As Measles Resurges Globally, Eritrea Makes Quiet Progress

Measles is among the most contagious infectious diseases known to humanity. Yet despite the availability of a safe, highly effective, and inexpensive vaccine, the disease continues to threaten children in countries across the world. The World Health Organization (WHO) estimates that in 2026 nearly 11 million people will contract the virus that causes measles. Most cases are expected to occur in Africa and Asia, but outbreaks are also being reported in countries across the Americas and Europe, affecting hundreds and, in some places, thousands of people. According to the US Centers for Disease Control and Prevention (CDC), measles outbreaks are currently occurring in every region of the world.

The persistence of measles is particularly troubling because the disease is preventable. There is no specific treatment for measles, but vaccination has been proven safe and effective in preventing infection and its potentially devastating consequences. Unvaccinated people who contract measles can develop serious complications, including deafness, blindness, encephalitis, and, in severe cases, death. The risk of a poor outcome is particularly high among people who are undernourished or unable to access adequate supportive medical care.

Although measles vaccination is one of the safest, most cost-effective, and most established tools in public health, too many children around the world remain unprotected. Global vaccination coverage remains below the level required to maintain strong population-wide protection, leaving room for the virus to circulate and outbreaks to occur.

Against this global backdrop, Eritrea’s experience offers an important example of what sustained investment in routine immunization, community-based health services, and child health can achieve. Despite considerable challenges, the country has made substantial progress in protecting children against measles and strengthening its broader national immunization program. Its experience also illustrates how improvements in vaccination coverage can translate into dramatic reductions in disease.

Over the years, Eritrea has maintained relatively high measles vaccination coverage and made considerable progress toward measles elimination. (While significant strides have been made, the country must still complete the necessary steps before it can achieve formal certification of measles elimination.) For many years, children in Eritrea received one dose of measles vaccine at approximately nine to 12 months of age.

In 2012, however, and also in view of WHO recommendations, the country introduced a second dose of measles vaccine into its national routine immunization schedule. The two-dose approach is important because a proportion of children, potentially as many as approximately 15 percent, do not develop adequate immunity after the first dose.  Since 2018, Eritrean children have received two doses of the combined measles-rubella vaccine.

The results are encouraging. In 2023, measles vaccination coverage for the first and second doses stood at 93 percent and 85 percent, respectively, with both figures considerably higher than continental and global averages. First-dose coverage has also risen dramatically over the longer term: from 34 percent in 1993 to approximately 76 percent in 2000.

The decline in measles transmission is even more striking when measured in terms of reported cases and incidence. In 2025, Eritrea recorded 27 reported measles cases nationwide, equivalent to an incidence rate of approximately 7.5 per 1,000,000 population. Both figures were slightly higher than in 2024, but remained very low in comparison with the wider African region. By comparison, more than 179,400 measles cases were reported across Africa, corresponding to an average incidence of approximately 141 per 1,000,000 population.

Of course, these figures do not mean that Eritrea can afford to become complacent. Measles remains extraordinarily contagious, and declining vaccination coverage can allow outbreaks to return rapidly. Nevertheless, Eritrea’s progress demonstrates the value of maintaining high routine immunization coverage and ensuring that children receive all recommended doses.

Eritrea’s progress against measles is part of a much broader national effort to strengthen routine childhood immunization. Vaccination is among the most important public-health interventions for preventing serious illness, disability, and death among children. In addition to measles, routine childhood immunization protects against diseases including diphtheria, tetanus, pertussis (whooping cough), influenza, pneumonia, and rubella.

Since independence, Eritrea has made major gains in routine vaccine coverage. In 1991, only six vaccines were available to children, and overall coverage was below 10 percent. Some of the vaccines available around independence included Bacille Calmette-Guérin (BCG), as well as vaccines against diphtheria, tetanus, and pertussis.

Over subsequent decades, however, Eritrea steadily expanded its national immunization schedule. Today, the country administers a total of 14 vaccines to young children, collectively protecting them against several dozen diseases. Overall coverage rates are above 90 percent.

