Measles cases are surging, making global elimination a ‘distant goal,’ WHO says
Fifty-nine countries reported large or disruptive measles outbreaks last year, almost triple the number reported in 2021.
Measles deaths have declined sharply since 2000 but cases are now surging, even in countries where measles has been declared eliminated. (Photo Credit: Sarah L. Voisin/The Washington Post/Getty Images via CNN Newsource)
(CNN) — For decades, measles vaccination has been a global success story. Deaths from measles dropped 88% around the world from 2000 to 2024, according to a new report from the World Health Organization, with an estimated 58 million lives saved in that time.
But now, with vaccine coverage well below the level needed to stop transmission, cases are surging. Fifty-nine countries reported large or disruptive measles outbreaks last year, almost triple the number reported in 2021. A quarter of outbreaks are happening in countries previously declared measles-free, including Canada and the United States.
“Global measles elimination remains a distant goal,” according to the WHO report released Friday. The progress of the last decades is in peril with the return of outbreaks and decline in resources for immunization and disease surveillance, according to the report — in particular, the US government’s reduced support for global health.
Elimination means a virus is no longer circulating and that a country has the capacity to “shut down” infections that come in via visitors and travelers. Canada recently lost its elimination status, and WHO is also concerned about the US backsliding and losing its status, said Dr. Kate O’Brien, director of the WHO’s Department of Immunization.
The US Centers for Disease Control and Prevention reports that there have been 1,798 confirmed measles cases in the US this year, the highest number of cases since the country reached elimination status in 2000.
“Measles remains the world’s most contagious virus,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said. Even though there’s a highly effective low-cost vaccine, the disease “exploits gaps in immunization coverage.”
Globally, more than 30 million children were under-protected against measles in 2024.
Victories and challenges
There have been some victories, officials say. Measles deaths have dropped sharply since 2000. Every WHO country and region has committed to eliminating measles and rubella by maintaining at least 95% vaccine coverage, strengthening surveillance systems and making measles elimination goals part of broader health care efforts.
Recently, Cabo Verde, Seychelles and Mauritius became the first countries in the African region to achieve measles elimination this year. Twenty-one Pacific island countries also eliminated measles and rubella this year.
“We have made measurable progress towards measles elimination,” said Diana Chang Blanc, unit head of WHO’s Essential Program on Immunization. But progress toward elimination is “still too slow. Cases and deaths are still unacceptably high.” Every measles death is preventable with a low-cost vaccine.
Three countries have yet to give the second dose of a measles vaccine as standard practice. That’s important, Chang Blanc said, because the second dose “increases vaccine effectiveness to 95%, providing most individuals with long-lasting immunity.”
In 2024, only 84% of children received the first dose and 76% received the second dose globally. “This means that 30 million children remain underprotected from measles in 2024,” Chang Blanc said. “Children living in fragile, vulnerable conflict-afflicted settings are the most adversely affected.”
Progress is not happening at the expected pace, she said, because of lower global immunization rates and backsliding of vaccination since the Covid-19 pandemic. It has been challenging for children who missed recommended vaccines during the pandemic to catch up.
Measles acts as a “fire alarm for immunization programs,” O’Brien said. When the disease resurfaces, “it warns that there are gaps in immunization coverage” and health care access inequities. That same gap persist with other vaccine-preventable diseases, too, like whooping cough and polio.
Slowing progress to elimination
The alarm has already been sounding on vaccines. The Covid-19 pandemic disrupted immunization program around the world. Measles vaccination levels are still slightly below pre-pandemic levels.
Misinformation and disinformation are notable factors in slowed vaccination rates, WHO says. But access is still the most significant problem.
Chang Blanc said that the breakdown or lack of “a strong foundation in the routine immunization system” is the No. 1 reason for high measles case counts and outbreaks.
Although it sounds simple, Chang Blanc said, those routine systems require trained health workforces, logistic systems, transport, surveillance systems and other resources that many countries do not have.
The major barrier to reaching 95% measles vaccine coverage is “access to populations that need it most,” Chang Blanc said.
Deep funding cuts aï¬ecting the Global Measles and Rubella Laboratory Network, which include 760 laboratories that help surveil and respond to outbreaks, and country immunization programs are “feared to widen immunity gaps and drive further outbreaks in the coming year,” the report says.
“Securing sustainable domestic financing and new partners is now a critical challenge to advancing eï¬orts toward a world free of measles,” the report says.
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