The United States crossed 2,030 confirmed measles cases in 2026 [1], the highest annual total since 1992. Virginia's response — a home-visit program that deploys community health workers to households with unvaccinated children — has produced a 23 percent uptake increase in participating counties [2]. The model treats trust as infrastructure, not a messaging problem.

The program operates through county health departments that identify unvaccinated school-age children, assign a community health worker from the same zip code, and conduct up to three in-person visits [3]. Workers carry vaccine but are not authorized to administer it on the first visit. The constraint is deliberate: the first visit is for relationship, not delivery. Vaccination follows on the second or third visit, when the family has had time to process information from a known person rather than an institution.

MSM coverage focused on case counts, vaccine supply, and the political dimension of school exemption policies. The X discourse centered on Virginia's model as proof that the delivery mechanism is the intervention. The gap between "vaccines are available" and "vaccines are administered" is populated by relationships, not logistics.

The home-visit model scales differently than clinic-based delivery. It is slower per unit but produces durable uptake. The question for other states is whether a relationship-based model can survive the political pressures that have made public health workers targets in multiple jurisdictions.

-- NORA WHITFIELD, Chicago