NEPAL ELIMINATES RUBELLA

Nepal Achieves Rubella Elimination: WHO Verification Confirms a Decade of Immunisation Progress

On August 18, 2025, the World Health Organization officially announced that Nepal had eliminated rubella as a public health problem, making it the sixth country in the WHO South-East Asia Region to achieve this milestone. The Regional Verification Commission for Measles and Rubella Elimination verified Nepal's status following its annual meeting held in late July 2025, reviewing surveillance data, immunisation coverage rates, and laboratory performance submitted by Nepal's National Verification Committee.

Rubella, commonly known as German measles, is caused by a highly contagious virus that produces a mild rash illness in most individuals but carries severe consequences for pregnant women. Infection during early pregnancy can cause miscarriage, stillbirth, or a range of lifelong birth defects in newborns, collectively known as Congenital Rubella Syndrome (CRS). Globally, approximately 100,000 infants are born with CRS each year, most in countries that lack robust vaccination programmes. In 2022, rubella was reported in 78 countries, with 17,865 cases recorded. In 2009, a study at Nepal's main maternity hospital found that nearly one in five pregnant women attending for antenatal care was infected with rubella.

Nepal's journey to elimination began in 2012 when the National Immunization Program launched a nationwide rubella vaccination campaign targeting children aged nine months to 15 years. A second dose of the rubella-containing vaccine was added to the routine immunisation schedule in 2016. Four national follow-up campaigns in 2012, 2016, 2020, and 2024 helped sustain and expand coverage, even through major disruptions including the 2015 and 2023 earthquakes and the COVID-19 pandemic. Nepal's door-to-door outreach in 2020 ensured that more than 14,800 children aged nine months to five years were caught up on missed measles-rubella vaccines. By 2024, Nepal had achieved over 95 percent coverage for at least one dose of the rubella vaccine.

Surveillance was a critical parallel investment. Laboratory-based rubella surveillance began in 2004. Case-based measles and rubella surveillance was introduced in 2007. In 2025, Nepal introduced a new WHO-endorsed molecular genotyping testing algorithm, becoming the first country in the WHO South-East Asia Region to implement this advanced case-confirmation method. By 2025, the non-measles non-rubella rate had reached 10.89 per 100,000 population, Nepal's highest recorded performance, exceeding global WHO benchmarks.

The institutional architecture supporting this effort was equally important. Nepal's National Immunization Act of 2016 provided a legal framework for vaccine access and delivery. Immunisation committees were established at all administrative levels. Female Community Health Volunteers, working in some of the country's most remote and difficult terrain, played an indispensable role in building community trust, with some health workers walking two to three days to reach mountainous communities.

Nepal is now one of 12 countries in the WHO South-East Asia Region that has achieved rubella elimination. The region has set a target of eliminating both measles and rubella by 2026, and Nepal's health officials have already indicated they will request independent verification for measles elimination in 2026 if no new outbreaks occur. Critically, elimination is not eradication. The rubella virus can return if immunisation programmes are interrupted, and Nepal's government has confirmed that vaccination will continue as part of the routine immunisation schedule.

For the clinical trials and global health research community, Nepal's success adds to a body of evidence showing how low-income countries with significant geographic challenges can achieve vaccine-preventable disease elimination through systematic, community-based, long-term investment.

Sources: WHO South-East Asia Press Release August 18, 2025 | WHO Nepal October 11, 2025 | UN News August 18, 2025 | GAVI VaccinesWork | Kathmandu Post August 20, 2025 | WHO Regional Verification Commission July 2025 Meeting‍