Measles and Rubella Elimination Trends in the WHO Eastern Mediterranean Region, 2023-2024: Progress and Recent Epidemiological Shifts.

Background

Measles and rubella remain key indicators of immunization system performance and are central to the Immunization Agenda 2030 (IA2030). Disruptions caused by the COVID-19 pandemic have widened immunity gaps and accelerated resurgence of vaccine-preventable diseases across multiple regions. This study assesses progress toward measles and rubella elimination in the WHO Eastern Mediterranean Region (EMR) during 2023-2024.

Methods

We conducted a retrospective descriptive analysis of measles and rubella surveillance data, WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), and Joint Reporting Form (eJRF) data for all 22 EMR countries and territories. Key indicators included disease incidence, MCV1 and MCV2 coverage, surveillance performance metrics, and verified elimination status.

Results

Regional measles incidence increased from 110.8 to 116.3 per million population, while rubella incidence more than doubled from 1.9 to 4.3 per million. Large outbreaks in Yemen, Iraq, and Afghanistan disproportionally drove regional trends. MCV1 coverage remained stable at approximately 80%, while MCV2 coverage increased marginally from 73% to 75%. Only nine of 22 countries achieved ≥95% coverage for both doses in 2024. Persistent zero-dose populations, high dropout rates, and ongoing immunity gaps sustained transmission across multiple settings.

Conclusions

The EMR remains off track to achieve measles and rubella elimination by 2030. Accelerated, equity-focused efforts are urgently needed to strengthen routine immunization systems, reduce zero-dose population, enhance surveillance capacity, and improve outbreak response-particularly in fragile and conflicted-affected settings.