Measles vaccination coverage has steadily declined since the start of the COVID-19 pandemic. In 2021, a record high of nearly 40 million children missed a dose of measles vaccine: 25 million children missed their first dose and another 14.7 million children missed their second dose, a joint publication by the World Health Organization (WHO) and the United States States reports from the Centers for Disease Control and Prevention (CDC). This decline is a significant setback to global progress toward achieving and sustaining measles elimination, leaving millions of children vulnerable to infection.
In 2021, there were an estimated 9 million cases and 128,000 deaths from measles worldwide. Large and destructive outbreaks occurred in 22 countries. Declining immunization coverage, weakened measles surveillance, and continued disruptions and delays in immunization activities due to COVID-19 and continued large outbreaks in 2022 mean that measles is an imminent threat in all regions of the world.
“The paradox of the pandemic is that while vaccines for COVID-19 were being developed in record time and deployed in the largest immunization campaign in history, routine immunization programs were severely disrupted and millions of children were missing out on life-saving shots against deadly diseases like measles,” said WHO Director General Dr. Tedros Adhanom Ghebreyesus. “It is absolutely critical to get immunization programs back on track. Behind every statistic in this report is a child at risk of a preventable disease.”
The situation is serious: measles is one of the most contagious viruses in humans, but it can be almost completely avoided by vaccination. 95% or greater coverage of 2 doses of a measles-containing vaccine is required to establish herd immunity, protect communities, and achieve and sustain measles elimination. The world is far below, with only 81% of children receiving their first dose of measles vaccine and only 71% of children receiving their second dose of measles vaccine. These are the lowest global coverage rates for the first measles vaccine since 2008, although coverage varies by country.
Urgent global need for action
Measles is a threat everywhere because the virus can spread quickly to multiple communities and across international borders. No WHO region has achieved and sustained measles elimination. Since 2016, 10 countries that had previously eliminated measles have had outbreaks and retransmission.
“The record number of children who are underimmunized and susceptible to measles demonstrates the profound damage immunization systems have suffered during the COVID-19 pandemic,” said CDC Director Dr. Rochelle P Walensky. “Measles outbreaks illustrate weaknesses in immunization programs, but public health officials can use outbreak response to identify vulnerable communities, understand causes of undervaccination and help provide locally tailored solutions to ensure immunizations are available to all.”
In 2021, nearly 61 million measles vaccine doses were postponed or missed due to COVID-19-related immunization campaign delays in 18 countries. Delays increase the risk of measles outbreaks, so now is the time for public health officials to speed up vaccination efforts and step up surveillance. CDC and WHO are calling for a coordinated and collaborative effort from all partners at the global, regional, national and local levels to prioritize efforts to locate and vaccinate all vulnerable children, including those who have gone missing in the past two years.
Measles outbreaks illustrate weaknesses in immunization programs and other key health services. To mitigate the risk of outbreaks, countries and global stakeholders need to invest in robust surveillance systems. As part of the Immunization 2030 Agenda’s global immunization strategy, global immunization partners remain committed to supporting investments in strengthening surveillance to quickly identify outbreaks, respond quickly and immunize all children who are not yet protected from vaccine-preventable diseases.
Learn more about measles
For more information on the CDC’s global measles immunization efforts, click here.
For more information on WHO measles control and support, click here.
Quotations from our partners
“Since 2001, the American Red Cross has mobilized volunteers in 47 countries around the world to reach vulnerable communities with life-saving vaccines. The global COVID-19 pandemic has once again highlighted the importance of vaccines in preventing the spread of deadly diseases. We and our partners in the global Red Cross movement are committed to preventing unnecessary deaths. It is imperative that we work together to close existing immunity gaps and ensure no one suffers from vaccine-preventable diseases.” Gail McGovern, President and CEO of the American Red Cross.
“The marked decline in measles coverage is alarming. Gavi is helping low-income countries restart routine immunization programs and continues to fund the global outbreak response through MR&I’s Outbreak Response Fund. As an alliance, we also continue to push, with focused efforts, to reach zero-dose children and communities who consistently miss immunizations and other essential services. This is fundamental to reducing outbreaks and keeping healthcare systems strong and resilient in the face of other threats.” dr Seth Berkley, CEO of Gavi.
“Declining measles vaccination rates should trigger every alarm. Until we restart the global immunization effort, tens of millions of children are at risk from this deadly but entirely preventable disease. There’s no time to lose. We urgently need to work to get life-saving vaccines to the last child.” Elizabeth Cousens, President and CEO, United Nations Foundation
“For three years we have been sounding the alarm about declining vaccination rates and increasing health risks for children worldwide. Widening gaps in immunization coverage are allowing measles – the most contagious yet vaccine-preventable deadly disease – to spread and cause disease and death. We have a short window of opportunity to make up urgent lost ground in measles vaccination and protect every child. The time for decisive action is now.” Ephrem Tekle Lemango, UNICEF Director of Immunization.
US Department of Health and Human Services
CDC works around the clock to protect America’s health, safety and security. Whether diseases begin domestically or internationally, are curable or preventable, chronic or acute, result from human activity or deliberate attack, CDC responds to America’s most pressing public health threats. CDC is headquartered in Atlanta and has experts across the United States and around the world.
World Health Organization
Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere, an equal chance at a safe and healthy life. Our mission is to promote health, protect the world and serve the vulnerable.