🟠 Moderate Evidence
Armed conflict systematically dismantles the infrastructure required to prevent measles outbreaks, according to a perspective published in PLOS Medicine by José E. Hagan. War weakens three critical pillars of measles control: routine immunization programmes, disease surveillance systems, and the socioeconomic stability that underpins public health resilience. The consequence is predictable: measles re-emerges during conflict and persists in the years that follow, creating cycles of preventable infection that claim lives among the most vulnerable populations.
Key takeaways
- Armed conflict disrupts immunization programmes, surveillance systems, and health infrastructure — three pillars essential to measles control
- Measles risk increases both during active conflict and in the post-war period, affecting displaced populations and fragile healthcare systems
- Protecting routine vaccination during humanitarian crises should be designated a core emergency response priority, not a secondary intervention
- Socioeconomic instability caused by war erodes the conditions necessary for sustained immunisation coverage
The Three-Pillar Framework of Measles Control Disrupted by Armed Conflict
How conflict weakens each essential component of measles prevention and control
Source: Hagan, PLOS Medicine Perspective | Georgian Medical Journal News
How Conflict Breaks the Chain of Measles Prevention
Measles prevention depends on three interconnected systems, each vulnerable to collapse during armed conflict. According to Hagan’s analysis in PLOS Medicine, routine immunization programmes are among the first casualties of war. Healthcare workers flee conflict zones, clinics are damaged or repurposed, cold chains for vaccine storage are interrupted, and populations become displaced, making routine vaccination appointments impossible to keep.
Simultaneously, surveillance systems that detect measles cases deteriorate. Without functioning disease reporting networks, outbreaks go unrecognized until they spread widely. This blind spot transforms a preventable cluster of cases into a full-scale epidemic.
The third pillar—socioeconomic stability—crumbles as conflict destroys livelihoods, displaces families, and diverts resources away from health services. Hagan argues that these three disruptions are not independent; they reinforce each other, creating a cascade of vulnerability that measles exploits ruthlessly.
Measles Outbreaks Persist Beyond the End of Fighting
One of the most concerning findings from Hagan’s perspective is that measles risk does not simply vanish when conflict ends. Post-war environments remain dangerous for measles transmission for years afterward. Vaccination coverage remains depressed in former conflict zones, populations are still displaced or living in crowded conditions, and health infrastructure takes years to rebuild to pre-war capacity.
This pattern has been documented across multiple conflicts globally. Countries transitioning from conflict to peace often face measles surges as the population immunity gap widens and surveillance systems remain incomplete. The virus finds these gaps and moves through them efficiently, particularly among children born during years when vaccination was impossible.
Armed conflict weakens immunization, surveillance, and socioeconomic resilience, increasing measles risk during and after war. Protecting routine vaccination in crises should be designated a core emergency response priority.
— José E. Hagan, PLOS Medicine Perspective
Reframing Vaccination as Emergency Response, Not Optional Service
Hagan’s core argument is a strategic reframing of vaccination priorities in humanitarian emergencies. Routine immunization is often deprioritized during conflicts in favour of acute medical care and emergency relief. However, Hagan contends that this calculus is short-sighted. Protecting vaccination programmes during crises prevents larger, costlier disease outbreaks in both the short and medium term.
This approach aligns with WHO guidance on measles elimination, which emphasizes that sustained vaccination coverage above 95% is necessary to prevent outbreaks. Once conflict drops coverage below this threshold, re-establishing it requires years of intensive catch-up campaigns. Prevention during crisis is far more efficient than remediation after crisis.
Policy frameworks for humanitarian response must therefore include explicit mandates to maintain immunization services alongside food security and emergency medical care. This does not require vast additional resources—it requires prioritization and planning.
What this means
Frequently asked questions
Why does measles resurge after conflict ends, not just during it?
According to Hagan’s perspective, populations born or living through conflict years have missed routine vaccinations, creating a large cohort of susceptible individuals. Even after fighting stops, health infrastructure remains degraded, surveillance incomplete, and socioeconomic conditions unstable. This environment sustains measles transmission for years.
What vaccination coverage is needed to prevent measles outbreaks?
WHO recommends 95% vaccination coverage to prevent sustained measles transmission. In conflict zones, coverage typically drops far below this threshold, necessitating intensive catch-up vaccination campaigns once stability returns—a far costlier intervention than preventing coverage loss in the first place.
How can vaccination programmes function during active conflict?
Hagan argues that vaccination is feasible even in insecure environments if explicitly protected as a priority. This requires pre-conflict planning, mobile vaccination teams in safer areas, cold chain maintenance, and explicit agreements with armed parties to allow health worker access. These steps prevent the infrastructure collapse that makes post-conflict recovery so difficult.
The evidence from conflict zones worldwide tells a consistent story: measles prevention cannot be a luxury service suspended during crises. Instead, maintaining routine immunization during humanitarian emergencies is a cost-effective investment in future disease prevention and a core pillar of emergency response strategy. As global conflict displacement increases, integrating vaccination protection into humanitarian frameworks becomes an urgent public health imperative.
Source: The well-worn path from armed conflict to measles resurgence, PLOS Medicine Perspective by José E. Hagan
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