Lessons from Measles Elimination in the Republic of Korea: Public Health Implications

To determine key policy implications, this study aims to examine the comprehensive national strategy implemented for measles elimination in 2001, the subsequent development of a public health system to sustain elimination, and its international verification.

The author conducted a review of government-issued measles outbreak control guidelines from 2000 to 2001, domestic and international academic literature and theses, and materials from the World Health Organization (WHO) immunization-related meetings, including firsthand observations from participation in these meetings.

Following the Republic of Korea (ROK)'s introduction of a monovalent measles vaccine in 1965, the measles-mumps-rubella vaccine was incorporated into the National Immunization Program in 1983. In 1997, a second dose was added for children aged 4-6 years due to recurrent outbreaks; however, a large nationwide outbreak occurred in 2000-2001. Incidence was highest among infants aged 0-1 years and school-aged children, and was associated with by low second-dose coverage. Furthermore, serological surveys indicated that 13.5-15.5% of elementary school students were seronegative for measles antibodies, and viruses consistent with the H1 genotype were detected. In response to these findings, the government launched a 5-Year National Measles Elimination Plan, including school-based mass vaccination campaigns and pre-entry vaccination verification. This resulted in approximately 5.8 million children receiving two doses of measles-containing vaccine and strengthening surveillance. Consequently, measles was declared eliminated in 2006. In 2014, the ROK introduced fully subsidized National Immunization Program services, and the WHO Western Pacific Regional Verification Commission verified that the ROK had effectively eliminated measles. Since then, this elimination status has been maintained.

The 2000-2001 measles epidemic in the ROK triggered a policy transformation that went beyond immediate outbreak control, fundamentally strengthening the public health system and positioning the country for greater engagement in global health collaboration.