Furthermore, the logistical and financial strain on healthcare systems cannot be ignored. Many low- and middle-income countries are already struggling to maintain the current two-dose schedule. Professor Mulholland noted that adding a third dose to the program would be an immense challenge for nations that are currently failing to reach adequate coverage with the second dose. There are also the perennial issues of vaccine hesitancy and the cost-effectiveness of expanding the program, which require a nuanced approach to public health policy.
The role of transmission also complicates the strategy. While infants are the most vulnerable to severe outcomes, they are not the primary drivers of the virus’s spread. Professor Mulholland explained that school-aged children remain the key transmitters of measles. Therefore, while protecting infants is a moral and clinical priority, the broader goal of measles elimination still relies heavily on preventing infections among older children to limit the overall circulation of the virus in the community.
The urgency of this debate is underscored by the current state of the global measles outbreak. The virus is a highly contagious airborne pathogen that requires a very high level of population immunity to be kept at bay. Darren Ong, a researcher at MCRI, explained that to attain herd immunity and effectively stop the transmission of measles, at least 95 per cent of a population must receive both the first and second doses of the vaccine. Achieving and maintaining this level of coverage has proven to be an uphill battle in recent years.
The COVID-19 pandemic significantly exacerbated the situation, dealing a heavy blow to global immunization efforts. Routine vaccination programs were interrupted, catch-up campaigns were delayed, and the rise of vaccine hesitancy—fueled by misinformation during the pandemic—has created a "perfect storm" for measles to return. Mr. Ong noted that poor vaccination coverage has sparked large-scale outbreaks in several countries since the beginning of 2024. The statistics are sobering: nearly 400,000 measles cases were reported globally in 2024. The trend appears to be accelerating, with more than 16,000 cases recorded in just the first two months of 2025.
For young babies who rely on herd immunity because they are too young for the vaccine under current guidelines, these outbreaks are particularly perilous. Measles can lead to severe complications in infants, including pneumonia, brain swelling, and permanent disability or death. The failure to maintain the 95 per cent immunity threshold means the virus can find these unprotected pockets of the population with ease.
