Measles is surging and it’s a warning we can’t ignore

In July, the United States recorded its highest number of annual measles cases in 33 years. In a nation that declared measles eliminated in 2000, upward of 1,400 cases have been recorded in 2025 so far. Measles is among the most contagious diseases, killing or disabling thousands each year. In high-income nations, measles still kills or disables as many as three per 1,000 infected. In low-income countries, the threat is much greater. In today’s interconnected world, borders offer no protection. Past U.S. flare-ups have been traced back to the Philippines, Israel, and Ukraine, among others. In 2023, 57 countries battled large-scale measles outbreaks. With measles cases located in countries across different continents, we’re reminded that our response to recent surges must be global. Measles is often seen as a litmus test for the strength of a country’s public health system. Its resurgence typically signals gaps in vaccination coverage, health equity, and trust in medical infrastructure. Unfortunately, investments in health and immunization systems have become siloed, and delivery has been uneven. Now measles is surging again. Yet this is also a story of hope. The measles vaccine is one of public health’s most powerful tools. Two doses of the measles vaccine are about 97% effective at preventing the disease. Since 2000, global deaths from measles have dropped by 87%. That’s what collaborative global action can achieve. However, coverage for the first and second doses of measles has stagnated globally, and in some Gavi-eligible countries, progress has even reversed, leaving tens of millions of children underimmunized. The next chapter of measles control must be smarter, more integrated, and grounded in real-world results. In practice, this means: 1. Strengthening routine immunization The foundation of measles control is strong routine immunization. That requires clinics that are open, staffed, stocked, and trusted, and communities that are routinely contacted by outreach teams. This is particularly important in rural areas where services rely heavily on outreach, and clinics are particularly susceptible to shortages of trained staff and stockouts. In 2012, Punjab’s low coverage meant that thousands of children died each year from preventable diseases, including measles. By geotagging the location of completed outreach activities, the government of Punjab was able to identify reached and missed communities, using the data to direct vaccinators each month to ensure full community coverage. This drove a 35 percentage point rise in full immunization rate between 2014 and 2017 — one of the fastest ever recorded in a large system. 2. Using real-time data to act fast High-quality data enables faster, smarter action. By using real-time measles data across sectors, countries can deploy better-equipped teams and respond rapidly to emerging clusters where vaccines are most needed, as well as ensure missed communities are identified and responded to. In Ethiopia, for example, measles cases continued to double year-on-year despite the implementation of a mass vaccination campaign in 2022, with active outbreaks reported across the country. In 2025, a targeted immunization campaign was launched to close immunity gaps. By using simple tools to select priority districts, deploying a team of trained monitors to each district, as well as tracking daily progress and emerging issues using dynamic dashboards, 30,000 children were surveyed in just six days. This identified thousands that were unvaccinated and highlighted areas that needed additional focus to improve service delivery and coverage. 3. Targeting the hotspots Measles doesn’t spread evenly, meaning interventions must be tailored. Identifying hotspots of under- and unimmunized children through rapid coverage surveys makes it possible to target high-risk and high-burden areas, as well as engage local partners to shape interventions that work in context. This has been particularly effective in Mozambique, which faced regional disparities in vaccination coverage, driven by poor service quality and missed vaccination opportunities. Surveys at provincial, district, and community levels helped map zero-dose children in real time and identify client-level drivers of nonimmunization. The data was visualized in real time and triangulated with other data sources to target and intensify outreach activities. Doing so saw the number of children vaccinated in the Tete province surge from 4,042 in the fourth quarter of 2023 to 11,704 in the fourth quarter of 2024. 4. Equipping leaders to lead Last-mile fixes only work with political will. From health ministers to frontline supervisors, and even community influencers, strong leadership at every level matters. When trusted local voices speak up, people listen. When government systems are held accountable by their leaders and citizens, results follow. Governments must be equipped — and motivated — to champion enabling policies, fund programs, and monitor progress. We know this simple approach works and have already seen it succeed in Pakistan, Ethiopia, and Mozambique. We can scale it globally if we act now, together, and with urgency. In summary, these cases in the U.S. are not just another outbreak — it is a symptom of weaknesses in global health systems. We must rise to the global challenge it truly represents. If we are serious about preventing future outbreaks, we must confront the reality that measles is thriving in regions where health systems are underfunded, fragmented, or stretched beyond capacity. The good news is that we know what’s required, the measles vaccine works, and reaching every community is possible.