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A new analysis of measles vaccination trends finds that less than one-quarter of low- and middle-income countries (LMICs) currently meet measles elimination targets, leaving populations vulnerable to outbreaks, according to a study published in the International Journal of Infectious Diseases. As measles cases resurge worldwide, the findings highlight the persistent challenge of achieving and sustaining herd immunity. 

Of the 79 LMICs studied, only 17 (21.5%) achieved the World Health Organization’s elimination target of at least 95% coverage for receipt of the first dose of the measles vaccine. Coverage below 50%, which the researchers dubbed “critically low,” was identified in the Central African Republic (41%), Yemen (41%), Benin (44%), Papua New Guinea (44%), Madagascar (46%), and Sudan (46%).

Coverage for the second dose of the measles vaccine was even lower. Only 11 of the 79 countries (13.9%) reached the elimination target. Three countries—Benin, the Central African Republic, and South Sudan—reported no data for the second dose, suggesting that the vaccine isn’t part of their routine immunization schedules. 

LMICs have different vaccination barriers

Barriers to vaccination in LMICs differ from those in higher-income settings. In wealthier countries, hesitancy is often driven by safety concerns and misinformation, even as measles cases are rising and elimination status is threatened. 

LMICs, however, tend to face different roadblocks, including weak health infrastructure, supply chain issues, political instability, and competing health priorities. The disruption of immunization services during the COVID pandemic further widened existing immunity gaps. 

The substantial regional gaps in achieving global measles elimination require urgent attention, write the authors, who advocate for promoting vaccine uptake during perinatal care, engaging religious and community leaders to counter misinformation, and specialized approaches for countries with political instability to help bolster measles vaccination rates.