The Shifting Epidemiology of Measles in India (2015-2025)

This report undertakes the first ever comprehensive epidemiological analysis of measles in India over the past ten years (2015-2025), which has witnessed remarkable public health gains, endemic challenges and the recent spike. Despite colossal mass immunization efforts that reduced measles incidence substantially, India has repeatedly missed the mark on the required 95% two-dose vaccination coverage to achieve elimination and has maintained an endemic immunity gap. A critical and contradictory pattern has developed: the overall case counts decreased but the case fatality rate (CFR) among reported cases increased ominously and especially following the COVID-19 pandemic. Routine immunization services markedly collapsed due to the pandemic and generated an immense cohort of susceptible children leading to massive outbreaks during 2022. Examination of national data demonstrates that susceptibility to measles is not accidental but is systemically structured along socio-demographic lines including wealth and maternal schooling and also along religious and geographic lines and results in an inequity landscape where the most marginalized children are at greatest risk. This report integrates evidence on epidemiological pattern analysis, vaccination policy, post-pandemic surge and socio-demographic and system-level determinants of failure to make progress. This report determines that the measles disease in the modern India is essentially an inequity disease and to reach the national goal of elimination requires an intensified multi-level strategy aimed at reinforcing routine immunization delivery and resolving the causes of under-vaccination through an equity perspective and strengthening and bolstering the capacity to do surveillance and clinical management.