Vaccination rates against the deadly measles disease stalled, leaving nearly 35 million children with no or only partial protection, according to the newly released WHO and UNICEF Estimates of National Immunization Coverage (WUENIC). Measles is more than a health challenge—it’s a significant contributor to child mortality and a clear marker of inequities in access to health services, particularly immunizations. 

In 2023, only 83% of children worldwide received their first dose of the measles vaccine, the same coverage as in 2022. The introduction of the second-dose measles vaccine in several countries has led to a modest 1% increase in children receiving their second dose—at 74%. These figures fall short of the 95% coverage of both measles vaccines needed to prevent outbreaks, avert unnecessary disease and deaths, and achieve measles elimination goals.

The data shows that since 2019, measles vaccination coverage in countries with large or disruptive outbreaks has been too low to control further outbreaks. As a result, large or disruptive measles outbreaks compromised global health progress and affected more than 100 countries worldwide between 2019 and 2023. Preventing outbreaks is critical, as an estimated three out of four children live in a country that experienced a measles outbreak within the past five years.

Despite ongoing efforts, first-dose measles immunization coverage has yet to return to pre-COVID-19 pandemic levels, and overall progress has stalled. Limited in-country data seems to reveal a more complex picture. While some districts show improvements, others face worsening conditions. This growing disparity within countries could indicate that the real issue is not just stagnant overall immunization coverage but increasing inequities in access to vaccination among different areas and populations.

In-country variation, measles outbreaks, and stalled progress underscore the urgent need to reinforce equitable immunization strategies. Sustained investments to strengthen primary health care, improvements in routine immunizations, and timely, high-quality immunization campaigns can effectively curtail measles transmissions. 

Additional key findings on measles: 

• Ten countries accounted for 55% of children without a measles vaccination. The countries are Nigeria, the Democratic Republic of Congo, India, Ethiopia, Pakistan, Sudan, Indonesia, Yemen, Angola, and Afghanistan. The countries with the most “measles zero-dose” children are a mix of those with large birth cohorts, weak health systems, or both.
• A disproportionate number of unvaccinated children live in fragile, conflict, and vulnerable (FCV) settings. Fifty-five percent of unvaccinated children live in countries with these settings, while these countries only account for 28% of the global birth cohort. In these settings, Sudan, Yemen, and Afghanistan are among the 10 countries with the lowest first-dose measles vaccination rates.
• The global estimate of vaccination coverage indicates that the number of zero-dose children is off-track for achieving the Immunization Agenda 2030 (IA2030) goals. Zero-dose children are defined as those lacking the first dose of the diphtheria-tetanus-pertussis (DTP1) vaccine, which indicates that they have not received any routine vaccinations. IA2030 calls on all countries to reduce the number of zero-dose children by half by 2030. 

 

At the same time, rubella continues to pose a significant threat, with about 32,000 children born with congenital rubella syndrome (CRS) each year. At the end of 2023, 19 countries, most of which were in the WHO Africa Region, still did not use a rubella-containing vaccine in routine immunizations. This gap in vaccination coverage exacerbates the risk of CRS, particularly in regions where pregnant women lack immunity. Efforts to accelerate the introduction of a rubella-containing vaccine are paramount. 

While the findings are concerning, the Measles & Rubella Partnership continues to collaborate with countries to provide measles and rubella vaccines through high-quality immunization services. Between 2021 and 2023, M&RP supported 20 countries to implement measles outbreak response campaigns, reaching nearly 27 million children with life-saving vaccines. In this same period, M&RP supported the implementation of 31 measles and rubella follow-up and catch-up campaigns in 28 Gavi-supported countries. The Partnership has also supported campaigns in three middle-income countries that reached nearly 1.5 million children and adolescents in 2022 and 2023. 

With the global increase in measles outbreaks, the time to act is now. Measles outbreaks anywhere are a threat to unprotected children everywhere. Measles and rubella vaccinations are essential milestones in the complete immunization of all zero-dose children. Together, we can stop measles and rubella from jeopardizing the health and future of all children.