“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.
