After decades of progress against measles, the highly contagious yet vaccine-preventable disease is making a slow and steady comeback. The World Health Organization (WHO) and the U.S. Centers for Diseases Control and Prevention said in a new report that there were nearly 10 million cases of measles and 142,000 deaths, with outbreaks on every continent.

“Our finding is that in 2018, there’s been an increase in both the cases and the deaths that have occurred from measles,” Dr. Kate O’Brien, director of WHO’s immunization program, said in a video release. “In other words, we’re backsliding.”

Poor vaccination coverage and large pockets of unvaccinated children have resulted in devastating measles outbreaks in many parts of the world – including in countries that had high coverage rates or had previously eliminated the disease. In some cases, conflict, security or a breakdown in services are making it hard to reach children in remote or hard-to-reach areas. In others, parents are not vaccinating their children due to complacency, mistrust or misinformation about vaccines. This year, for example, the United States reported its highest number of cases in 25 years, while four countries in Europe — Albania, Czechia, Greece, and the United Kingdom — lost their measles elimination status in 2018 following protracted outbreaks.

Samoa and the Asia Pacific

The latest region to be affected is Asia Pacific, where measles is being reported even in places where the disease had been eliminated such as Australia, Japan, and New Zealand. In Samoa, the Government has declared a state of emergency, and all schools are temporarily closed. According to the latest data released by the Government, measles had already claimed 63 lives, mostly young children.

More than 4,300 cases have been reported among a relatively small population, and new cases are being reported daily. According to estimates from UNICEF and WHO, vaccination coverage in Samoa plummeted from 58 percent in 2017 to just 31 percent in 2018, largely due to misinformation and mistrust among parents.

Five countries account for almost half of measles cases in 2018

Democratic Republic of the Congo (DRC): Immunization services have been hampered since 2018 because of poor infrastructure, violence and insecurity, attacks on health centers, lack of access to healthcare, shortages of vaccines and lack of trust in health workers.

The situation has further deteriorated in 2019, with more than a quarter of a million people infected this year alone, more than three times the number of measles cases in 2018 and more than the number of cases and deaths attributed to Ebola in the country. Most of the 5,000 reported deaths so far this year were among children under five. UNICEF has provided the Ministry of Health with 8 million doses of bundled measles-containing vaccines, and distributed over 1,300 medical kits – containing antibiotics, rehydration salts, Vitamin A and other medicines – to all affected health zones to treat children with complications.

Liberia: The outbreak began in 2017 due to low vaccine coverage. In 2018, the country had recorded the highest number of cases, with outbreaks reported in 5 out of 15 counties, and recorded about 3,948 suspected cases including 16 deaths. The recurrent outbreaks continued through 2019, even though the number of cases has declined.

Madagascar: From August 2018 to November 2019, there were 244,607 cases of measles, and 1,080 died due to measles, of which 91 percent were children under 14 years old. Although the rate of new cases is significantly decreasing, some districts are still reporting cases. UNICEF has helped purchase 8.7 million doses of measles vaccine and supported the government to distribute these vaccines at the local level.

Somalia: In 2018, low vaccination coverage, and crowded living conditions created ideal conditions for the spread of measles and other vaccine-preventable diseases. The number of cases has substantially reduced this year compared to 2018, thanks to immunization campaigns supported by UNICEF and partners of the Measles & Rubella Initiative.

Ukraine: Since the start of the outbreak in 2017, over 115,000 people have been infected with 41 deaths, including 25 children. In 2018 alone, there were over 54,000 cases and 16 deaths. Cases remained at alarming levels in 2019. Over 58,000 cases were registered until 6 November 2019, with 20 deaths. UNICEF has increased its support to the Ministry of Health to vaccinate more children by training health care workers and promoting vaccines. UNICEF has also provided support to accelerate routine immunization across the country and address vaccine hesitancy.

In the Americas, Brazil listed 11,887 cases, most of which were reported in Sao Paulo. Two outbreaks in New York state in the US have been declared over, though the WHO says other outbreaks are occurring throughout the country.

Measles is among the most infectious diseases and can be prevented with two doses of vaccine. Even with the implementation of routine immunization, measles continues to circulate globally due to sub-optimal vaccination coverage and population immunity gaps. Any community with less than 95% population immunity is at risk for an outbreak. If an outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread within and beyond the affected countries. As long as measles continues to circulate anywhere in the world, no country can be assured to avoid importation.