Measles: When it’s rich countries that don’t get immunized

This entry is part of some findings in the exercises for the MOOC
Data visualization for storytelling and discovery. 


In the last few years there’s been some raising numbers in the spreading of viral illnesses that are completely avoidable by vaccines. Measles is one of them and I’ve downloaded the dataset of the World Bank for the last years to analize that information by country and by groups of them. The last data is from 2015. 

Measles is a highly contagious infectious disease caused by a virus, and it can lead to complications including pneumonia and encephalitis. In 2016, there were 89,780 measles deaths globally – marking the first year measles deaths have fallen below 100,000 per year.

The World Health Organization has recommended that to achieve herd immunity, more than 95 % of the community must be vaccinated. As a result of widespread vaccination, the disease was declared eliminated from the Americas in 2016. It, however, occurred again in 2017 and 2018 in this region. 

Studies have shown that if an unvaccinated minority (around 5-10%) remains small, herd immunity can still be effective. A problem arises when the minority begins to grow.

A view to the world map

Graph: Measles world map

The world map shows the countries in a sequencial colour scale where in the vivid red shows the areas where the percentage of children immunized runs under 85 %. In the orangish medium tone we can see those countries where this ratio sits between 85-95 % which is not enough to prevent spreading of measles. Only those countries with more than 95 % of the children vaccinated are safe from measles, they are the lightest hue in the map. 

Most of the lowest numbers of countries where children are protected against measles are in Africa, with many in Oceania as well. But also a continent with traditionally good healthcare policies as Europe is not completely safe

Ukraine, Bosnia, Serbia and Macedonia are under 85 %, and countries as France, United Kingdom, Ireland, Italy, The Netherlands, Denmark, Croatia, Slovenia, Switzerland, Finland, Estonia, Latvia, Lituania, Belarus, Moldovia, Romania and Bulgaria stay behind the 95 % of vaccination. In Europe, eighteen countries — Austria, Belgium, Iceland, Luxembourg, the Netherlands, Spain and Sweden among them — reported more cases of measles during the first half of 2017 than during the same period in 2016, according to the European Centre for Disease Prevention and Control. 

Also rich countries in America, such as United States and Canada don’t get a 95 % of immunization. 

The distribution shows a median of 92, which falls apart from the recommendation of the WHO for 3 points. There’s a definite outlier with only 20 % of vaccinated children, South Sudan. It’s a new country that has suffered ethnic violence and has been in a civil war since 2013, and is acknowledged to have some of the worst health indicators in the world. 

Equatorial Guinea is the next outlier, with 27 % of vaccination, and in spite of being one of sub-Saharan Africa’s largest oil producers the wealth is distributed extremely unevenly. The country’s authoritarian government is cited as having one of the worst human rights records in the world. Less than half of the population has access to clean drinking water and that 20 % of children die before reaching the age of five.

Countries – Measles & health expenditure per capita

Graph: Measles & health expenditure per capita

If we consider the variable of health expenditure per capita in USD we can explore some interesting cases. There’s an outlier also in this case: San Marino. Health expenditure media of all countries is USD 1,005 per capita. San Marino spends 3,243 USD in public health, almost 3 times more than the media and still has very low numbers of immunized population against measles. It does not seem to be a problem of money. 

The correlation between public expenditure on health and vaccination is interesting because it shows that most of the countries above the levels of immunizations recommended by the WHO don’t necessary spend higher levels on public health. Tanzania, with the lowest amount, only 37 USD reaches a 99 % immunization, and there’s a similar correlation in other countries: Russia, Mexico, Turkey, Vietnam, Georgia, Latvia, Poland, El Salvador, Rwanda, Seychelles, Nauru, and others that stay below the mean and still make the WHO achievement of immunization. 

Cuba is perhaps the most cited example of efficiency in health public policies, and in this case can be it too: with only 817 USD got 99 % of it’s population immunized. As I said before, it’s really compelling that rich countries with higher levels of GDP and also higher health expenditure per person as Canada, the United States, Denmark or France don’t get a 95% of immunization. 

Exploring regions

Graph: Measles & health expenditure per capita per regions 

Click on the graph to open interactive scatterplot


In a scatterplot that shows groups of countries or continents there are other observations that we can remark or take as a clue for further research. The mean of the whole world in these variables is 1001,66 USD on health expenditure per capita, and a 84 % of children vaccinated. So we can see that there’s still work to do in this area, cause it’s 11 points below of what WHO recommends. 

South Asia and Sub-Sahara Africa are the less immunized groups of countries. Fragile and conflicted affected situations states, low income, and heavily indebted poor, and least developed countries as per UN cualification, are those in which we can see a strong correlation with less percentage of children vaccinated. 

No continent is completely enough immunized, though Europe and Central Asia have the closest percentages to 95 %, without reaching it. The OECD members have a 94.48 %. The countries that reach the measles vaccination goal of the WHO have only one group in common: they are all upper middle income countries.

These explorations are the first observations and are intended to bring up some clues on to keep doing research. More variables should be considered in a big study like this, as well as getting into the particular economic, demographic and social situation in each country. An interesting variable could be to try to track somehow the anti-vaccines groups in some countries or states and their influence in media or social networks. I couldn’t find this kind of data but I guess that education and information should be an interesting variable to take into account here. 

Other findings in this series:

Body mass index: not (only) a matter of income

Exploring datasets: Bikes in Madrid and education expenditure in Argentina