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“Misinformation or distrust of vaccines can be like a contagion that can spread as fast as measles.”
– Theresa Tam, chief public health officer, Canada

In an age of unprecedented medical advancement, the resurgence of measles, a disease once nearing global elimination, is both disheartening and alarming. It stands as a stark reminder that scientific breakthroughs alone cannot defeat disease; public trust and unified action are equally essential. Measles, a highly contagious illness, had been declared eliminated in the United States in 2000 and in several European countries by 2016, following decades of successful immunization campaigns. Yet today, outbreaks are surging across globally.

This resurgence is not due to a failure in medical science, but rather a growing crisis in public perception fueled by misinformation, distrust in health systems and increasing complacency. Despite the proven safety and effectiveness of vaccines like the MMR (measles, mumps, rubella), vaccine hesitancy has weakened herd immunity, allowing the virus to spread rapidly, especially in under-vaccinated populations. In essence, fear and falsehoods have become nearly as infectious as the disease itself.

According to the US CDC, measles is an acute viral respiratory illness marked by high fever, cough, runny nose, red eyes and red rash appearing 7–14 days after exposure. It’s caused by a single-stranded, enveloped RNA Morbillivirus virus, with humans as its only natural hosts. Measles spreads through respiratory droplets when an infected person coughs or sneezes. Up to 90 percent of susceptible individuals in close contact with an infected person can get infected. The virus can remain airborne or survive on surfaces for up to two hours, making transmission possible even after the infected person has left the area.

While measles can affect varied ages, it poses the highest risk to infants and children under five and immunocompromised (pregnant women, leukemia, HIV-infected) individuals. Complications include ear infections and diarrhea, while severe complications include pneumonia, encephalitis and death. Out of every 1,000 children infected with measles, up to three die due to respiratory or neurological complications.

Laboratory confirmation is key for diagnosing sporadic measles cases and outbreaks. Diagnosis typically involves detecting measles-specific IgM antibodies in serum and RNA via RT-PCR in respiratory specimens. Collecting serum and nasopharyngeal swab at the first patient contact is recommended. Viral molecular genotyping aids in tracing transmission and distinguishing between wild-type infections and vaccine-related rashes, thereby playing a vital role in outbreak control and epidemiological surveillance.

Global reawakening
Despite the availability of a safe and affordable vaccine, measles remains a serious global health threat. In 2023, the WHO reported 10.3m measles cases globally, with an estimated 107,500 deaths, primarily among unvaccinated or under-vaccinated under-fives. In India alone, measles claims around 49,000 young lives each year. The European Region experienced its highest case count in over 25 years, with 1.27 lakh hospitalizations reported in 2024. Romania recorded 30,692 cases amid low vaccine coverage (62 percent), while Kazakhstan reported 28,147 cases with coverage below 80 percent. Notably, Kazakhstan’s measles cases surged from just four in 2010 to over 28,000 in 2024. According to Akhmetzhanova et al., 35 percent of Kazakhstani respondents expressed vaccine hesitancy, with 22 percent wrongly linking vaccines to autism, undermining immunization efforts and endangering vulnerable populations.

In the US, as of April 17, 800 measles cases were confirmed across 25 states, threefold higher than in 2024. Ten outbreaks were reported, with 94 percent of cases outbreak-associated. Alarmingly, 96 percent of infected individuals were unvaccinated or of unknown status. Texas was the hardest hit with 597 cases, largely in undervaccinated communities. Tragically, two unvaccinated children in Texas and one adult in New Mexico died from measles complications.

Historically, measles has caused devastating pandemics. In 1529, an epidemic in Cuba killed two-thirds of the indigenous population that survived smallpox. In 1531, half of Honduras’ population was wiped out by the measles epidemic, underscoring the deadly legacy of measles when vaccination rates faltered.

Resurgence in Nepal
From January to August 2023, Nepal recorded 1,013 measles cases, a tenfold increase compared to 2017. The highest case counts were reported in the Tarai. Although Nepal achieved 90 percent MMR vaccine coverage by 2019, the Covid-19 pandemic disrupted routine immunization, contributing to a resurgence in 2023–2024.

