Peer-reviewed article
Insights from 25 Years of Measles and Measles-Rubella Vaccination Campaigns in the WHO African Region (2001-2025).
Balcha Girma Masresha, Goitom Gebremedhin Weldegebriel, Emmaculate Jepkorir Lebo, Sarah Wanyoike, Ado Mpia Bwaka et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This analysis reviewed 25 years of measles and measles-rubella vaccination campaigns across 44 African countries from 2001 to 2025. The region delivered over 1.5 billion vaccine doses through 326 campaigns, mostly nationwide efforts targeting all eligible children. While two-thirds of campaigns met national administrative coverage targets, fewer than one-fifth achieved the 95% coverage goal when verified by post-campaign surveys, indicating significant gaps between reported and actual coverage.
Key points
- 326 preventive measles/measles-rubella supplemental immunization activities implemented across 44 African countries delivered more than 1.5 billion doses
- 64.7% of campaigns (209 SIAs) met the 95% national administrative coverage target, but only 19% of those with post-campaign surveys achieved 95% coverage
- District-level coverage targets were rarely met, with only 11 of 164 campaigns achieving 95% coverage across all districts
- Only 29% of campaigns were followed by post-campaign coverage surveys to verify actual coverage
- 62% of campaigns implemented between 2006-2025 integrated additional child survival interventions alongside measles vaccination
Limitations
This is a retrospective analysis of administrative reports and surveys; it does not explain the underlying reasons for coverage gaps or identify specific barriers to reaching unreached children. The document also notes significant discrepancies between administrative reporting and survey-verified coverage, so actual performance may differ from what is documented.
Abstract
INTRODUCTION: The WHO African Region is working to eliminate measles and rubella in 80% of countries by 2030. In countries with sub-optimal routine immunization coverage, periodic supplemental Immunization Activities (SIAs) are implemented to boost childhood immunity against measles and rubella. METHODS: We reviewed the SIA technical reports and reports from post-campaign surveys shared by countries with the WHO Regional Office for Africa, and we analyzed the coverage data from preventive measles campaigns implemented during the years 2001-2025. RESULTS: A total of 326 preventive measles/measles-rubella SIAs were implemented across 44 countries in the years 2001-2025, providing more than 1.5 billion doses of vaccine to eligible children according to the type and scale of the campaigns. Four fifths (82%) of the SIAs were nationwide exercises, and all of the SIAs were implemented as non-selective vaccination campaigns targeting all eligible children irrespective of past vaccination history, with the exception of four SIAs. The 95% administrative SIA coverage target at national level was met in 209 SIAs (64.7%). At district level, 11 of 164 SIAs had 100% of districts attaining 95% administrative coverage. Only 94 SIAs (29%) were followed by post-campaign coverage survey, and only 18 (19%) of these attained coverage of 95% or more by survey. Nearly two thirds (62%) of the 272 SIAs implemented during 2006-2025 had at least one additional intervention included with the measles/MR vaccination. DISCUSSION: Measles and MR vaccination campaigns have served as excellent opportunities for providing integrated child survival interventions in the African Region. While two thirds of the SIAs met the national administrative coverage target, district-level coverage targets were not met in the majority of the SIAs, and only one fifth of the SIAs met the national-level survey coverage targets. Moreover, discrepancies were noted between administrative and survey coverage results, possibly due to inaccuracies in the reporting of the number of doses administered and/or reliance on inaccurate denominators. For optimal impact, SIAs need to adequately reach unreached populations. CONCLUSIONS: In view of the documented sub-optimal coverage, countries should provide strong leadership and ownership of the measles elimination strategies for the attainment of the SIA coverage targets as well as the overall measles and rubella elimination goal. There is an urgent need for improved tools to identify unvaccinated children, high-risk populations, and innovative strategies to reach them. All countries implementing SIAs should also include systematic monitoring of zero-dose children, and conduct post-campaign coverage surveys in a timely manner.