Measles cases are rising – here’s what can be done

In 2022, there were 941 cases of measles across 41 countries in Europe and parts of central Asia.

In 2023, that figure rose to 42,200.

That’s an almost 45-fold increase in a year and, as the World Health Organization (WHO) warned in January, “an alarming rise” that requires urgent collective action.

Measles is caused by a highly contagious virus that infects the respiratory tract and spreads throughout the body, causing fever and a rash.

At its most severe, it can lead to complications including blindness, pneumonia and encephalitis, or swelling of the brain, which can kill.

From January to October 2023, more than 20,000 people were hospitalized and five deaths due to measles were reported by two countries in the WHO’s European region.

Children under five, pregnant women, adults over 20 and those with compromised immune systems are most at risk of measles complications.

While measles is still common in Africa and parts of the Middle East and Asia, countries in Europe and the US had been declared measles-free in recent years – and these are now seeing a worrying resurgence.

Kazakhstan, one of 53 countries included in the WHO European Region, has seen the highest number of measles cases, with 13,677 recorded in 2023, 65% of which were in children under five.

In western Europe, the UK is one of the worst affected countries. On 19 January, the UK’s Health Security Agency (HSA) declared a “national incident”, the Financial Times (FT) reports, after seeing suspected cases more than quadruple in England and Wales – from 360 in 2021 to 1,603 in 2023.

In 2017, the UK had received “measles-free status” from the WHO, when it had just 284 cases. The city of Birmingham alone registered 250 cases in the four months from October 2023 to January, according to the FT.

As the Chief Executive of the HSA Professor Dame Jenny Harries warned, children who get measles can be “very poorly, and some will suffer life-changing complications”.

The US Centers for Disease Control and Prevention (CDC), which is monitoring outbreaks, warned healthcare providers to be on the alert for patients with symptoms of measles, as 23 cases were reported since early December.

To keep progressing in the fight against measles, countries are expected to achieve a rate of 95% coverage with 2 doses of measles-containing vaccine.

In the two decades between 2000 and 2020, second-dose vaccine coverage rose in all regions, albeit unevenly, as seen in the chart using WHO and CDC data below. This saved an estimated 57 million lives.

But these rates of vaccination coverage have since been dropping.

Between 2020 and 2022, more than 61 million doses of vaccines against measles were missed due to delays caused by the COVID-19 pandemic.

In the UK alone, more than 3.4 million children under 16 are either completely unprotected or only partially protected against measles, says NHS England.

Globally, the spread of misinformation about vaccine safety has contributed to the largest sustained drop in the uptake of childhood vaccinations in 30 years, in what UNICEF Executive Director Catherine Russell warned in 2022 was a “red alert” for child health.

“We need immunization catch-ups for the missing millions or we will inevitably witness more outbreaks, more sick children and greater pressure on already strained health systems,” she said.

As the figures show, there’s urgent work needed to get immunization programmes back on track and to rebuild trust in vaccine safety to reach the 95% coverage threshold.

“Vaccination is the only way to protect children from this potentially dangerous disease,” as the WHO’s Regional Director for Europe, Dr Hans Henri P. Kluge said.

Countries also need to detect and respond quickly to measles outbreaks to limit further transmission.

Kluge praised Kazakhstan for taking decisive action to tackle measles, with measures including: isolating patients, observation of people that patients have been in contact with; catch-up immunizations for all children under 18 who missed routine vaccination; and a public education campaign.

In the UK, confidence in vaccines has dropped since the pandemic, but access is a major factor in vaccine uptake, according to Helen Bedford, professor of children’s health at University College London.

She told the FT: “We need to be thinking more about taking vaccination to the people, rather than expecting them always to come to us.”

Building up regional vaccine manufacturing capacity can help to make access to vaccines more equitable. To this end, the Forum has been working with its healthcare partners including the Coalition of Epidemic Preparedness Innovations and the US National Academy of Medicine on the Regionalized Vaccine Manufacturing Collaborative.

In January, we published A Framework for Enhancing Vaccine Access Through Regionalized Manufacturing Ecosystems – to serve as a roadmap for regions to grow production and distribution capabilities sustainably and establish local capacities to respond at scale in epidemics.