41,000 cases of measles have been recorded in Europe as of June. Those are the highest numbers we’ve seen in years.

Measles is one of the most contagious diseases in existence, traveling person to person through contaminated air or surfaces. It’s not often fatal, but it can kill – especially babies and people who have other health problems. Sometimes it causes massive nervous system damage after the virus passes. Measles can also lead to complications like pneumonia, encephalitis and secondary bacterial infections.

The virus should be a thing of the past – the measles vaccine is one of the great child survival success stories of global health. Before 1980, measles killed about 2.6 million people every year. In 2015, measles killed 134,200 people – a massive reduction in lives lost. In 2016, however, things began to backslide in Europe. A measles outbreak in Romania spread rapidly through the region. And now, the World Health Organization has reported record numbers of measles infections so far in 2018. 41,000 people have been infected, and 37 people have died.

The current European outbreak is spreading through unvaccinated older children and babies too young for vaccination. Those babies are also at an increased risk of death, because measles is much more fatal in infants. 95% of the population has to be vaccinated to stop the spread of measles, and European countries just aren’t reaching those numbers.

More than half of the measles cases in this outbreak are in Ukraine.

While childhood vaccine coverage was nearly universal in the Soviet Union, the countries of the former Soviet Union have struggled to maintain this coverage after independence. Ukraine faces a number of challenges to successful vaccination. Ongoing conflict with Russian in the Crimean region limits access to health care services in the area. But measles outbreaks in Ukraine are evenly distributed throughout the country, reflecting the low vaccination rates in the nation as a whole. Research on vaccine uptake in Ukraine indicates widespread mistrust of vaccines among parents, and more shockingly, among health care providers. Vaccine refusal is increasingly common in Ukraine, with parents refusing to have their children immunized and some health care providers not making the case for immunization. As a result, in 2014, less than half the children in the country had been vaccinated for measles. That kind of failure has consequences, not just for Ukraine but for the whole European region.

Aside from Ukraine, the outbreak affects Italy, Greece, Georgia, Russia, Serbia and France most strongly, with over 1000 measles cases occurring in each country. Not coincidentally, France, Russian, and Italy have some of the highest recorded anti-vaccine sentiment among the European population.

This outbreak is driven by poor human choices. Of all the regions of the world, Europe is best resourced for effective vaccination. With the exception of Russia and Ukraine, it’s not an issue of government capacity or logistical challenges. It’s some other kind of breakdown – parents not trusting physicians or the medical system. Vaccinations are one of the cornerstones of public health – we know the epidemiology, we know how to main a cold chain for fresh vaccines, we know when children should receive them for maximum protection. But we don’t, apparently, know to convince people that vaccines are good for their kids.

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