Context:

• Vaccines are pivotal tools not only for individual protection but also for reducing community transmission. The COVID-19 pandemic (2021) triggered the fastest global vaccine rollout in history.
• However, the United States is currently experiencing a significant resurgence of measles, with 1,046 confirmed cases as of May 27.
• Its resurgence is a global warning that even advanced health systems are vulnerable without consistent immunisation.

Historical Evolution of Vaccine Introduction:

• The Expanded Programme on Immunisation (EPI): The programme was launched by WHO in the 1980s and 1990s, and focused on vaccines for:
  • Diphtheria, Tetanus, Pertussis (DTP)
  • Polio
  • Measles
  • BCG (Tuberculosis)
  • Hepatitis B and Hib (Haemophilus influenzae type B)
• Widening vaccine access (2000s to 2010s):
  • Hepatitis B, Hib, Yellow Fever vaccines introduced widely in low-income countries.
  • Inclusion of newer vaccines:
    • Pneumococcal Conjugate Vaccine (PCV)
    • Rotavirus
    • HPV (Human Papillomavirus)
    • Measles-Rubella (MR)

Measles Resurgence in the United States:

• Current outbreak status: Sharp increase in cases from last year, and the majority of cases occurring among unvaccinated individuals in regions with declining immunisation rates.
• Implications for public health:
  • Measles was officially eliminated from the US in 2000, implying that new cases occur only when someone contracts measles abroad and returns to the country.
  • The significant drop in childhood vaccination rates is concerning because herd immunity requires at least 95% vaccination coverage.

Vaccine Effectiveness and Hesitancy:

• Measles is highly contagious, and can be deadly for unvaccinated children.
• The MMR vaccine is probably one of the most effective vaccines. A single dose gives 93% protection from infection, and two doses up to 98%.
• Rising hesitancy due to:
  • Post-pandemic skepticism
  • Non-evidence-based fears linking MMR to autism
  • Complacency in disease-free generations

Global Measles Coverage - A Warning Signal:

• Current global scenario: Only 83% of children received the first dose of the measles vaccine in 2023; 74% received the second dose. These figures fall short of the 95% coverage needed to prevent outbreaks.
• Warning signal: The disease is often regarded as the ‘canary in the coalmine’ - if cases spread, it is a warning that other disease outbreaks might spring up where there are gaps in vaccination coverage.

India’s Immunisation Success and Challenges:

• Mission Indradhanush and UIP achievements:
  • Universal Immunisation Programme (UIP): India achieved a national immunisation coverage of 93.5% in 2023–24, indicating that the majority of children received all recommended vaccines by the age of two.
  • Mission Indradhanush: Since its inception (2014), it has focused on areas with low immunisation rates, and has completed 12 phases, vaccinating 5.46 crore children and 1.32 crore pregnant women across 554 districts.
• Vigilance against complacency:
  • Despite progress, India must not ignore global patterns of vaccine hesitancy.
  • In resource-poor settings, reduced uptake can overwhelm healthcare systems.

Concerns and Way Ahead:

• International concerns: The flu vaccination rates among NHS staff in the UK dropped to their lowest in nearly 15 years in 2024-25.
• India’s advantage and future strategy:
  • Positive perception: Previous experience with successful vaccination campaigns and government endorsements have played an important role in creating a positive perception of vaccines.
  • Government advocacy: Need for a multi-pronged, culturally sensitive strategy to sustain trust and counter misinformation.

Conclusion:

• The resurgence of measles, even in developed countries like the US, highlights the fragility of immunisation gains in the face of vaccine hesitancy.
• India must consolidate its achievements by remaining vigilant, promoting awareness, and crafting robust community-based responses to maintain and enhance vaccine coverage.