Measles vaccination coverage has seen a 25% increase in some counties in Romania in the first quarter of 2026, following targeted interventions to reverse the downward trend in vaccine uptake in the country.
Efforts by health authorities and WHO, with funding from the European Union (EU), aimed to identify and address the reasons behind the decline in measles, mumps and rubella (MMR) vaccine coverage, with multiple communication initiatives targeting both health-care providers and the public, and intensified community outreach.
“This joint effort, bringing together the National Institute of Public Health [INSP], county public health directorates [DSPs], WHO and partners, shows that when we actively do something – strengthening primary health care and supporting local promotion activities – it is possible to reverse this trend by enabling health workers to communicate clearly and confidently about vaccination and reaffirm their role as trusted sources of information on vaccination,” noted Dr Simona Pârvu, Director of the INSP.
Identifying barriers to vaccination
National immunization coverage declined in Romania from 2018 to 2024, from 90% to 78% for the first dose of MMR vaccine, and 81% to 62% for the second dose. WHO recommends at least 95% immunization coverage against measles every year to achieve herd immunity and prevent outbreaks. As a result of this suboptimal coverage, Romania reported over 25 000 measles cases in 2024 – the highest number reported in the country since 1993.
In 2025, WHO, INSP and the Ministry of Health, with financial support from the EU, conducted qualitative research on immunization inequities affecting vulnerable populations in Brașov, Covasna and Timiș counties. Brașov and Timiș were selected due to low MMR vaccine coverage (< 50%). Covasna (> 90% MMR vaccine coverage) served as a comparison to better understand enabling factors.
The study found multiple examples of good practice, such as outreach activities by community health mediators in Covasna County. However, it also found that caregivers, particularly those with partially vaccinated children, often lacked reliable information on childhood vaccination but were interested in receiving it. Meanwhile, family doctors were sometimes reluctant to raise the topic of vaccination because they felt they lacked updated technical knowledge and the skills to respond appropriately to concerns.
Based on the study findings, the Foundation Centre of Health Policies and Services, in close collaboration with INSP, launched a pilot accredited training programme in November 2025 in Brașov, Covasna and Timiș counties, covering technical aspects of MMR vaccination and empathetic communication approaches. The programme has been accredited by the College of Physicians, the Order of Nurses, Midwives and Medical Assistants, and the respective DSPs. To date, over 400 primary health-care providers (family doctors, nurses, community health workers, health mediators) have participated in the trainings from the 3 counties included in the study.
Positive impact
INSP’s preliminary monitoring in the first quarter of 2026 shows an average increase of around 20 percentage points in vaccination with the first dose of MMR vaccine in children aged 12–24 months compared to August 2025 in the 3 targeted counties. This rises to a 25 percentage-point increase in Timiș county – where the local DSP placed particular emphasis on promoting childhood vaccination and where the trainings on how to communicate about vaccination were especially well attended.
Next steps
Based on positive feedback and an assessment of the impact of the training, a scale-up beyond Brașov, Covasna and Timiș is planned for July–November 2026, focusing on other counties with low MMR vaccine coverage. In future trainings, pharmacists will also be invited to participate, in addition to primary health-care providers.