Measles is circulating in 25% of countries in the WHO’s 53-member European region. It has made an unwelcome return to six countries which had previously eliminated the disease and is endemic in thirteen others.
It’s not all bad news: Albania, Bulgaria, Lithuania and Slovakia have interrupted measles transmission for at least 36 months. However, Europe can do better by improving vaccination rates and disease protection systems.
Read: Measles ‘reestablished’ in six European countries
Background
In September 2025, the independent Regional Verification Commission (RVC) met to analyse the latest national data (2024), and published its assessment in January 2026. The RVC’s conclusions were then presented to the WHO/Euro leadership and to the European Technical Advisory Group of Experts on Immunization (ETAGE).
Europe recorded 127,320 cases, with very large outbreaks in Romania (30,000 cases) and Kazakhstan (28,000). The situation is an ‘extreme challenge’ for a region aiming to eliminate measles and rubella, according to Dr Dragan Jankovic, Team Lead, Disease Control and Elimination, Vaccine-Preventable Diseases and Immunization Programme, WHO/Europe.
Vaccines Today asked Dr Jankovic what can be done to get the continent back on track.
What is your response to the latest RVC report showing measles has been reestablished in six countries in the European Region?
Measles outbreaks in 2024 demonstrated that even with strong health systems in high-income economies and timely detection of cases, measles outbreaks can happen, and the measles virus can reestablish itself as endemic.
This is possible in all countries if they do not know and address their risks with respect to immunity gaps, response capacity and vaccine acceptance among medical staff and the public.
Where does this leave the measles and rubella elimination effort?
The WHO Regional Office (RO) commends Albania, Bulgaria, Lithuania and Slovakia for achieving elimination in 2024 by maintaining interrupted measles transmission for longer than 36 months.
However, the WHO RO is concerned by the lack of progress towards Regional measles elimination, with six countries having lost their status of measles elimination in 2024.
The RVC and RO are again reminding countries, colleagues in national health systems and the general population that we are still within reach of elimination of measles and rubella across the whole European Region.
This is especially relevant for rubella, where some additional activities and more information collected, analyzed, and provided to the RVC may result in achievement of rubella elimination in all 53 countries. The path to measles and rubella elimination is clear; reaching this goal requires more engagement and commitment of all stakeholders.
What should be done to address the challenges?
Increased measles transmission and outbreaks in 2023 and 2024 present an extreme challenge for many countries in the European Region and globally. This resurgence is alarming especially in light of information received through the annual reporting process on decreased and challenged routine and supplemental immunization activities in countries in the previous years, together with observed inadequate and untimely response measures taken during the outbreaks.
WHO and the RVC have repeatedly insisted that countries and health systems demonstrate ownership and commitment to elimination by taking immediate action to address these shortcomings.
Are you concerned about vaccination rates?
It is clear that measles and rubella elimination can be achieved and maintained only in a population protected with immunization, where each year over a long period of time ≥ 95% of the targeted birth cohorts for routine immunization in all territories of the country receive their vaccines on time, and where all of those who missed immunization in the past are reached and immunized at any age through supplemental immunization activities.
It has also been observed that delayed detection of measles outbreaks, slow and weak implementation of outbreak response measures, and absence or refusal of outbreak response immunization among susceptible individuals results in prolonged transmission.
What has been done to help Europe back on track amid ongoing outbreaks?
In 2024 and 2025, [WHO/Euro] supported countries in routine, supplemental and outbreak response immunization and strengthening MR surveillance. Strengthening the laboratory segment of surveillance is especially important to ensure sensitivity in early detection of suspected cases and their confirmation or discarding and to identify chains of transmissions.
Together with partners, VPI supported measles outbreak response in Kyrgyzstan and Tajikistan, collaborated on outbreak response with Armenia, Azerbaijan, Bosnia and Herzegovina, Kazakhstan and Serbia among other countries, developed materials and conducted trainings on MR elimination and verification, vaccine acceptance, building trust in immunization, communication for health care workers and conducted qualitative and quantitative studies on barriers to vaccination.
What are the most important steps that must be taken to control measles and rubella?
Given that there is no way to prevent importation of measles and rubella viruses, the core strategies for achieving and sustaining measles and rubella elimination are to:
- achieve and sustain high vaccination coverage (≥ 95%), with two doses of measles- and rubella-containing vaccine administered through high-quality routine immunization services.
- provide measles and rubella immunization opportunities covering high-risk groups, including supplementary immunization activities, for all populations susceptible to measles and rubella.
- strengthen surveillance systems through rigorous case investigation and laboratory confirmation of suspected sporadic cases and outbreaks.
- build up methodologies and capacities to timely and adequately respond to outbreaks.
- improve the availability and use of high-quality, evidence-based information for health professionals and the public on the benefits and risks associated with immunization against measles and rubella to build confidence and demand for immunization.
To make this happen in all countries we need more commitment at the decision-maker level, in the health system and from the population. And we need preparedness to respond to measles virus importation with timely and adequate outbreak response measures including immunization. This will also help in addressing and pushing back against anti-vaccination misinformation and attitudes, which also result in politicisation of this public health-related topic.
How can healthcare professionals help combat measles in Europe?
Healthcare professionals working in Primary Health Care are the frontline for immunization programmes and surveillance, and vitally important for the success of the measles and rubella elimination activities.
Despite the largest resurgence of measles in the European Region in over 25 years, and the scores of deaths this has caused, there is still a lack of awareness among some healthcare professionals about the dangers of measles and rubella and the importance and safety of vaccination to prevent them.
Measles outbreaks are a preventable tragedy, but they are also a warning sign that something is not right with the immunization programme, the surveillance system, the capacity of the health system to implement response measures, public-facing communication, and/or accessibility of the health system for some segments of the population.
We need evidence-based health systems that support immunization programmes and staff, including by offering training to healthcare professionals at all levels, so they are well-informed about vaccine-preventable diseases and immunization and can confidently communicate the facts about immunization to the public.