New studies of trends in the global burden of measles and pertussis offer a reminder of how much vaccination has achieved and a warning of the need to build more resilient and sustainable vaccination programs.
Despite long-standing immunization programs, pertussis remains a major cause of vaccine-preventable mortality, particularly among infants. Here we present a primary assessment of global pertussis incidence, mortality and disability-adjusted life years across 204 countries and territories from 1990 to 2023. We show that despite short-term pandemic-period fluctuations, the dominant global pattern from 1990 to 2023 was long-term decline: age-standardized mortality decreased by 61.2% and age-standardized incidence by 41.6%. Relative to the anomalously low pandemic-period estimates, incidence and mortality rebounded by 102.6% (95% uncertainty interval, 77.0–128.2%) and 66.1% (95% uncertainty interval, 2.4–174.5%), respectively, between 2020 and 2023. In 2023 alone, we estimated 18.9 million cases and 115,000 deaths attributable to pertussis. This burden remains profoundly inequitable and inversely correlated with the sociodemographic index; sub-Saharan Africa now accounts for roughly 65% of global deaths, with the highest population-adjusted risk concentrated among infants younger than 6 months. Our findings highlight a modeled geographic concentration of pertussis mortality and support strengthening timely infant vaccination, maternal immunization where recommended and feasible and robust surveillance in highly susceptible regions. Updates to the Global Burden of Disease study showed that while global trends in pertussis (whooping cough) declined from 1990 to 2023, the rebound in incidence and mortality since 2020, particularly in high-income regions, reflects stalled vaccination progress worldwide.
Measles remains a leading cause of vaccine-preventable burden among children, particularly in low-income settings. Despite decades of progress, there are indications of measles resurgence due to stagnation in vaccine coverage. Here, using the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2023, we systematically assessed measles incidence, mortality, disability-adjusted life years (DALYs) and vaccine coverage (measles-containing vaccine 1 (MCV1) and measles-containing vaccine 2 (MCV2)) among children under 5 years of age across 204 countries and territories from 1990 to 2023. Between 1990 and 2019, global measles incidence and mortality declined by approximately 80% and 90%, respectively, but rebounded sharply after 2020, with 15.6 million cases and 118,000 deaths estimated in 2023 (+40% and +12% increases, respectively, between 2019 and 2023). Sub-Saharan Africa and South Asia continue to bear the highest burden. Global MCV1 coverage rose from 67.2% in 1990 to 83.6% in 2019 but stalled and declined slightly to 81.0% by 2023; MCV2 coverage increased from 14.4% in 1990 to 68.4% in 2019 and reached 71.4% by 2023. Several regions remain well below the Immunization Agenda 2030 (IA2030) target of 90% coverage. The recent measles resurgence underscores the fragility of global immunization progress and the urgent need to restore routine vaccination, close immunity gaps and strengthen outbreak preparedness. Updates to the Global Burden of Disease Study showed that although global measles incidence and mortality had declined in 1990−2019, its resurgence since 2020 reflects stalled vaccination progress worldwide.
