Romania's Measles Outbreak: Factors, Consequences, and International Comparisons
The United States is currently experiencing its most significant measles outbreak in three decades. Romania, an upper-middle-income country within the European Union, serves as a case study for measles resurgence challenges, having ranked fifth globally in measles cases last year.
Outbreak Data in Romania
In the preceding year, Romania reported 30,692 measles cases and 23 associated deaths. Of these deaths, five involved children under the age of one. Measles cases have continued into 2025, although initial figures are lower, consistent with typical disease wave patterns.
Historical Context and Political Transition
Under Romania's authoritarian Communist government, childhood vaccinations, including the measles vaccine introduced in 1979, were mandatory. This policy resulted in a greater than 95% immunization rate and a 90% reduction in cases.
Following the democratic transition in 1989, mandatory vaccination policies were discontinued. This shift coincided with a decline in public trust in government institutions, which facilitated the emergence of anti-vaccine sentiments. Some citizens viewed vaccine refusal as an assertion of personal freedom after decades of state control.
Factors Influencing Declining Vaccination Rates
Public confidence in vaccine benefits subsequently decreased. A report by Romania's National Institute for Public Health indicated that parental refusal contributed to this decline.
The 2008 campaign to vaccinate girls against HPV further increased general vaccine skepticism. At the time of the HPV vaccine rollout, measles vaccine coverage was approximately 95%. This rate steadily decreased to 62% by 2023. A 2023 study found that only one of Romania's more than 40 regions maintained measles vaccine coverage above 95%.
The COVID-19 pandemic also exacerbated the reduction in vaccine coverage due to disruptions in routine immunization services. Persistent outbreaks in the 2010s did not uniformly lead to increased vaccine uptake.
Systemic Challenges in Healthcare
Romania's healthcare system is among the least funded in Europe. This, combined with a decreasing number of primary care providers due to burnout and low compensation, and the absence of mandatory immunization policies, contributes to low vaccination rates.
Inadequate outreach and access to care disproportionately affect minority groups, such as the Roma population, rather than intrinsic refusal within these communities.
Concurrently, religious leaders and certain far-right politicians, including European Parliament member Diana Sosoaca, have publicly expressed anti-vaccine views, which has influenced public opinion.
Consequences of Low Coverage
Currently, approximately two-thirds of Romanians are fully vaccinated against measles, representing the lowest rate within the European Union. A single individual with measles can infect up to 18 unvaccinated people. Children too young to complete the two-dose vaccination protocol (administered at 12 months and age 5) are particularly vulnerable.
Measles can lead to severe complications, including pneumonia, eye inflammation, diarrhea, and ear infections, with 5-10% of ear infection cases resulting in deafness. A rare, fatal complication known as subacute sclerosing panencephalitis can manifest 7-10 years post-infection, with approximately a dozen cases reported in Romania in recent years.
Public Health Responses
Public health professionals in Romania, such as pediatricians and family physicians, have adopted evidence-based communication strategies, including motivational interviewing, to address vaccine hesitancy. This technique involves empathetic listening and exploring patient concerns before providing information.
International Comparisons and Implications
Despite Romania's experience, global measles counts indicate that other relatively affluent countries are facing similar challenges. In 2025, Canada lost its measles elimination status, recording 5,000 cases, and the U.S. confirmed 1,723 cases, marking its highest annual number in over three decades. These occurrences illustrate a pattern: a significant decline in measles vaccination coverage typically leads to a resurgence of the disease.