London School of Hygiene & Tropical Medicine

Measles infections are rising globally, according to new figures published by the World Health Organization (WHO). Since 2022, cases have increased by 20%, with an estimated 10.3 million infections recorded in 2023. 

Measles infections are caused by one of the world’s most contagious viruses, Rubeola, and can be deadly. For those who survive measles, serious health effects can occur, some of which are lifelong. Infants and young children are at greatest risk of serious complications from the disease, which include blindness, pneumonia, and encephalitis, an infection which can causes brain swelling and subsequent damage. 

Measles is preventable through two doses of measles vaccine, which has saved more lives than any other vaccine in the past 50 years. Yet, according to WHO, more than 22 million children missed their first dose of measles vaccine in 2023. Globally, an estimated 83% of children received their first dose of measles vaccine last year, while only 74% received the recommended second dose. 

Coverage of 95% or greater of two doses of measles vaccine is needed in each country and community to prevent outbreaks. As a result of global gaps in vaccination coverage, 57 countries experienced large or disruptive measles outbreaks in 2023, affecting all regions except the Americas. 

In January 2024, the UK Health Security Agency (UKHSA) declared the increase in UK cases of measles a national incident and initiated a public campaign to increase childhood vaccination against the disease.   

Speaking about the reasons why cases may be increasing in the UK and more widely, Dr Ben Kasstan-Dabush, Assistant Professor in Medical Anthropology at the London School of Hygiene & Tropical Medicine (LSHTM), said: “Blaming parents for ‘vaccine hesitancy’ will not bring solutions to the declining levels of vaccine coverage we are seeing in the UK and internationally.  There are many other factors that need to be considered to ensure we develop a sustainable response to the challenges we are seeing. 

“The links between declining childhood immunisation coverage and political decisions over the past decade need to be examined. Austerity has influenced the health and development of a generation of children across many countries. I would hazard to guess that it has reconfigured the ways that systems invest in public health and immunisation – whether that’s the funding available for the ‘where’ of vaccine delivery or the ‘how’ of communication about vaccines. These factors are crucial considerations when working in urban settings or with underserved communities, who may need additional support to participate in a routine immunisation programme. 

“Declining rates of immunisation coverage have also been happening amidst an unforgiving cost of living crisis, characterised by a generational decline in living standards, and unequal pandemic recovery. There are clear links between deprivation and lower immunisation coverage because uncertainty affects so many aspects of a parent’s life.   

“The pre-austerity area often saw healthcare professionals discuss and deliver immunisations in Sure Start Children’s Centres, which were premised on improving child health and development at local levels. This saw immunisation packaged as part of a broader commitment to child, family and community wellbeing. High profile public health responses to the spread of polio and measles is a sign that the UK once again needs to develop an answer to the unacceptably high rates of child poverty and poorer child health outcomes that are plaguing our society. 

“Our research at LSHTM is evaluating targeted outreach initiatives to try and boost vaccine uptake in London’s ultra-Orthodox Jewish community. We have seen vaccinations being offered as part of family fun days, alongside free toothbrushes for oral health, and diet and nutritional advice, because inequalities cause a domino effect. While it may not be possible to offer this as a standard service, the point is trying to offer vaccines as part of that bigger picture of a creating family-friendly service. To reverse the decline in vaccine uptake, immunisation services require sufficient resources to effectively engage communities and ensure capacity.  

“The UK lost its World Health Organization (WHO) measles elimination status in 2019. Five years later, the prospect of re-gaining this status feels further away than ever.  The COVID-19 vaccination programme was a lesson for the UK Government in ‘putting money where your mouth is’ to bolster vaccine coverage and to address inequalities. Declining rates of immunisation coverage for diseases such as measles should be taken just as seriously as vaccine programmes during the COVID-19 pandemic and resourced appropriately.”