Global and regional burden of measles and vaccine coverage among children under 5 years, 1990−2023: a Global Burden of Disease Study

Despite decades of marked progress in reducing measles incidence and mortality worldwide, recent data indicate a troubling reversal in these gains. According to updates from a comprehensive global health study detailed by nature.com, measles cases and fatalities have surged since 2020, exposing vulnerabilities in vaccination efforts across diverse regions.

From 1990 through 2019, substantial declines were recorded: measles incidence fell by approximately 80%, with mortality dropping by around 90%. These improvements were largely attributed to expanded coverage of measles-containing vaccines (MCV), particularly the first dose (MCV1), which increased globally from just over two-thirds of children vaccinated in 1990 to more than 80% by 2019. Similarly, the administration of the second dose (MCV2) saw considerable growth, reaching over two-thirds of children by the same year.

However, the momentum stalled post-2019, with global MCV1 coverage slipping slightly to about 81% by 2023, while MCV2 coverage plateaued just above 70%. This stagnation coincides with a sharp rise in measles cases, which reached an estimated 15.6 million infections worldwide in 2023—an increase of roughly 40% compared to 2019. Measles-related deaths also rose by 12% during this period, with 118,000 fatalities reported in 2023 alone.

The resurgence is not uniformly distributed but disproportionately affects regions with persistent healthcare challenges. Sub-Saharan Africa and South Asia remain the most heavily burdened areas, reflecting ongoing gaps in vaccination coverage and health infrastructure. Despite the overarching global targets set by the Immunization Agenda 2030, which aims for at least 90% coverage with both MCV doses, many countries continue to fall short, undermining efforts to achieve measles elimination.

This resurgence underscores the fragility of global immunization gains and the complex interplay of factors contributing to vaccine coverage challenges. Disruptions related to the COVID-19 pandemic, including healthcare system strain and vaccine delivery interruptions, have exacerbated these issues. Additionally, regional conflicts, resource limitations, and vaccine hesitancy pose significant barriers to restoring and expanding routine immunization.

Experts emphasize the urgency of reinvigorating vaccination programs to close immunity gaps, particularly among children under five, who remain the most vulnerable to measles complications. Strengthening outbreak preparedness, improving vaccine supply chains, and enhancing community engagement are critical components of this strategy.

The data presented by nature.com stem from the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, which offers an extensive analysis of measles trends across 204 countries and territories. This comprehensive approach integrates incidence, mortality, and disability-adjusted life years (DALYs) to provide a nuanced understanding of measles’ impact on global child health.

The study’s findings serve as a call to action for international health organizations, governments, and civil society to prioritize measles vaccination within broader public health agendas. Failure to address the current regression risks reversing years of progress, potentially leading to further outbreaks and increased mortality.

In conclusion, the recent rise in measles cases and deaths highlights a critical juncture in global health. Sustained commitment to immunization, coupled with innovative strategies to overcome systemic obstacles, is essential to safeguarding children worldwide from this preventable disease.