Feb 24, 2026
3 min read
A few days ago, the World Health Organization (WHO) announced that Spain, along with five other countries in the European region, would lose its status as a country free from ...
Just a few days ago, the World Health Organization (WHO) announced that Spain, along with five other countries in the European region, is losing its status as a measles-free country.This is the result of an assessment based on pollution data in 2024, but the numbers have not improved since then and the latest outbreak in two companies in Alicante does not predict a decrease for this year that has just started.
What happened to measles, a disease that seems to be extinct, reappeared in the world in a few years?We are talking about one of the most contagious viruses that exist, at the same time a virus that is only found in humans, for which there is a safe and effective immunity to prevent infection and its consequences.At the moment, none of these maxims hold up, so we can only look at one culprit: reduced vaccine uptake.
The pandemic had an immediate and undeniable effect not only in delaying vaccination campaigns, but also in creating some aversion to vaccines.And all this adds to the indifference to the threat, which, with the comfortable distance of those who no longer remember the consequences, seems less important or urgent.Experts say dying successfully.
Regarding the specific situation in Spain, our country is considered measles-free since 2017 and now it is time to work seriously to return to that level."This change of status is not good news," explains Antoni Trilla, epidemiologist and professor of Preventive Medicine at the University of Barcelona, "they have given us a yellow card to eliminate measles."For epidemiologists, it is clear what underlies this change in status: "We have a good level of vaccination coverage, but maybe not optimal, and this has allowed us to have a relatively constant transmission of measles, althoughalso limited, domestically."
Fernando Moraga-Löp, pediatrician and spokesperson for the Spanish Association of Vaccinology (AEV), helps us understand the recent number of measles cases in Spain: "Several cases in 2014, 2015 and 2016 were linked to imports."In 2024, the number of confirmed cases increased from 14 (in 2023 - as a result of the disease) to 227. Among them, again, there are many related to imports: 53 cases directly and 98 of them.
However, the AEV spokesman is still focusing on 76 cases that are still marked as "of unknown origin or under investigation."We are talking about 32.1% of cases, which even in the eyes of WHO proves that the virus can spread.
In 2025 and after the WHO assessment, this number worsened even further, from 227 to 397 cases, with 194 cases of unknown origin.This accounts for nearly half (48.9%) of confirmed cases.“This shows that the virus is spreading, so Spain has gone from being a measles-free country to being an endemic country,” explains Moraga-Lop.
Antoni Trilla adds another idea, "a small secret word in the recommendations of the committee is amazing, which says that it is important to know what kind of strain or variation is going around to know if there is an internal release or not."As an epidemiologist, it is possible that not all relevant genetic information is available, and it is decided to assume that internal transmission has sometimes been overlooked.
The fact is that in the current recovery situation, cases from abroad will continue to be a reality, and we have to face it."The problem is not always vaccinated," warned the AEV spokesperson, "it is not the fault of foreign travel or immigration: if a person travels to Morocco without vaccination, they can return with measles; if an immigrant who is not vaccinated comes with measles, they can cause an outbreak or infect others. They can."The result is the same and what they have in common is: lack of vaccination.
Measles has long been absent from our daily lives, in fact for those born after the 80s it is not even a memory.That is the reason to explain that measles is a contagious disease, along with whooping cough, one of the most widespread, and the consequences are not small."One in a thousand people die from measles," Trilla remembers, "and the vaccine also reduces that, in addition to the risk of complications such as pneumonia, gastroenteritis or other serious problems."
Because of its high transmissibility, the vaccine required to control it should be very high, 95%.The percentages required to achieve herd immunity vary with each disease, given its infectivity and vaccine effectiveness.Fortunately, measles (in many countries, for example, Spain, is part of the MMR) is not only safe, but also very effective, 93% in the first dose and 97%-100% in the second dose.This means that the number of people who receive the vaccine is a real protective shield, but without the vaccine, everyone who is affected becomes a new patient.
What do we need to do to get back on the road to elimination?The epidemiologist Antony Trilla sets several goals:
Access to the vaccine: This is something that is on the table in countries around us with the worst records, such as the UK, which has a similar health system to ours.It is necessary to bring the vaccine closer, put in a lot of effort and make it easier for those interested to update the calendar.
Epidemiological monitoring and diagnosis: Trilla warns that doctors and nurses must reconsider measles as a possibility, because, although a priori it is an easy disease to diagnose, lack of knowledge can lead to deception or delay a potentially important action.
Likewise, epidemiologists believe that with the current number of cases, we should have the capacity to set the diagnosis correctly from a virological point of view, send samples to a reference laboratory for typing.
Last but not least, we must improve the vaccination coverage."We are very good, for example, if we compare ourselves to Romania," explained Fernando Moraga-Llop, "but we are not great."The pediatrician reminds that although the area for the first dose is 97.3%, the second does not reach the 95% required (93.7%) and in any case we are talking about some national measures: self-governing societies have something more to worry about.
What is the reason for this decline?The two experts agree that the immigrant population has generally reluctantly welcomed updates to vaccination programs.“The important thing is that the children contact the health system as soon as they arrive,” explains Trilla, “and that they are well informed that the vaccines here work, that they are safe, that they have the right to get all the vaccines, and that the guidelines need to be updated, even if they have only had two of the 12 or 13 vaccines that I should have had.”
Another usual suspect is anti-vaccines, but again experts agree that, although they make a lot of noise, there are not many of them and they are explained by the decrease in coverage in our country.However, what has increased is the doubt or the fear of negative reactions, positions that are usually reflected, as Moraga-Llop explains, delays in doses or even in the request of independent vaccination against each virus, it is not possible in Spain, because rubella, for example, is part of the triple virus vaccine, which also immunizes against rubella and rubella.
Perhaps the most important thing is in small, big-minded groups, whether it's a school community or a family group that doesn't have a stable relationship."It would be good to know the release by regions, provinces or groups," says the AEV spokesperson."We need to increase preventive measures, but use preventive measures for vulnerable groups."
In addition to this, there are two other open fronts: one is the possible progression of the second dose, because contact with the health system is lost as children grow, so that the first doses achieve greater coverage.And the other is addressed to adults, estimated to be born before '78. He got over measles as a child, but since then the vaccination campaigns have started and in some cases there are doubts whether they received one or both doses, or even it is possible that they have lost a little immunity."If there are doubts, it is indicated to revaccinate or to administer another dose," explains Trilla, "which can also be a gap when there is some spread."
Can we eradicate measles?We have all the necessary elements, but the effort must be combined.Indeed, the reward is worth it.Moraga-Lope notes that the Expanded Program on Immunization (EPI), which celebrated its fiftieth anniversary in 2024, has prevented more than 150 million deaths from vaccine-preventable diseases, 93 million from measles alone.
