Global measles cases among children under five rose 40% between 2019 and 2023 as disrupted immunisation services left millions of children unprotected.
Global measles vaccination slumped after the Covid-19 pandemic, and the consequences were visible in 2023, when cases and deaths rose again after years of progress, according to a new analysis published in Nature Medicine and reported by Folha de S.Paulo. The study found that measles incidence among children under five had fallen sharply over the long term, but that gains made before 2020 began to erode once routine immunisation services were disrupted.
The researchers estimated that global measles cases in children under five dropped from 52.2 million in 1990 to 11.1 million in 2019, a reduction of nearly 79 per cent. By 2023, however, that figure had climbed back to 15.6 million, a rise of 40 per cent from 2019. Mortality followed a similar pattern: deaths fell from 148 per 100,000 children in 1990 to 15.3 in 2019, then rose again to 18.4 per 100,000 in 2023. Over the four-year period from 2020 to 2023, measles was the sixth leading cause of death in children under five, with 118,000 deaths recorded.
The World Health Organisation and the US Centers for Disease Control and Prevention said late last year that the world recorded 10.3 million measles cases in 2023, a 20 per cent increase from 2022. Their figures also showed that more than 22 million children missed their first dose of measles vaccine, while global coverage stood at 83 per cent for the first dose and 74 per cent for the second dose, both well short of the 95 per cent needed to stop outbreaks. The Nature Medicine paper said coverage had risen steadily for decades before stalling after 2020.
The sharpest setbacks were concentrated in poorer regions. According to the study, sub-Saharan Africa saw a 57.3 per cent rise in cases and a 13.5 per cent increase in deaths between 2019 and 2023. South-east Asia recorded a 39.5 per cent rise in cases and a 27.2 per cent increase in deaths, while North Africa saw cases increase by 37.4 per cent and deaths by 54 per cent. The analysis also noted that the number of children who had received no measles vaccine at all rose from 19.3 million in 2019 to 22.2 million in 2023.
The picture in high-income countries has also worsened. Folha reported that parts of Europe have seen their heaviest measles burden in more than 25 years, with more than 127,000 cases in countries including Poland, France, Germany and Italy. In the United States, the CDC has warned of one of the worst outbreaks in decades. Public-health experts say the lesson is clear: once confidence in vaccines weakens, restoring it is far harder than maintaining it. Denise Garrett, an epidemiologist and vice-president of the Sabin Vaccine Institute, told Folha that when coverage falls far below the 95 per cent target, measles becomes extremely difficult to control because one infected person can pass the virus to many others.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