Vaccine hesitancy
Globally, measles vaccination has prevented over 60m deaths between 2000 and 2023. To achieve herd immunity, the CDC recommends 95 percent coverage with two MMR doses, administered at 12–15 months and 4–6 years of age. However, between 2000 and 2017, global two-dose MMR coverage plateaued at just 67 percent, far below the threshold needed to prevent outbreaks.

Despite its 97 percent effectiveness and proven safety, MMR vaccine hesitancy remains a formidable challenge. Defined as the delay or refusal of vaccination despite availability, hesitancy stems from cultural beliefs, misinformation, distrust and socioeconomic barriers. A key driver is the debunked Lancet study (Wakefield et al 1998) falsely linking MMR to autism. Although retracted in 2010 for ethical violations and debunked by multiple large-scale studies, its impact endures, amplified by social media.

As the saying goes, “A lie can travel halfway around the world while the truth is still putting on its shoes.” Common myths “natural immunity is better” or “vaccines contain harmful chemicals” continue to circulate, despite evidence that measles can be life-threatening and vaccine ingredients are safe and rigorously tested.

Achieving 95 percent MMR coverage is vital, not only for individual protection but also to safeguard those who can’t be vaccinated due to age or medical reasons. Herd immunity limits the spread of measles, preventing large-scale outbreaks.
Nepal has made progress in expanding immunization, yet challenges remain, particularly in remote and underserved areas. To improve coverage, Nepal must disseminate evidence-based authentic information to counter misinformation, engage local communities to build trust and strengthen policy measures, including school-entry vaccination requirements.

As the saying goes, “Vaccines don’t save lives; vaccinations do.” A sustained, multipronged approach is essential to safeguard vulnerable populations and prevent future outbreaks.

Over the past few months, Nepal and India have intensified bilateral engagement, yielding tangible progress in economic and development partnerships. Although Prime Minister KP Sharma Oli’s visit to New Delhi remains uncertain, a series of ministerial meetings and bilateral mechanism discussions have taken place. Within two weeks, two senior ministers from Narendra Modi’s cabinet visited Nepal and met with Prime Minister Oli.

The past month witnessed a flurry of diplomatic activity, with three Nepali ministers traveling to India for meetings with their Indian counterparts. Foreign Minister Arzu Rana Deuba engaged in comprehensive bilateral talks with India’s External Affairs Minister, S Jaishankar, focusing on enhancing political and economic collaboration. Meanwhile, Forest Minister Ain Bahadur Shahi Thakuri met with India’s Minister for Environment, Forest and Climate Change, Bhupender Yadav, to discuss transboundary environmental conservation and sustainable forestry initiatives.

Another significant development occurred during Water Supply Minister Pradeep Yadav’s visit to New Delhi, where he met India’s Jal Shakti Minister CR Patil. The two leaders signed a landmark agreement to expand cooperation in water resource management, sanitation and hygiene—an area of critical importance for both nations. This agreement is expected to facilitate knowledge-sharing, infrastructure development and joint projects to address water scarcity and improve public health outcomes.

Indian Minister for Power and Housing and Urban Affairs Manohar Lal Khattar is currently in Nepal for a two-day official visit. According to Indian officials, the trip aimed to advance discussions on key power projects of mutual interest, including cross-border electricity trade and hydropower development. 

Over the past few years, energy cooperation between Nepal and India has seen remarkable progress, with Nepal exporting surplus hydropower to India and Indian firms investing in Nepal’s hydroelectric projects. This growing synergy in the power sector is expected to bolster Nepal’s energy independence while supporting India’s renewable energy goals.

Early this month, Nepal and India signed a Memorandum of Understanding (MoU) to strengthen cooperation in agricultural science and technology. The agreement, which replaces a 1991 pact, covers a wide range of areas, including agricultural production, crop management, trade and marketing. Nepal’s Agriculture Minister Ramnath Adhikari and India’s Agriculture Minister, Shivraj Singh Chouhan, formalized the deal, which is expected to enhance food security, boost farmer incomes and promote sustainable farming practices through joint research and technology transfer.

