A joint publication by the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC) published today highlights an alarming rise in measles cases, disruptive outbreaks and deaths in 2022. Measles cases globally in 2022 are reported to have increased by 18% to over 9 million, deaths went up by 43% (136,200) compared to 2021, while 37 countries experienced outbreaks in 2022.
The findings reiterate the continued need for accelerated efforts to support recovery from the COVID-19 pandemic and strengthen health systems, especially in the lower-income countries most impacted by this deadly disease. Of the 22 million children who missed their first measles vaccine dose in 2022, more than half live in just ten countries, six of which are lower-income countries supported by Gavi, the Vaccine Alliance: Democratic Republic of the Congo, Ethiopia, India, Madagascar, Nigeria and Pakistan.
Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance comments:
“Measles is a highly contagious and deadly disease: preventing outbreaks requires consistently vaccinating at least 95% of eligible children. This was already challenging before the COVID-19 pandemic, and with cases, outbreaks and preventable deaths rising so sharply due to increased immunity gaps related to the pandemic, it shows how even more important it is that our Alliance provides an unprecedented level of support to countries in 2024.”
With routine immunisation hard-hit by the COVID-19 pandemic, in 2023 Gavi supported nine lower-income countries in accelerated efforts to plan and launch measles and measles-rubella follow-up vaccination campaigns, and disbursed more than US$ 12 million to support outbreak response in six countries. An additional three preventive vaccination campaigns are planned before the end of this year. In response to the sustained and alarming trend in measles cases, in 2024 Gavi will support a record number of lower-income countries – at least 15 in total – to undertake measles and rubella preventive vaccination campaigns aiming to reach about 38.5 million children, in addition to routine vaccine introductions and outbreak response.
The Vaccine Alliance supports measles immunisation activities in lower-income countries in close collaboration with WHO, UNICEF, CDC, American Red Cross, UN Foundation, the Bill & Melinda Gates Foundation and other partners, including through the Measles & Rubella Partnership (M&RP).
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FACTSHEET: STATE OF MEASLES IMMUNISATION IN LOWER-INCOME COUNTRIES
How does vaccination against measles work in lower-income countries?
- One of the top vaccine-preventable killers of children, measles is highly contagious and requires at least 95% vaccine coverage through routine vaccination and highly effective supplementary campaigns. This presents a significant challenge to countries, particularly lower-income countries, that continue to struggle to close immunity gaps.
- The measles-containing vaccine is safe, effective and inexpensive. Children should receive two doses of the vaccine through a combination of routine and supplementary activities to ensure they are immune: the first dose at 9 months and the second dose at 15–18 months of age.
- Measles vaccination also represents an important opportunity to strengthen health systems. Measles is a tracer, and when an unimmunised child is identified and reached through a measles or measles-rubella (MR) vaccination campaign, it serves as a critical entry point for both routine immunisation and other essential services.
- Routine immunisation: Gavi supports lower-income countries to introduce two doses of measles-containing vaccine (MCV1 and MCV2) into routine programmes.
- Preventive catch-up and follow-up vaccination campaigns: In addition, the Vaccine Alliance supports the planning, application, implementation and evaluation of regular preventive measles/measles-rubella (M/MR) follow-up and catch-up vaccination campaigns that supplement routine immunisation activities, with the specific aim to identify and reach missed communities with un- or under-immunised children, and thus reduce immunity gaps wherever possible.
- Outbreak response: Gavi is the primary funder of immunisation activities in response to measles outbreaks in lower-income countries, through contributions to the Measles & Rubella Partnership (M&RP)’s Outbreak Response Fund.
2023: Recovery from the COVID-19 pandemic
- Preventive vaccination campaigns: So far in 2023, nine lower-income countries have planned and rolled out follow-up vaccination campaigns in an accelerated effort with Gavi support: Democratic Republic of the Congo (DRC), South Sudan, Cameroon, Malawi, Mozambique, Papua New Guinea, Yemen, Syria and Nigeria. Two of these countries (DRC and Nigeria) are among the top ten countries with unvaccinated or “zero-dose” children. An additional three countries are scheduled to roll out campaigns before the end of the year: Chad, Central African Republic and Sudan.
- Routine immunisation: In 2023, Mauritania introduced a second dose of measles-containing vaccine into its routine immunisation programme.
- Outbreak response: In 2023, Gavi dedicated more than US$ 12 million to the Measles & Rubella Partnership (M&RP)’s Outbreak Response Fund to support outbreak response in six lower-income countries.
- The Big Catch-up: In April 2023, Gavi joined global and national health partners for “The Big Catch-up”, a targeted global effort to boost vaccination among children following declines driven by the COVID-19 pandemic. This effort aims to reverse the declines in childhood vaccination recorded in over 100 countries since the pandemic.
2024: Doubling down on measles immunisation
- In 2024, Gavi plans to support at least 15 lower-income countries to roll out measles and rubella catch-up and follow-up vaccination campaigns aiming to reach about 38.5 million children – an unprecedented number of campaigns. These 15 countries – Burkina Faso, Cambodia, Chad, Côte d’Ivoire, Eritrea, Ghana, Lao PDR, Liberia, Madagascar, Mali (rubella catch-up), Mauritania, Nepal, Rwanda, Sierra Leone and Tanzania – represent those with approved plans to-date.
- In parallel, Alliance partners are continuing to work with other priority and at-risk countries. In November 2023, Gavi’s Independent Review Committee (IRC) of experts will review plans for measles vaccination in an additional five countries, to be implemented in 2024: Guinea-Bissau (MR introduction with catch-up campaign), and Guinea, Kyrgyzstan, Mozambique and Zambia (supplementary follow-up campaigns). The IRC is composed of a range of technical experts from across the world who meet regularly to review applications for support from Gavi-eligible countries and to advise on roll-out plans.
Gavi support: 2000–2022
- From 2000–2022, Gavi has supported lower-income countries to reach more than 863 million children through measles-rubella campaigns; more than 366 million through measles follow-up campaigns; and more than 172 million through routine immunisation. For more information, visit Gavi’s 2022 Annual Progress Report.
- Working through the Measles & Rubella Partnership’s Outbreak Response Fund, Gavi has also been the main funder of measles outbreak response activities in lower-income countries – providing nearly US$ 100 million to cover the 68 country applications for outbreak response support received since 2013.
Global immunisation coverage: 2000–2022
- During 2000–2022, estimated measles vaccination prevented approximately 57 million deaths worldwide/globally.
- Coverage with first and second doses of measles-containing vaccine increased in 2022 but still falls short of the required 95% threshold as demonstrated by significant increase in disruptive outbreaks (37 in 2022, compared to 22 in 2021).