‘It’s a powder keg’: Romania leads EU measles cases as vaccination rates collapse

By 10am on a spring day, the corridor of the clinic in the Transylvanian town of Săcele was already crowded with parents and children. They were all waiting to see Dr Mirela Csabai, one of just seven general practitioners serving a population of more than 30,000.Most of the cases that morning were routine: colds, checkups, chronic conditions. The calm, however, is recent. In 2024, a measles epidemic tore through this community and left one unvaccinated toddler dead.“As long as vaccination rates remain low, it’s a powder keg,” says Csabai. “Once an epidemic starts, it is already too late to vaccinate. We need to act now.”Romania is facing the worst measles crisis in the EU. The country has had four epidemics of the illness since 2005, each separated by only a few years of fragile calm.Dr Mirela Csabai: ‘Once an epidemic starts, it is already too late to vaccinate.’ Photograph: Guy Peterson/The GuardianBetween 2023 and 2025, it recorded more than 35,000 cases and at least 30 deaths, most of them infants too young to be vaccinated, infected by older, unvaccinated children. About 87% of all measles cases in the EU were reported in Romania in 2024; the next most affected country, Italy, recorded just over 1,000. Measles can cause serious complications, especially in children and infants, who can develop pneumonia and in some cases encephalitis.The crisis has a single, measurable root: a collapse in vaccination. The first dose for the MMR vaccine is recommended at between 14 and 18 months, and while coverage rises to 81% by the later age (from just 47.4% at 14 months), it still falls well short of the 95% threshold needed for herd immunity.Uptake of the second dose at five is just over 60% nationally and as low as 20% in some communities, according to the National Institute of Public Health. Romania’s MMR rate stood above the European average of 93% in 2010 but has been falling ever since, a decline that accelerated after the COVID-19 pandemic.“It’s absolutely insufficient for measles,” says Dr Aurora Stanescu, an epidemiologist at the institute. “A firm political commitment to limit the number of deaths is necessary. This is a national security issue.”Casandra Stoica: ‘I got scared when the girls fell ill and now I want to vaccinate them all.’ Photograph: Guy Peterson/The GuardianCasandra Stoica, 25, entered Csabai’s consultation room with three of her children. Two of her older daughters, now aged five and eight, contracted measles during the 2024 outbreak, when Brașov county became the hardest hit in Romania, recording the highest number of cases and four child deaths.There was no space at the local hospital at the time so Stoica had to travel to a neighbouring county to find care. “I got scared when the girls fell ill and now I want to vaccinate them all,” she says.But even when parents are convinced, access remains a barrier. Stoica is part of Romania’s Roma community and lives with her husband and four children in two rooms with no access to running water or electricity. These precarious conditions make it difficult for her to attend appointments or keep up with vaccination schedules.“The decision not to vaccinate doesn’t always come from the parents,” says Gabriela Alexandrescu, a country director for Save the Children. The organisation sounded the alarm in early March, saying Romania was facing “its worst vaccination crisis in decades”.The causes, Alexandrescu says, are also structural: poverty, medical deserts and GPs without the time or resources to counsel hesitant families.Vaccination is not mandatory in Romania. In 2015, responsibility for administering vaccines was shifted exclusively to GPs, increasing bureaucracy and piling pressure on to an already stretched system.At the same time, school nurses – who had provided a crucial safety net for children who missed their scheduled jabs – were not allowed to administer vaccines any more.Dr Simona Codreanu: ‘The majority of children get vaccinated at birth, but then they never return for the full schedule.’ Photograph: Guy Peterson/The GuardianAt the Săcele clinic, Dr Simona Codreanu tends to more than 3,000 patients and sees more than 50 a day. “The majority of children get vaccinated at birth, but then they never return for the full schedule,” she says, flipping through charts in which children over five have barely a couple of vaccines recorded. One of her patients died during the last epidemic after contracting measles from an unvaccinated sibling.Dr Mihai Negrea, an epidemiologist from Târgu Mureș, another county seriously hit in 2024, says structural bottlenecks and an over-reliance on GPs are slowing vaccination efforts.Under current rules, only general practitioners are reimbursed by the state for administering vaccines. Other doctors must complete additional certification and often pay out of pocket for supplies.“The main cause is not just anti-vaccine views but bad management of the system,” he says. “By the time you manage to get your child vaccinated, it can take a month with all the paperwork – and parents can change their minds.”When vaccination becomes difficult to access, delayed or bogged down in red tape, rates inevitably drop, he explains, even when parents want to protect their children.Negrea’s prescription is practical: community vaccination centres and expanding the right to vaccinate to other doctors, rather than a system in which a single family doctor is expected to cover vaccination needs for thousands of families.Yet if the system is broken, it is also true that fear has found fertile ground within it. Across Romania, closed online groups have become spaces where anxieties are shared and amplified by mothers who are for or against the MMR vaccine.The Guardian spoke to half a dozen mothers who had decided to stop the vaccination schedule or not vaccinate their children at all against measles.Laura, 36, decided not to give her child the second MMR dose after the first jab, driven by fears about a link to autism – a claim that has been comprehensively debunked and for which there is no scientific evidence.“I’m not anti-vaccines, but I have fears around the MMR vaccine and most of all I’m put off by doctors not explaining things and not taking responsibility for side-effects,” she says.Some parents find their way back. Nicoleta Dima did not immunise her child with the MMR vaccine until the age of six, held back by fears of allergic reactions that she now recognises were unfounded.“My fear was largely fuelled from the outside,” she says. “I realised just how manipulated we are, and that I had effectively trapped myself in an unfounded fear. I realised that every unvaccinated child contributes to these epidemics.”In Bucharest, at the Matei Balș National Institute, the country’s leading infectious disease hospital, wards that were full during last year’s outbreak are now quiet. During the 2024 epidemic, the most severe cases in the country came to this hospital. There were five deaths from measles complications in Bucharest during the epidemic.Dr Gabriel Lăzăroiu-Nistor: ‘There’s a small minority who are firmly anti-vaccine but the rest are undecided.’ Photograph: Guy Peterson/The GuardianDr Gabriel Lăzăroiu-Nistor, an infectious disease doctor at the hospital, says the respite will not last. With vaccination rates so low, he expects another serious outbreak soon. “We must not forget our empathy and patience to explain to patients,” he says. “There’s a small minority who are firmly anti-vaccine, but the rest are undecided.”That distinction – between the committed refusers and the uncertain, anxious middle – is the one that most animates the doctors working on the frontline.Back in Săcele, Csabai saw Maria Olescu, 31, who vaccinated her first two children on schedule until the normal side-effects frightened her into stopping before the second dose. She has refused further vaccines since then, also partly because of influence from her religious community.“We don’t cut ties with parents who choose not to vaccinate their children, because that means we lose them for ever,” says Csabai. She tries to earn their trust by treating their other health issues and hopes they will vaccinate in time before the next epidemic comes through.“It is sad and regrettable that we still have children dying of measles,” Csabai says. “It hurts to see children suffer from preventable diseases. I think it’s our fault as doctors first: we have to earn their trust and we have to break the cycle.”