Progress Toward Measles Elimination — World Health Organization Eastern Mediterranean Region, 2019–2022

Discussion

Despite the regional challenges, 11 (50%) of the 22 EMR countries are progressing toward measles elimination, and elimination has been verified in four (18%) countries. Important characteristics of these four countries include having health ministries committed to measles elimination, sustained high (≥95%) immunization coverage, and strong surveillance systems and laboratory support. An additional seven countries (Kuwait, Morocco, Palestine, Qatar, Saudi Arabia, Tunisia, and United Arab Emirates) are near elimination based on high measles immunization coverage, low measles incidence, and high-quality surveillance.

However, eleven (50%) EMR countries are experiencing conflicts or humanitarian crises that prevent immunization system strengthening and prioritization of measles elimination. These challenges have resulted in underperforming immunization programs, leading to measles immunity gaps. Of particular concern are undervaccinated children (those who have not received 2 MCV doses) and unvaccinated children (those who have not received any MCV or other vaccine doses). These children generally reside in hard-to-reach locations and experience conflict-related insecurity, misinformation, and underperforming vaccination campaigns. Communities with large numbers of undervaccinated and unvaccinated children are at increased risk for measles outbreaks and measles-related deaths.

Among countries with fragile health systems and measles immunity gaps, increasing MCV1 and MCV2 coverage and conducting high-quality SIAs with a focus on reaching populations at high risk, particularly those living in areas with civil strife, are needed. A strong global partnership is needed to work together to build measles immunity and prevent measles mortality through routine immunization services and preventive SIAs. Conducting preventive SIAs in areas with complex humanitarian emergencies, however, requires strong coordination among global and local partners and stakeholders in all facets of vaccination campaigns for these SIAs to be successful.

In addition, conducting surveillance in areas with political instability, insecurity, and a complex operating environment is challenging. This challenge is often compounded by the absence of strong data systems that prevent efficient reporting, analysis, and use of data for action. As a result, responses to outbreaks might not be timely and effective. Further, poor immunization and surveillance data quality in many countries hamper their ability to assess measles immunity gaps and plan timely campaigns to prevent outbreaks. Overcoming these challenges will require partnerships and support at global, national, and local levels to optimize surveillance and ensure rapid detection and response to measles cases and outbreaks.

Limitations

The findings in this report are subject to at least three limitations. First, administrative coverage might be inaccurate because data quality and consistency vary substantially among different countries. Second, measles cases might be underestimated because not all measles patients seek health care, not all cases are reported or investigated, and measles surveillance quality varies among countries. Finally, this report did not consider measles mortality because few EMR countries monitored or reported measles-related deaths.

Implications for Public Health Practice

Measles cases increased in EMR after the COVID-19 pandemic because of inadequate vaccination coverage, resulting in widening of immunity gaps, and declining measles surveillance performance. Routine measles vaccination activities and SIA implementation need to continue or increase in those countries, and efforts to conduct timely case-based surveillance and laboratory testing need to resume. Supporting countries with fragile health systems and reaching undervaccinated and unvaccinated children with ≥2 MCV doses are critical to achieving regional measles elimination.