Routine vaccine program disruptions and under-resourced health systems are driving a global decline in childhood measles vaccination rates post COVID-19, a study has found.
University of Queensland researchers examined measles cases, deaths and vaccine gaps in children under 5 across 204 countries and territories from 1990 to 2023, finding estimated cases rose 40 per cent from 11.1 million in 2019 to 15.6 million in 2023.
Associate Professor Benn Sartorius , from UQ’s Frazer Institute, said childhood measles immunisation rates have been going backwards since COVID-19.
“This has contributed to a global resurgence of measles in young children,” Dr Sartorius said.
“It backtracks on decades of progress, where a nearly 80 per cent decline in measles cases was recorded worldwide between 1990-2019.
“The resurgence coincides with COVID-19 related disruptions to immunisation programs, health systems, and funding – reflecting both the fragility of measles control and vulnerability of children in lower-resourced areas.
“Our study shows urgent action is needed to restore routine immunisation programs and build resilient health systems capable of sustaining high coverage during global crisis.”
Measles is a preventable, yet highly contagious airborne virus that can lead to complications and death, especially in young children.
The World Health Organization estimates one case can generate up to 18 secondary infections where immunity is low.
A study published in Lancet Global Health in 2023 estimated measles were fatal in as many as 3 out of every 100 infected infants under 1 years of age in 2019 across low and middle-income countries.
Prevention is key
Dr Sartorius said 2 doses of the measles vaccination in childhood was the most effective way to prevent the disease and was estimated to have prevented nearly 59 million deaths between 2000 and 2024.
However, an estimated 23.7 million infants – or 1 in 5 - missed their first dose in 2023.
“Sub-Saharan Africa – which recorded the highest mortality rate throughout the study period – accounted for 50 per cent of these missed doses, followed by South Asia at 20 per cent,” Dr Sartorius said.
“The greatest burden occurs in lower-resourced settings, yet recent outbreaks in the United States show measles can remerge in high-income countries where immunity gaps develop.”
Vaccine coverage of Measles, Mumps and Rubella (MMR) fell from 95 to 92 per cent in kindergartens across the United States.
“We have also seen a rise in misinformation in pockets of populations post COVID-19, and the United States has not helped with this narrative,” Dr Sartorius said.
Despite COVID-19 disruptions, the study found Australasia maintained some of the highest measles vaccination coverage in the world.
Between 1990-2019, Australasia recorded one of the largest increases in second-dose measles vaccination coverage, and by 2023 had the highest coverage of any region - with an estimated 96 per cent of children under 5 receiving their second dose of vaccine.
Dr Sartorius said the data could help authorities identify under-vaccinated populations to prevent future outbreaks.
“We hope the data from our study will be used to target catch-up vaccination efforts and strengthen immunisation where support is needed most.”
Read the research in Nature Medicine.
Collaborations and acknowledgements:
Researchers used data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2023.
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Global and regional burden of measles and vaccine coverage among children under 5 years, 1990-2023: a Global Burden of Disease Study
21-Oct-2026