The WHO announced in November 2022 that almost 40 million children were “dangerously susceptible” to the “growing threat” of measles following a decline in vaccination coverage. This decline is recorded from the beginning of the COVID-19 pandemic and is observed across a range of routine childhood vaccinations.  

A worrying decline 

The statement from WHO, published on 23rd November 2022, suggested that WHO and CDC data identified 25 million children who had missed their first dose and a further 14.7 million children who missed their second dose.  

“This decline is a significant setback in global progress towards achieving and maintaining measles elimination and leaves millions of children susceptible to infection.”  

In 2021 we experienced an estimated 9 million cases, with an unfortunate 128,000 deaths. 22 countries had “large and disruptive outbreaks”. This is attributed to “declines in vaccine coverage”, poor surveillance, and COVID-19 related disruptions.  

A grave situation 

Measles is “one of the most contagious human viruses but is almost entirely preventable through vaccination”. Herd immunity can be obtained with coverage of 95% and higher. Sadly, we are “well under” this, with only 81% of children receiving the first dose of a measles-containing vaccine, and only 71% of children a second.  

“These are the lowest global coverage rates by the first dose of measles vaccination since 2008, although coverage varies by country”.  

Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, identified the “paradox of the pandemic” as the contrast between the “record time” of the “largest vaccination campaign in history” and the disruption of routine immunisations. 

“Getting immunisation programmes back on track is absolutely critical. Behind every statistic in this report is a child at risk of a preventable disease.”  

Calls to action 

No WHO region has achieved and sustained elimination of the virus. Furthermore, 10 countries that had previously eliminated measles have experienced outbreaks since 2016. This is concerning to CDC Director Dr Rochelle P. Walensky, who suggests that “public health officials can use outbreak response to identify communities at risk”. In doing so, she hopes that they will be able to “deliver locally tailored solutions to ensure vaccinations are available to all.”  

CDC and WHO now “urge coordinated and collaborative action”, as is their wont. In addition, several WHO partners have come forward to comment on the situation. Gail McGovern, President and CEO of the American Red Cross emphasised the importance of “averting needless deaths”. 

“It is imperative we work together to close existing immunity gaps and ensure that no one suffers from vaccine preventable diseases.” 

Gavi’s CEO, Dr Seth Berkley describes the decline in measles coverage as “alarming”. Gavi’s support for lower-income countries will continue to “get routine immunisation programmes back on track”. Furthermore, it is “pushing” with “targeted efforts” to reach zero dose children. Elizabeth Cousens, President and CEO of the United Nations Foundations agrees that “plummeting measles vaccination rates should set off every alarm”.  

“There is no time to waste.” 

The alarm motif continues in a comment from UNICEF’s Chief of Immunisation Ephrem Tekle Lemango. His team have been “sounding the alarm” for 3 years and he demands “decisive action”. So, how can a world battling vaccine reluctance and emerging from COVID-19 spring back into defensive mode against a vaccine preventable virus? Will “coordinated and collaborative action” engage communities in hard-to-reach areas, and will vaccines reach every child? 

For more on measles vaccination programmes at the World Vaccine Congress in Washington next year, get tickets at this link.