In late March, the Nepal-India Joint Working Group convened to address critical border management issues. The discussions centered on curbing cross-border crime, improving border infrastructure—such as Integrated Check Posts (ICPs), roads and railway networks—and enhancing the operational capacity of security agencies. Both sides also explored collaborative measures for disaster risk reduction and management, recognizing the shared vulnerabilities to natural calamities like floods and earthquakes.

Further reinforcing security and trade ties, the two countries held the 21st Director General-level talks this month, focusing on measures to streamline cross-border commerce and combat smuggling. These discussions are crucial for ensuring smooth trade flows, particularly given Nepal’s reliance on Indian ports for third-country trade.

Despite the positive trajectory in bilateral relations, certain contentious issues remain unresolved. Nepal has persistently raised concerns over the delayed implementation of the Eminent Persons’ Group (EPG) report and lingering border disputes, particularly in regions like Kalapani, Lipulekh and Limpiyadhura. India, however, maintains that these matters should be resolved through established bilateral mechanisms rather than public posturing.

Recently, India’s Ministry of External Affairs Spokesperson Randhir Jaiswal reiterated this stance during a weekly press briefing, stating, “We have a bilateral mechanism with Nepal to discuss these issues. Unilateral actions do not alter ground realities.”

While Prime Minister Oli’s visit to New Delhi remains uncertain, he has met with his Indian counterpart Modi on two occasions—first on the sidelines of the UN General Assembly in September 2024 and again during the BIMSTEC summit early this month. These interactions suggest a willingness to maintain dialogue despite political sensitivities.

However, a new point of friction emerged last month when reports surfaced alleging India’s tacit support for Nepal’s pro-monarchy movement. India swiftly denied these claims, but the episode highlights the delicate nature of Nepal’s domestic politics and its implications for bilateral relations. Additionally, some analysts speculate that India may view Nepal’s growing engagement with China—particularly its participation in China’s Belt and Road Initiative (BRI)—with caution.

Foreign policy experts say that despite occasional political tensions, India has adopted a pragmatic approach by prioritizing economic and developmental partnerships with Nepal. This strategy aims to insulate mutually beneficial projects from geopolitical fluctuations while gradually addressing contentious issues through diplomatic channels.

The Constitution of Nepal has stipulated the right against child marriage as a fundamental right. Nepal is also a party to various international treaties against child marriage. In this sense, it falls within the theoretical scope of human rights. According to the existing laws of Nepal, marriage under the age of 20 is defined as child marriage. There is also a provision for imprisonment of up to three years and a fine of up to Rs 30,000 for those who commit marriage-related offenses, including child marriage. These provisions notwithstanding, instances of child marriage are not hard to find in Nepal.

An alarming picture

According to the statistics of the Nepal Police, in 2022, 52 complaints related to child marriage were registered in Koshi province, 10 in Madhes province, 10 in Bagmati province, five in Lumbini province, 10 in Sudurpaschim province, two in Gandaki province and nine in Karnali province.

These figures are merely representative records. Whether it is the parents who get their children married off to avoid responsibility or the children themselves opting to tie the nuptial knot, there is a widespread practice of covering up child marriages in families or societies by not filing complaints.

Therefore, it’s no surprise that Nepal still has a sizable population that disregards the minimum marriageable age and sees marriage only as a matter of obligation, maybe because of illiteracy also.

According to the 2011 census, child marriage, which stood at 27 percent, came down to 21 percent (per the 2021 census). One can take a little bit of solace in these data. Still, child marriage remains a matter of concern with rural and marginalized communities still opting for it in the name of tradition and culture.

I myself had the pathetic experience of child marriage, so I am committed to playing a concrete role in reducing child marriage by empathizing with the overall development of girls from ordinary families. A resolution registered in the House of Representatives aims to initiate a concrete and diagnostic debate on the abolition of child marriage in Nepal. It is necessary to debate whether the abolition of child marriage is possible, not its reduction.

In our society, child marriage is not limited to any specific community or geography; it has spread throughout the country, depriving the children, first and foremost, of their right to education.

No matter how strict the law is, traditional thinking and socio-economic environment encourage child marriage with factors like poverty, inequality, lack of education and gender discrimination all playing their respective parts.

