Kampala, Uganda - In 2025, Uganda confirmed 66 separate measles outbreaks across the country, with a cluster of deaths in an underserved region. The outbreaks hit hardest among young children who had never received a single dose of the vaccine.
For health authorities, that gap between effort and outcome deserved a hard look. The recurring outbreaks signaled that the challenge was driven not by parental hesitation, but by systemic gaps in reaching every child.
As Uganda prepares for its nationwide Measles-Rubella Follow-up Campaign in October 2026, the Ministry of Health, the World Health Organization (WHO), and partners have spent the past year reviewing performance, investigating outbreaks, and listening to caregivers to rebuild the response around what evidence shows.
The burden of recurring outbreaks
Uganda has conducted measles vaccination campaigns since 2003, with the latest nationwide campaign in 2022. However, routine immunization coverage for the two doses of MR has remained below the 95% threshold needed to achieve herd immunity.
In 2025, only 43% of districts reached the target for the first measles-rubella dose, and just 21 of 146 districts achieved the target for the second dose. Among confirmed measles cases during the 2025 outbreaks, 64% had never received a single vaccine dose, and none of the cases investigated had received both recommended doses.
"The recurring outbreaks remind us that too many children are still missing life-saving measles vaccines,” says Dr Annet Kisakye, Immunization Officer at WHO Uganda. “Strengthening routine immunization and ensuring that every eligible child receives both doses remains our best defense against future outbreaks.”
The consequences were particularly severe among young children. In Karamoja, a review of measles deaths in Moroto and Napak districts found that 92% of children who died had never received a measles vaccine. Many suffered severe complications, including death, pneumonia, diarrhoea, dehydration and malnutrition.
Action built on evidence
To better understand the causes of low coverage, WHO Uganda, the Ministry of Health, UNICEF and research partners conducted behavioral surveys among nearly 1,900 caregivers in rural, urban, island, refugee-hosting and pastoralist communities.
The survey revealed strong demand for childhood vaccination across the communities studied. Nearly 93% of rural caregivers reported intending to fully vaccinate their children, while 99% knew where vaccination services were available. Support for vaccination was also widespread, with 96% of caregivers reporting encouragement from family members, friends and community leaders. Together, these findings suggest that coverage gaps are driven less by vaccine acceptance and more by barriers that prevent willing families from accessing services.
What is different this time?
The October 2026 campaign is designed to address the specific gaps identified during the review of prior nationwide immunization campaigns.
District readiness assessments have been conducted eight weeks before implementation, with several field-based consultants engaged to support district readiness, allowing time to correct problems before vaccination begins. Microplanning started eight months ahead of the campaign and uses both national census data and district household counts to improve target population estimates. New readiness dashboards allow stakeholders to monitor preparedness in real time.
Communities with persistent resistance are receiving tailored engagement, with district teams working alongside community leaders and local influencers to address specific concerns. National supervisors were also identified and deployed earlier than in previous campaigns to provide ongoing support and oversight. All stakeholders, including non-health stakeholders and partners, are fully engaged and committed to ensuring that no child is missed during the campaign. Above all, logistics planning has improved significantly, with materials delivered well ahead of the campaign.
Closing the gap together
Dr Fred Nsubuga from Uganda’s Ministry of Health says the campaign remains essential because immunity gaps persist among children aged 9 to 59 months.
“Studies have shown no problems with the additional doses, and the extra protection they provide is beneficial,” says Dr Nsubuga. “Through this campaign, we are committed to reaching every eligible child, irrespective of previous MR dose and ensuring that no child is left unprotected against measles and rubella.”
The campaign is being led by Uganda’s Ministry of Health with support from Gavi and a broad coalition of partners, including WHO, UNICEF, CDC/Atlanta, IFRC, PATH, Baylor Uganda, Task Force for Global Health, AFENET, the Infectious Diseases Institute and others.
For families, the message is simple: the October campaign is an opportunity to ensure that eligible children receive the protection they need.
Ugandan caregivers have repeatedly demonstrated that they want their children vaccinated. The challenge now is ensuring that health services are equally ready to meet that demand.
Success will be measured not only by the number of doses delivered, but by whether every eligible child is reached and no community is left behind. The countdown to 1 October 2026 has begun. Together, we can make this a reality.
