Measles is one of the most contagious but vaccine-preventable diseases, infecting about 12 to 18 persons per case patient.
The introduction of the measles vaccine, and later the combined MMR (Measles, Mumps and Rubella) vaccine, has been a monumental public health success, preventing an estimated 57 million deaths between 2000 and 2022.
However, the World Health Organization (WHO) has recently reported alarming increases in cases, outbreaks, and deaths globally. This is driven largely by gaps in routine childhood immunisation, pandemic-era service disruptions, and vaccine misinformation and disinformation.
The WHO estimated about 10.3 million measles cases worldwide in 2023, a 20% increase from 2022, reversing earlier progress towards control and elimination. An estimated 107,500 people, mostly children below 5 years of age, have lost their lives.
In the WHO Europe region, there were 127,350 measles cases in 2024. This is double the cases in 2023, and the highest since the late 1990s.
More than half of the reported cases required hospitalisation, with 38 deaths. Missed routine vaccinations during the Covid-19 pandemic and widespread misinformation were the major drivers.
The Americas, which is the only WHO region to eliminate measles twice, has now lost its measles-free status (no endemic measles transmission for at least 12 months, less than one measles case per million population). This is due to the recirculation of the measles virus for the past 12 months in Canada.
As of November 7, 2025, 12,596 confirmed measles cases have been reported across ten countries, a 30-fold increase compared to 2024. Twenty-eight deaths have been recorded.
In the United States, a total of 1,753 confirmed measles cases were reported as of November 18, with three confirmed deaths. 92 per cent of the cases were unvaccinated or whose vaccination status was unknown. It is highly likely that the US, like Canada, would lose its measles-free status early next year.
In the Western Pacific Region (including Malaysia), measles cases increased by 743 per cent between 2022 and 2024. This regional rise increases importation risk for neighbouring countries and places greater pressure on national vaccination programmes.
Malaysia, which had made significant strides in controlling measles, is now experiencing a severe and worsening outbreak.
National data reported in 2024 showed 3,791 measles cases, a sharp increase from 2,002 cases in 2023. The incidence rate nearly doubled from 60 to100 measles cases per million population. The highest number of cases were recorded in Sabah (2015), Selangor (491), and Kedah (260).
The number of measles outbreaks increased two-fold from 112 in 2023 to 231 in 2024. A substantial number of cases involved very young children. About 44 per cent of cases in 2024 were children under five.
Although Malaysia’s national MMR coverage is reported as exceeding 95 per cent overall, coverage is uneven.
Only 62 per cent of districts achieved ≥95 per cent MMR coverage in 2024, leaving pockets vulnerable to outbreaks. Herd immunity requires uniformly high coverage across communities ≥95 per cent MMR.
Around 28.9 per cent of cases involved non-citizens, a group with lower documented vaccination rates. Many of those infected had never received measles vaccine. These populations are epicentres of outbreaks of measles and other vaccine preventable diseases.
The bulk of the measles cases were in Sabah (53 per cent). A notable share of infections among non-citizens highlights the importance of making vaccination accessible regardless of immigration status and improving outreach in migrant, refugee and other marginalised communities.
Perhaps we are victims of our own success, where the highly successful National Immunisation Programme has so effectively reduced the spread of infectious diseases that people have forgotten its dangers.
In fact, many young doctors today have not encountered severe cases of measles or its complications unless they worked at remote, underserved areas.
The escalating number of measles exposes an underlying risk, which is the return of communicable, vaccine-preventable diseases such as polio, which was reported in Sabah in December 2019, despite Malaysia being declared polio-free in the last 27 years (December 2019).
We need to act fast to prevent undoing all the decades of public health efforts in arresting the spread of communicable diseases and stopping the infectious chain of transmission. This includes:
- Active surveillance and rapid case investigation and local outbreak control (including targeted vaccination around detected cases) to reduce spread and hospitalisations.
- Stepping up the Measles and Rubella Supplementary Immunisation Activity (MR SIA) in high-risk areas.
- Prompt and regular reporting of measles and other vaccine preventable disease cases (VPD) and outbreaks as per the US’ Centers for Disease Control and Prevention, the United Kingdom’s National Kealth Service, and PAHO (Pan American Health Organization) where VPD data is contemporary and accessible as of November 2025.
- National averages hide local vulnerability. Micro-planning programmes such as conducting school-based campaigns, and community outreach in districts under 95 per cent coverage.
- Combatting misinformation, disinformation and communicating vaccine safety and effectiveness are central, especially where hesitancy has taken hold since the Covid-19 pandemic. Evidence from the WHO and UNICEF analyses points to misinformation as a driver of declining vaccine uptake and coverage.
The current outbreak in Malaysia is a stark reminder that the success of vaccination programmes is fragile and requires constant vigilance and commitment. Proactive steps must be taken to prevent vaccine-preventable communicable diseases from increasing the national health care burden.
Dr Musa Mohd Nordin and Dr Husna Musa are paediatricians, and Chan Li Jin is a health activist.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
