Why a child rights approach to measles vaccination is urgently needed

By guest contributor Ben Ramalingam

In 1982, Sri Lanka was hit by a major measles epidemic: 13k cases. The measles vaccine wasn’t yet part of the national immunisation programme; that came two years later.
 
I was seven, living in Mannar, when the disease swept through, and I caught it. I still remember how horrible it was. I couldn’t stand up. I couldn’t lie down. My whole body hurt more than I thought possible. My skin turned scaly under the rash. Nothing felt soft or nice. Daylight was too sharp for my eyes – so I spent many days in a darkened room.
 
My father was the main medical practitioner in the local area. He had grown up in the shanty settlements nearby and after being fortunate enough to study and travel to the UK, he came home to set up a clinic to support families there who wouldn’t otherwise have access to health.
 
When measles hit, he found what medicines he could and organised a basic response: information, isolation, and care for the sick.
 
For me, it meant getting two injections every day – one in each buttock, alternating sides. He gave the injections quickly – he couldn’t linger because the next child was waiting, and the next one after that.
 
My mum says that without the treatment, I would have died. She also believes measles left me changed. I developed pneumonia. My physique was affected. And after that, I became more susceptible to illness. But still, I’m here to tell the tale. In some impoverished areas, the Sri Lankan government estimates the mortality rates for children who contracted measles reached 10%.
 
Fast forward to last week. The World Health Organization confirmed that the UK no longer meets the criteria for measles elimination. Armenia, Austria, Azerbaijan, Canada, Spain, and Uzbekistan have also lost their elimination status recently. The United States is on the brink of losing its status, with the CDC recording 2,242 confirmed cases in 2025, the most since 1991.

Some recent policy responses have been worrying. A senior CDC official described the risk of losing elimination status as “the cost of doing business” and framed it as a necessary trade-off with freedoms and choices of particular communities. More alarmingly, the chair of the CDC’s Advisory Committee on Immunization Practices stated: “what we’re going to have is a real-world experience of when unvaccinated people get measles. What is the new incidence of hospitalization? What’s the incidence of death?”
 
This mentality is indicative of a worrying trend of treating measles as regrettable but unavoidable: a flare-up here or a cluster there as the unfortunate consequence of modern life and differences in values.
 
This approach fundamentally misrepresents what measles is. It is not a benign rite of passage or an acceptable trade-off. Measles can overwhelm previously healthy children, cause lifelong complications, and kill. It spreads fastest where we allow immunity gaps to widen.

And it is almost entirely preventable through vaccination. In 1982, the incidence rates in Sri Lanka reached 87 per 100000. After the vaccination programmes, this dropped to 0.5 per 100000 in 1998 – and this despite the brutal civil war that disrupted services, displaced communities, and made routine healthcare harder to deliver during those years.

This is why the argument made by Madhukar Pai and Stefan Swartling Peterson in November 2025 resonated so strongly for me: all children have a right to the highest attainable standard of health, and protection from dangerous, vaccine-preventable diseases is part of what that right means in practice. Taking that right seriously requires us to stop framing measles as an acceptable consequence of choices and trade-offs.

A child rights approach begins with the best interests of the child and the principle of non-discrimination. When measles immunity falters, the costs are not abstract. They land on infants too young to be fully protected; on children living with serious illnesses like cancer or immune suppression; and on children living in overcrowded areas, temporary shelters and other resource-poor settings where exposure is harder to avoid and care is harder to access.

Immunity gaps correspond to inequality: poverty, marginalisation, disability, geography, and distrust born of exclusion. Treating measles as “the cost of doing business” means the least advantaged children will pay the highest price. This is not a neutral trade-off; it is a rights failure.

As the 2023 UNICEF State of the World’s Children put it:

“Failure to immunize children undermines their right to what the Convention on the Rights of the Child describes as “the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health.”

Rights-based approaches mean treating avoidable child death and disability as unacceptable – and organising our laws, budgets, services, and public narratives accordingly.

Importantly, a rights-based approach begins by asking whether duty-bearers are meeting their obligations to realise children’s rights. The evidence is clear that these rights are best advanced when systems make vaccination easy and equitable: by removing practical barriers; ensuring reliable, high-quality services; communicating clearly and addressing concerns without stigma; tackling misinformation; resourcing frontline delivery; and building trust through respectful engagement.

In other words, rights are made real through access, inclusion, and accountability – so that protection is not a privilege for those who can most easily obtain it.

My father saw children suffering – including his own – and did what he could, with the tools he had at his disposal. If he were here today, I believe he would put it quite simply: measles doesn’t negotiate.

About the author:

Ben Ramalingam currently leads the UN-wide strategic review of child rights mainstreaming. He has worked on global and humanitarian health for over 20 years.

Connect with him on LinkedIn: Ben Ramalingam | LinkedIn

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.