The scale of the delivery system is also significant. Through the Ministry of Health and the National Immunization Programme, approximately 300 health facilities across the country provide free routine vaccination services six days a week. Vaccination services are also offered at approximately 450 outreach sites nationwide. For nomadic communities and people living in extremely remote or difficult-to-reach areas, services are extended through mobile health units, barefoot doctors, and mass vaccination campaigns organized in close cooperation with community coordinators, volunteers, and local contacts.

This emphasis on reaching children where they live is particularly important in a country characterized by geographically dispersed and mobile populations. High national coverage cannot be achieved simply by making vaccines available at fixed health facilities; it requires sustained efforts to reach communities that might otherwise be left behind.

Eritrea’s progress has also attracted recognition from regional and international organizations. In November 2009, the country was recognized by Gavi, the Vaccine Alliance, for its outstanding performance in improving child health and immunization. Among 17 countries recognized at a ceremony in Vietnam, Eritrea received the award for “Best Immunization Performance.”

The recognition continued in subsequent years. In 2016 and 2017, Eritrea received back-to-back awards from UNICEF’s Eastern and Southern Africa Regional Office for effective vaccine-management practices. In September 2018, UNICEF again recognized the country for improvements in its national vaccine store.

During a working visit to Eritrea in late 2021, Mohammed Malick Fall, then UNICEF Regional Director for East and Southern Africa, also praised the country’s immunization performance. He said he was “struck by the level of immunization [of children],” adding that “there are many advanced countries that have a hard time reaching [those coverage levels].”

Behind Eritrea’s vaccination achievements is a broader national emphasis on the health, welfare, and development of children.

Eritrea is one of the world’s youngest countries and possesses a rich history, diverse cultures, a long Red Sea coastline, significant marine and natural resources, considerable biodiversity, and substantial agricultural potential. Its strategic location along one of the world’s major international maritime shipping routes also provides important economic opportunities. Yet its most important resource is neither its coastline nor its natural resources. It is its people, particularly its young.

Across the decades since independence, Eritrea has maintained a strong emphasis on the health and well-being of its children and youth. The first international convention ratified by the Eritrean government after independence was the United Nations Convention on the Rights of the Child. Eritrea also acceded to the African Charter on the Rights and Welfare of the Child in December 1999, not long after the Charter entered into force.

The Eritrean National Charter, adopted in Nakfa in February 1994 and serving as a guiding vision for the country, likewise places considerable emphasis on children. It declares that:

“Eritrea should strive to minimize infant mortality and to care for its children. The children of martyrs, in the tens of thousands, who were deprived of the love of their parents, as well as other orphans, must be provided with proper upbringing and care. In Eritrea, the rights of children to education, health, love, safety, play, and to human dignity must be respected.”

Seen in this broader context, Eritrea’s high measles vaccination coverage and wider immunization achievements are more than isolated public-health statistics. They represent a continuation of a longstanding effort to protect children and invest in their future.

The progress Eritrea has made against measles is significant, but the global resurgence of the disease is a reminder that such progress cannot be taken for granted. Measles spreads rapidly wherever immunity gaps emerge, and even countries that have achieved substantial reductions in transmission can experience outbreaks when vaccination coverage declines.

For Eritrea, therefore, maintaining high routine immunization coverage, ensuring that children receive both recommended doses, sustaining outreach to remote and mobile communities, and strengthening disease surveillance will remain essential. Continued vigilance is particularly important as measles continues to circulate internationally.

At the same time, Eritrea’s experience demonstrates what can be accomplished through sustained commitment to routine immunization. From extremely low vaccination coverage around independence to coverage rates exceeding 90 percent across much of the national childhood immunization program, the country has built a system capable of reaching children in urban centers, rural communities, remote areas, and among nomadic populations.

As measles continues to challenge countries across every region of the world, Eritrea’s experience offers an important lesson: protecting children from preventable disease requires more than having an effective vaccine. It requires sustained political commitment, functioning health services, community participation, reliable delivery systems, and the determination to ensure that no child is left beyond the reach of protection.