Measles Worldwide, 2000–2019: 25.5 Million Deaths Averted, Then a Global Resurgence

In 2010, the World Health Assembly set three measles milestones for 2015: first-dose vaccine (MCV1) coverage of at least 90% nationally and 80% in every district; incidence below 5 cases per million; and a 95% cut in deaths from 2000. In 2012, the Global Vaccine Action Plan aimed to eliminate measles in five of WHO's six regions by 2020. This report measures progress through 2019.

Key findings

• Vaccination averted an estimated 25.5 million measles deaths from 2000 to 2019.
• MCV1 coverage rose from 72% to 84% by 2010 and has stalled at 84%–85% since.
• After the 2016 low, reported cases rose 556% — the most since 1996 — and estimated deaths rose nearly 50%.
• No WHO region had achieved and kept elimination; 83 countries (43%) were verified measles-free, with Iran and Sri Lanka added in 2019.

Estimated annual measles deaths worldwide with and without vaccination, 2000–2019. From CDC's MMWR.

Vaccination

• 122 of 194 countries (63%) reached 90% MCV1 coverage in 2019, up from 86 in 2000 but down from a peak of 127 in 2012; only 42 also reached 80% in every district.
• 19.8 million infants missed MCV1 in 2019. Nearly half were in six countries: Nigeria (3.3 million), Ethiopia (1.5 million), DR Congo (1.4 million), Pakistan (1.4 million), India (1.2 million) and the Philippines (0.7 million).
• Countries offering a second dose rose from 95 to 177; six added it in 2019.
• About 204 million people were vaccinated in campaigns in 55 countries in 2019, plus 9 million in outbreak responses.

The resurgence

In 2019, nine countries — Central African Republic, DR Congo, Georgia, Kazakhstan, Madagascar, North Macedonia, Samoa, Tonga and Ukraine — had more than 500 cases per million, together accounting for 631,847 (73%) of cases worldwide. The Americas, verified measles-free in 2016, lost that status when endemic spread returned to Venezuela (2018) and Brazil (2019).

The root cause everywhere was failure to vaccinate, leaving immunity gaps in young and some older people:

• DR Congo and Madagascar: years of very low MCV1 coverage, no second dose and weak campaigns.
• Samoa: falling coverage from 2014 to 2018, worsened by lost confidence after two infants died from an error in giving measles-mumps-rubella vaccine.
• Ukraine: low confidence among health workers and low public demand.

Surveillance

All countries conduct measles surveillance and nearly all have access to the WHO lab network, but only 81 of 157 reporting countries (52%) met the sensitivity target of two discarded cases per 100,000. Of 24 known measles genotypes, 20 have been eliminated since 2005; in 2019, D8 (78%) and B3 (22%) dominated, with a few D4 and H1.

What's needed

Countries need help to reach every child with two doses, find and close immunity gaps, and strengthen case-based surveillance, following the Immunization Agenda 2030 and the Measles-Rubella Strategic Framework 2021–2030. China, Colombia and India offer lessons in success.

Sources

Based on Patel MK, Goodson JL, Alexander JP Jr, et al., "Progress Toward Regional Measles Elimination — Worldwide, 2000–2019," Morbidity and Mortality Weekly Report 69(45), CDC; a work of the United States government in the public domain.