WHO's Eastern Mediterranean region is off track on measles and rubella, study finds

Measles and rubella are the diseases public-health officials watch to judge whether an immunisation system is holding together, because both spread fast enough to expose any gap in coverage. A new analysis in the journal Vaccines assesses how WHO's Eastern Mediterranean Region (EMR) fared on that test in 2023 and 2024, and the verdict is that it is falling behind [s1].

What the analysis measured

The study is a retrospective descriptive analysis covering all 22 EMR countries and territories [s1]. It draws on measles and rubella surveillance data, WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), and Joint Reporting Form data, tracking disease incidence, first- and second-dose measles vaccine coverage, surveillance performance and verified elimination status against the targets of the Immunization Agenda 2030 [s1].

The numbers moved the wrong way

Over the two years, regional measles incidence increased from 110.8 to 116.3 per million population [s1]. Rubella incidence more than doubled, rising from 1.9 to 4.3 per million [s1]. The authors attribute much of the regional trend to large outbreaks in three conflict-affected countries — Yemen, Iraq and Afghanistan — which disproportionately drove the figures [s1].

Coverage, the other half of the picture, barely moved. First-dose measles vaccine coverage (MCV1) remained stable at approximately 80%, while second-dose coverage (MCV2) increased only marginally, from 73% to 75% [s1]. Both sit well below the 95% two-dose coverage generally considered necessary to interrupt measles transmission — and only nine of the 22 countries reached at least 95% coverage for both doses in 2024 [s1]. The gap between first and second doses, the study notes, reflects the high dropout rates and persistent zero-dose populations that sustain transmission across the region [s1].

Why the gap matters

The distance between MCV1 and MCV2 is the quiet signal in the data. A child who gets a first dose but not a second is only partially protected, and a region where roughly one in four children misses the second dose leaves a standing pool of susceptibility for the virus to find. Layered on top are the zero-dose children who receive nothing at all — a population the authors single out as a driver of continued transmission [s1]. The COVID-19 pandemic widened these immunity gaps and accelerated the resurgence of vaccine-preventable diseases across multiple regions, the study notes, and the EMR is still working through that backlog [s1].

The wider measles picture

The regional findings track a global pattern. WHO's measles fact sheet records that vaccination averted nearly 59 million deaths between 2000 and 2024, yet in 2024 an estimated 95,000 people — mostly unvaccinated or under-vaccinated children under 5 — still died of the disease [s2]. Global first-dose coverage was 84% in 2025, slightly below the 2019 level of 86%, meaning the world has not yet clawed back the ground lost during the pandemic [s2]. A region holding MCV1 near 80% is therefore below even that stalled global average [s2].

What the authors conclude

The study's conclusion is unambiguous: the Eastern Mediterranean Region remains off track to achieve measles and rubella elimination by 2030 [s1]. The authors call for accelerated, equity-focused efforts to strengthen routine immunisation, reduce the zero-dose population, enhance surveillance capacity and improve outbreak response — with particular emphasis on fragile and conflict-affected settings, where the largest outbreaks are concentrated [s1].

What to watch

Two things will determine whether the trend reverses. The first is whether MCV2 coverage — the number that has moved least — can be pushed toward the mid-90s in the countries still far from it, since first-dose gains alone will not stop measles [s1]. The second is whether the outbreaks in Yemen, Iraq and Afghanistan can be contained, given that they drove the regional figures and that conflict is precisely the condition under which routine immunisation breaks down [s1]. The analysis does not forecast the next two years, but it makes the arithmetic plain: on 2024 coverage, with nine of 22 countries at target and the rest below it, elimination by 2030 is not on the current trajectory [s1].

Sources

• Measles and Rubella Elimination Trends in the WHO Eastern Mediterranean Region, 2023–2024, Vaccines, 27 July 2026
• Measles — fact sheet, World Health Organization, 15 July 2026