low average' outcome virtually impossible unless the remaining years drop to near-zero, which contradicts current epidemiological trends.
Analysis
The average number of measles cases during the Trump Administration is already mathematically determined to be extremely high based on the first 1.5 years of data. With 2,289 cases in 2025 and 2,260 confirmed as of mid-July 2026, the average for just these two years is approximately 2,270 cases. Even if 2027 and 2028 saw a complete return to the pre-2024 baseline of roughly 285 cases, the four-year average would still exceed 1,200 cases. The current market price of 0.33 for 'Yes' implies a low probability of a high average, which contradicts the hard data showing the surge is driven by structural failures in vaccination rates and public health infrastructure that are unlikely to reverse abruptly.
The market appears to be mispricing this event due to a misunderstanding of how averages work over partial terms or an unrealistic expectation of immediate containment. The surge is not a temporary spike but a result of 93% of cases occurring in unvaccinated individuals, indicating a deep-seated herd immunity gap that will persist through 2027 and 2028. Experts predict 2026 will 'almost certainly race past' the 2025 record, pushing the two-year average even higher. Unless the US achieves a miraculous and immediate vaccination turnaround, the average will remain well above 2,000 cases, a stark contrast to the historical baseline of 200–300 cases.
Arguments for a 'Yes' outcome (high average) are overwhelming because the denominator is fixed at four years while the numerator is already over 4,500. The only way the average drops significantly is if the remaining two years see near-zero cases, which is epidemiologically improbable given the current transmission pace where 2026 has matched 2025's total in half the time. The market's low probability assessment fails to account for the fact that the 'average' is already dominated by the 2025–2026 surge, making the 'No' outcome (low average) mathematically unlikely.
Arguments
For
- The average for the first two years is already approximately 2,270 cases, making a low overall average mathematically impossible without near-zero future counts
- 2026 transmission pace is a sharp escalation from 2024, with experts predicting the year will exceed 2025's record
- 93% of cases are in unvaccinated individuals, indicating a persistent herd immunity gap that will sustain high case counts
- The surge is driven by hollowed-out local health departments and slipping vaccination rates, structural issues unlikely to resolve quickly
Against
- If 2027 and 2028 see a return to the 285-case baseline, the four-year average could drop to around 1,200, potentially below the 'high' threshold
- Preliminary CDC data for 2025 and 2026 is subject to change and could be revised downward
- The event definition of 'average' might be interpreted in ways that exclude partial year data or use different denominators
- Unforeseen public health interventions could theoretically halt transmission before the end of the term
Key drivers
- 2025 record of 2,289 cases and 2026 partial count of 2,260 cases locking in a high two-year average
- Structural decline in vaccination rates with 93% of cases in unvaccinated individuals preventing rapid containment
- Projected 2026 total exceeding 2,300 cases, further elevating the term average
- Lack of immediate policy or infrastructure changes to reverse the 120-fold incidence difference in outbreak states
Risk factors
- Unexpected rapid containment of outbreaks leading to near-zero cases in 2027 and 2028
- Definition ambiguity in the event resolution regarding whether 'average' includes partial years or only full calendar years
- Data revisions by CDC that could significantly lower the preliminary 2025 and 2026 counts
- Sudden mass vaccination campaigns or policy shifts that could drastically reduce transmission in remaining term years
Scenarios
Best case
The outbreak is contained by early 2027, with 2027 and 2028 seeing only 200–300 cases each, resulting in a four-year average of approximately 1,200 cases.
Most likely
The average remains above 2,000 cases per year as 2026 exceeds 2,300 cases and 2027–2028 see a slow decline to 1,000–1,500 cases, keeping the four-year average around 1,800–2,000.
Worst case
The trend continues through 2028 with annual counts exceeding 2,500 cases, resulting in a term average well above 2,400 cases.
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