Drivers of measles resurgence in Africa: Strategies to increase vaccine coverage in remote communities

Abstract

Measles remains a major public health challenge in Africa, despite substantial progress in immunisation and the availability of safe, effective vaccines. Between 2000 and 2024, measles vaccination averted nearly 20 million deaths in Africa, yet persistent immunity gaps continue to permit outbreaks, particularly in remote and underserved communities. In 2024, coverage with the second dose of measles-containing vaccine in the WHO African Region was 55%, substantially below the 95% level required to interrupt transmission. This commentary examines the structural, health system, behavioural, and access-related factors driving persistent measles transmission, including suboptimal routine immunisation, pandemic-related disruptions, health workforce constraints, conflict and displacement, weak surveillance, vaccine hesitancy, geographic barriers, and inconsistent outreach. It proposes context-sensitive strategies centred on strengthening routine immunisation, expanding mobile and outreach services, engaging communities, improving risk communication, using digital tools for immunisation tracking and microplanning, strengthening surveillance, and securing sustainable financing. Closing measles immunity gaps requires more than improving national coverage averages; it requires targeted approaches that identify and address barriers preventing underserved populations from accessing and accepting vaccination. Sustained political commitment, equitable resource allocation, and locally adapted service delivery are essential to advancing measles elimination in Africa.