Various researches show that child marriage increases the risk of early pregnancy, maternal mortality, malnutrition, school dropout rates and violence. It is also a subtle and distorted form of gender violence. Child marriage is both a cause and a consequence of poverty.

In terms of the right to education, child marriage effectively ends the formal education of children. Child marriage in lower and middle-class families leads to the compulsion to have children and shoulder the responsibility of parenthood. Not only this, most of the men and women, who marry at an early age, have their decision-making capacity diminished, which impacts their participation in the ‘economic cycle’ necessary to sustain the life cycle.

On account of factors like these, 193 countries expressed commitment to the United Nations’ Sustainable Development Goals (SDGs) and set various goals with 17 indicators to set global development priorities by 2030, in 2015. ‘Target 5.3’ under the SDGs talks about ending child marriage within the deadline.

We have enacted laws against child marriage but our campaigns and programs aimed at ending this scourge do not seem to have reached sections of the society that are lagging behind in terms of human development indexes like literacy. We need to be more serious vis-a-vis child marriage, also to achieve SDGs by aligning our efforts with the United Nations and various donor agencies working to end child marriage. 

With all three tiers of the government—central, provincial and local levels—lacking a clear vision, will we be able to achieve these goals within the deadline for SDGs? 

The way out

Let’s make it mandatory for every youth to obtain an ‘adult registration certificate’ from the ward office of the concerned municipality for marriage upon completing 20 years of age. This kind of arrangement can bring about desired positive changes. Just as the state provides birth certificates, citizenship or other official documents, our policy initiative should be toward making it mandatory to obtain an adult registration certificate from the ward before marriage after attaining the minimum marriageable age. Some local levels appear to have implemented this system, which is quite commendable. A legal system governing this throughout the country will make way for its integrated implementation and a measurable impact. 

The author is a lawmaker

You can never have too many cookbooks but you also only need one or two to become a pro in the kitchen with an arsenal of recipes up your sleeves. Over the past few years, I’ve amassed quite a few cookbooks as I’ve developed a sort of fascination with learning different cooking tricks and tips. I find cookbooks extremely helpful on that front. Every cookbook author has his/her own unique ways in the kitchen and it’s fun to pick up unconventional ways of doing things.

I recently got my hands on a copy of ‘The Great Indian Thali’ by Nandita Iyer who is a doctor, nutritional expert, wellbeing advocate, and columnist. In the past 15 years, she has written three books on health, nutrition, and food. She is also the founder of the popular blog ‘Saffron Trail’ that has many healthy, vegetarian recipes. I had wanted to buy this book when I was in Delhi, India, some time ago but I had already bought way too many books so I had simply put it back on the shelf. Despite being enthralled by the pictures in the book, I thought the thali was something Nepalis didn’t need help with and I wouldn’t be missing out. But now I know how wrong I was.

Though the book, at the beginning, teaches you to make steamed rice, dal, khichdi, green chutney and the likes (recipes you’d roll your eyes at), it also has recipes of many other dishes that you’ve only enjoyed at restaurants or when traveling and never thought of making yourself. You’ll learn to make a variety of dosas, pickles, sweets, and snacks. The recipes are also categorized according to the season so you know which dish is most suited for which weather. I’d never come across a cookbook that has done this before. It shows how Iyer views food: as something that can work as medicine when taken in the right form and time.

One thing I like about cookbooks is their ability to double as decor or a coffee table book. The Great Indian Thali is no different. This beautifully illustrated and bound hardcover book is a visual delight. With colorful pages separating each section and full page photographs of food, the book is a fun one to just flip through when you are in need of some kitchen inspiration. There are great, heartwarming recipes of snacks, soups, and desserts that you can quickly whip up in minutes. The ingredients are clearly listed out and the instructions are easy to follow. There are many handy tips as well that will make you a pro in the kitchen. All in all, The Great Indian Thali, which feels like a culinary tour of India, is a must have if you are looking to eat healthy and want to learn how to make some delicious vegetarian food at home. 

https://www.goodreads.com/book/show/123509645-the-great-indian-thali 

The Great Indian Thali

Nandita Iyer

Illustrations: Abhilasha Dewan, Anita Verma

Published: 2022

Publisher: Roli Books

Pages: 191, Hardcover