As we enter the third decade of the 21st century, measles, a deadly disease, is back because of foolhardy beliefs regarding the requirement for vaccination. Over the last 10 years, outbreaks of vaccine-preventable diseases have been reported in developed countries around the world. In particular, measles outbreaks have been ongoing in the EU since 2017, with the majority of cases concentrated in Romania and Italy. Measles has been identified as a powerful indicator of the status of vaccination programs in a region, as outbreaks have been reported to quickly emerge as a result of underlying issues in immunization routines because of local belief systems due to poor educational reach. It is important to consider the psychological, cultural, social and political causes of vaccine hesitancy and refusal reasons among some populations in rejecting or avoiding treatment programs. Measles, also known as rubeola, is one of the most contagious infectious diseases, with at least a 90 percent secondary infection rate in susceptible domestic contacts. Despite being considered primarily a childhood illness, measles can affect people of all ages. The viral illness infected nearly 10 million people in 2018 and killed 140,000, mostly children, as devastating outbreaks hit every region of the world even though a safe and cost-effective vaccine was available. Today, there are an estimated 21 million unvaccinated infants globally, half of whom are in five countries: Ethiopia, India, Indonesia, Nigeria and Pakistan. Although measles vaccination resulted in a 73 percent drop in measles deaths between 2000 and 2018 worldwide, in 2018, about 86 percent of the world’s children received one dose of measles vaccine by their first birthday through routine health services — up from 72 percent in 2000. Between 2000 and 2018, measles vaccination prevented an estimated 23.2 million deaths, making the vaccine a success in public health goals. So, progress against measles has been made over the past decade but now we are entering a period of time where anti-vaccination sentiment, influenced by quack scientific design, could affect that progress. But there is a catch that makes measles a health security issue: According to public health specialists, with each cohort of children born to parents who distrust or fear vaccines, the number of people susceptible to the measles virus expands. Simultaneously, there is a growing population of adults who were children in the early days of measles vaccination whose immunity may have worn off. Where these age groups merge is where the transmission spread of the disease becomes confluent. The phenomena of avoiding vaccination in Western countries is of negative consequence and the implications for public health issues is one of frustration and dismay. To be sure, measles cases are on the rise globally, including in wealthy nations such as the US and Germany, as some parents shun life-saving vaccines due to extraordinary false theories suggesting links between childhood immunizations and autism, plus other maladies. The false literature countering such interpretations regarding vaccine against measles is replete with errors in judgment and scientific, fact-driven metrics. That means fake findings, and thus a phenomenon that is being manipulated by well-placed dissemination of the worst form of information warfare: Ignorance. Consequently, there are infections occurring at increasing rates that are causing cases to pop up and affect wide communities where public health becomes a security issue and ultimately affects society and economy. In April 2019, New York City Mayor Bill de Blasio declared a state of emergency because of an ongoing measles outbreak. The mandatory immunization extended to anyone who lived, worked or went to school within zip codes assigned to a specific neighborhood in Brooklyn. This example of action by city officials was an important marker of response to an urban disease contagion. The island nation of Samoa recently experienced a measles disaster that stood out as an example of the illness running amok in a country where vaccination rates were not high enough. The state was ravaged by the disease that killed 81 people, mostly babies and young children, and affected more than 5,600 others. The Samoan outbreak came from New Zealand, a hub for travel to and from the South Pacific islands, the disease finding a highly susceptible population in Samoa which had far lower vaccination rates than its other island neighbors. A robust action program saw school closures and travel restrictions among measures to control the outbreak. If there had ever been a test sample of how a geographical area could be infected with a contagion, this was it. There is no doubt that without sustained attention, hard fought gains can easily be lost in the struggle to wipe out measles. Where children are unvaccinated, outbreaks occur. Because of low coverage nationally or in pockets, multiple regions were hit with large measles outbreaks in 2018, causing many deaths. The conclusion by the World Health Organization’s strategic advisory group of experts on immunization that measles elimination was greatly under threat because of disease resurgence in a number of countries that achieved disease elimination, illustrated the return of the disease as a vector threat. Given the continuous nature of the disease, modes of transport such as planes can become primary transition belts along with confined spaces including offices and commercial locations. Quickly identifying ill passengers or asking non-invasive questions based on their travel is an important part of mapping disease spread. Overall, measles and its spread can be controlled on a global level and world health specialists are not the only practitioners focusing their efforts on raising public awareness and delivering vaccines to communities. The security implications of whole communities becoming infected is one to be taken more seriously, as demonstrated in cases around the globe. Samoa’s six-week state of emergency was a case in point for better understanding responses to future outbreaks. Dr. Theodore Karasik is a senior adviser to Gulf State Analytics in Washington, D.C. He is a former RAND Corporation senior political scientist who lived in the UAE for 10 years, focusing on security issues. Twitter: @tkarasik Disclaimer: Views expressed by writers in this section are their own and do not necessarily reflect Arab News" point-of-view