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Cases of measles doubled last year in the European region, climbing to the highest level in nearly three decades, after the Covid-19 pandemic caused delays in routine vaccination and rampant misinformation, the World Health Organization and Unicef have said.
A joint analysis published on Thursday said 127,350 cases of measles, resulting in at least 38 deaths, were reported last year across the region, which includes 53 countries in Europe and Central Asia. In the vast majority of cases, those infected were unvaccinated or had an unknown vaccination status.
“Measles is back, and it’s a wake-up call,” said Hans Henri P Kluge, WHO’s regional director for Europe, in a statement. “Without high vaccination rates, there is no health security.”
Last year the region was home to a third of the world’s reported measles cases. The highest number was in Romania, at 30,692, followed by Russia and Kazakhstan.
Across the UK, 2,900 cases were reported last year. After Romania, Italy reported the second-highest number of cases in the EU, at 1,057, followed by 647 in Germany, 555 in Austria and 531 in Belgium.
The figures marked a stunning reversal for the region, said Fatima Čengić, Unicef’s chief of immunisation for Europe and Central Asia. As children’s health steadily improved across the region, officials had shifted focus to how to ensure that all children in the region flourished. Now they were grappling with how to tackle one of the world’s most contagious diseases. “We were talking about thriving. Now all of a sudden we have to go back to survival,” she said.
Across Europe, more than 50,000 cases of measles – which can lead to complications such as pneumonia, brain swelling and blindness – involved children under the age of five. About 60% of all of the people who became ill required hospitalisation.
Health officials linked the soaring number of cases to the fact that in many countries vaccination rates had yet to return to pre-pandemic levels. Instead vaccination levels had lagged; between 2019 and 2023, the number of children receiving their first dose of the vaccination dropped by 10%. In 2023, half a million eligible children missed their first dose of the measles vaccine.
In some cases, this was tied to healthcare systems that had been overburdened during the pandemic, leading to disruptions in routine vaccinations, said Čengić. “So we’ve been calling on governments to do a catchup – to find all the children who didn’t get a vaccination and make sure they are getting vaccinated.”
Another factor was the swirling falsehoods over vaccines. “Covid-19 seemed to have brought out a lot of misinformation, particularly on Covid-19, but then there was a spillover effect to the routine immunisation,” she said.
“We need to make sure that parents do understand that they need to look at the credible sources,” she added. “You cannot just do a Google search on vaccination. That’s not how it works.”
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The misinformation has seemingly continued even as the pandemic ended. In Romania, where cases of measles soared past 30,000 last year, three political parties that entered parliament in the recent election espoused anti-vaccination narratives, the Centre for European Policy Analysis said in a report which noted the growing threat of “medical populism”.
Between 2013 and 2023, the percentage of Romania’s population who had their first dose of the measles vaccine dropped from 92% to 78%, data from the WHO and Unicef showed – far below the 95% coverage rate required to retain herd immunity.
Thursday’s analysis also noted that the rates of first-dose vaccination were “critically low” in Bosnia and Herzegovina, which in 2023 reported a coverage rate of 55%, and in Montenegro, where coverage was 24% last year.
The European figures follow the deaths of two people in the US state of Texas – the first from measles in nearly a decade – in an outbreak that has caused at least 250 people to become ill and which health officials have said they expect to “expand rapidly”.
In the US, the outbreak of measles, spread through respiratory droplets that can linger in the air for up to two hours after an infected person leaves an area, has been widely seen as a test for the new health secretary and vaccine critic, Robert F Kennedy Jr. So far he has responded by downplaying the virus’s dangers and the vaccine’s efficacy, framing vaccination as a personal choice and recommending vitamin A and “good” nutrition.
