Progress and Barriers Define the Journey to Measles Elimination in Africa

Abstract

Measles remains one of the most contagious and deadly childhood diseases. Africa bears disproportionate burden of measles despite >50 years of vaccine availability. The objective of this review was to examine recent epidemiological evidence on measles elimination progress and barriers in Africa towards WHO’s 2030 goal and to identify scalable strategies through holistic analysis of epidemiological, systems, innovation, and social-cultural aspects. Review of approximately 451 sources (2017-2025) from PubMed, Google Scholar, WHO/UNICEF databases, and African regional health databases using Boolean strategy: "Term 1" AND "Term 2" AND "Term 3". Term 1 included: "measles", "measles virus", "rubeola". Term 2 included: "epidemiology", "MCV1 MCV2 coverage", "elimination", "outbreaks", "barriers", "innovations". Term 3 included: "Africa", "African Region", or specific countries. 65 sources were selected and thematically synthesized to gather evidence via a four-domain framework (epidemiology, health resilience, innovations, socio-cultural factors). Comparative analysis of successful cases and challenges was done. From 2017–2021, regional incidence rose from 69.2 to 81.9 cases per million. MCV1 coverage at 69% and MCV2 at 41% fell below the 95% herd immunity threshold. Key barriers included weak health systems, vaccine hesitancy, COVID-19 disruptions, and cross-border transmission. Innovations included drone delivery of vaccine, DHIS2/SMS reminders, thermostable microarray patches, and genomic surveillance. Case studies show Rwanda sustained >95% MCV1 via digital systems and DRC outbreak in 2018-2020 resulted to 458,000 cases and 8,000 deaths. Integrated strategies including resilient systems, regional collaboration, domestic funding, and community engagement are critical to close immunity gaps and achieve WHO's 2030 elimination goal in Africa.