Intended for healthcare professionals


Measles is now “an imminent threat” globally, WHO and CDC warn

BMJ 2022; 379 doi: (Published 24 November 2022) Cite this as: BMJ 2022;379:o2844
  1. Gareth Iacobucci
  1. The BMJ

Falling vaccination rates and reduced surveillance during the covid-19 pandemic have created an “imminent threat” of measles spreading in every region of the world, the World Health Organization and the US Centers for Disease Control and Prevention (CDC) have warned.

Globally, measles vaccination coverage has fallen steadily since the beginning of the pandemic, with a record of nearly 40 million children missing a vaccine dose in 2021, a joint report1 from the organisations highlighted. Globally, 25 million children missed their first dose and another 14.7 million children missed their second dose last year.

The report said that declining vaccine coverage, weakened measles surveillance, continued interruptions and delays in immunisation because of covid-19, and persistent large outbreaks in 2022 were leaving millions of children at risk of infection and hampering global progress towards achieving and maintaining elimination.

Worldwide, there were an estimated 9 million cases and 128 000 deaths from measles in 2021, with 22 countries experiencing large and disruptive outbreaks.

WHO director general Tedros Adhanom Ghebreyesus said, “Getting immunisation programmes back on track is critical. Behind every statistic in this report is a child at risk of a preventable disease.

“The paradox of the pandemic is that while vaccines against covid-19 were developed in record time and deployed in the largest vaccination campaign in history, routine immunisation programmes were badly disrupted, and millions of kids missed out on life saving vaccinations against deadly diseases like measles.”

The report highlighted that global coverage for full two dose measles vaccination is currently well below the 95% needed to create herd immunity, with only 81% of children receiving their first dose, and only 71% receiving their second dose. It said these are the lowest global coverage rates of the first dose of measles vaccination since 2008, but said coverage varied by country.

In the UK, the most recent figures2 show that only 89.2% of children at 24 months had completed their first dose of the measles, mumps, and rubella vaccine—a decrease from 90.3% the previous year—while coverage for the second dose was down by nearly 1% from 86.6% to 85.7%.

In 2021, nearly 61 million measles vaccine doses were postponed or missed globally because of covid-19-related delays in 18 countries. The 10 countries with the highest number of infants who did not receive a first dose of vaccine were Nigeria (3.1 million), India (2.5 million), Democratic Republic of the Congo (1.7 million), Ethiopia (1.7 million), Indonesia (1.2 million), Pakistan (1.2 million), Philippines (1.0 million), Angola (0.8 million), Brazil (0.7 million), and Tanzania (0.5 million). These countries accounted for 59% of all children who did not receive a first dose.

The report added that since 2016, 10 countries that had previously eliminated measles experienced outbreaks and re-established transmission.

CDC director Rochelle Walensky said, “The record number of children under-immunised and susceptible to measles shows the profound damage immunisation systems have sustained during the covid-19 pandemic.

“Measles outbreaks illustrate weaknesses in immunisation programmes, but public health officials can use outbreak response to identify communities at risk, understand causes of under-vaccination, and help deliver locally tailored solutions to ensure vaccinations are available to all.”


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