Malawi hosted a Measles-Rubella Vaccination After-Action Review (AAR) workshop in Salima, convening national and district health officials, the World Health Organization and other key stakeholders to reflect on the country's response to the recent measles outbreak and map a way forward.

The review was initiated after the implementation of key outbreak response activities   to the Ministry of Health officially declared Grade 2 Measles Outbreak in multiple districts. As of April 2025, more than 1000 confirmed measles-rubella cases had been reported in ten districts, with six districts namely Blantyre, Mangochi, Ntcheu, Salima, Lilongwe and Nkhotakota still battling active transmission as at the time.

The outbreak, primarily affecting districts in the central and southern regions, was driven by immunity gaps due to low vaccine coverage, logistical challenges in hard-to-reach areas, urban overcrowding, vaccine hesitancy, and cross-border transmission.

To close these gaps, WHO supported the Ministry of Health in securing funding through the Measles & Rubella Partnership (M&RP) Outbreak Response Fund, enabling a reactive vaccination campaign in June this year. The campaign targeted more than 2million children aged nine months to nine years in Lilongwe, Blantyre, Nkhotakota, Mangochi, Salima, and Ntcheu districts, identified as high-risk based on outbreak history and the 2024 national measles risk assessment.

“The past campaign reached children who had previously been missed. It was a vital step in closing immunity gaps and averting more severe outbreaks,” said Mike Chisomo, Malawi’s EPI (Expanded Programme on Immunization) Manager. “We hope that integrating lessons learnt into routine services for the upcoming campaigns will ensure that no child is left behind.”

The AAR workshop aimed to document successes and challenges from the outbreak response and develop an actionable roadmap for future emergencies. Its objectives included evaluating the effectiveness of the Measles-Rubella Supplementary Immunization Activities (SIA), analyzing gaps in surveillance, logistics, communication, and vaccine delivery and conducting a root cause analysis of the outbreak.

“This After-Action Review is a crucial opportunity to conduct outbreak root cause analysis and assess our Measles Rubella outbreak response and adequate preparedness for future emergencies for vaccine preventable diseases,” said Dr Chris Kaliisa, WHO Immunization Officer. “While great efforts were made to contain the outbreak, we must strengthen routine immunization and integrated active surveillance systems.”

For District Health Officials who attended the workshop, the process was both informative and inspiring.

“We’ve been able to share real-world experiences from our districts—what worked and where we struggled. As a district that was awarded for best coverage in the previous campaign, it’s empowering to know that our insights will shape better responses from now on,” said Innocent Mvula, District Health Officer for Blantyre. “The discussions around community engagement and reaching zero-dose children have been especially valuable.”

Globally, measles remains a disease of public health interest. It is estimated that over 300,000 measles cases were reported in 2023, a troubling 18% increase from the previous year, largely due to disruptions in routine immunization caused by the COVID-19 pandemic.

In Malawi, despite prior gains in measles control, the recent outbreak highlights the urgent need to bridge community immunity gaps, strengthen immunization systems, address vaccine hesitancy, and reinforce cross-border disease surveillance. Continued investments in public health, routine vaccination, and risk communication are key to ensuring outbreaks like this one are not repeated.