In August 2025, the World Health Organization granted Nepal a certification that only a few countries possess: official confirmation that rubella has been eliminated as a public health problem. Nepal is the sixth country in the WHO South-East Asia region to reach this milestone. Behind the success lie two decades of vaccination work that neither a severe earthquake nor a global pandemic interrupted.
Why Rubella Is So Dangerous
Rubella typically runs mild in healthy adults: rash, fever, swollen lymph nodes. The virus becomes dangerous when a pregnant woman is infected in the first trimester. At this stage, the rubella virus damages the developing organs of the unborn child and causes Congenital Rubella Syndrome (CRS). Affected children are born deaf, blind or with heart defects; in severe cases, the infection results in miscarriage or stillbirth. According to WHO, deafness and heart defects are among the most common consequences, intellectual impairment can occur as well.
CRS is completely preventable when enough people are vaccinated. This is what makes Nepal's milestone so significant: a CRS case is now virtually impossible there. Pregnant women in Nepal carry a risk that was very real a decade ago but today is virtually nonexistent.
How Nepal Eliminated a Disease in Two Decades
In 2012, Nepal launched its first nationwide vaccination campaign reaching children aged nine months to 15 years. Four years later, the health ministry integrated a second dose of the measles-rubella vaccine into the regular vaccination schedule. Further campaigns followed in 2020 and 2024. By 2024, vaccination coverage had reached over 95 percent according to WHO, the threshold for herd immunity.
Nepal achieved this under extraordinarily difficult conditions. The April 2015 earthquake, which killed about 9,000 people and strained the health system nationwide, did not permanently interrupt the vaccination program. The same applies to the 2023 earthquake in western Karnali region and the COVID-19 pandemic: Nepal continued its rubella campaigns even when many countries suspended such programs. Since 2018, Nepal has recorded not a single confirmed CRS case.
WHO verification on August 18-19, 2025, followed thorough review by the South-East Asia Regional Verification Committee for Measles and Rubella Elimination (SEA-RVC). The committee assessed surveillance data, laboratory findings and vaccination coverage figures from multiple years. Nepal met all conditions.
What Elimination Actually Means
For Nepal, WHO certification is not symbolic recognition but an obligation. The surveillance system must be permanently maintained: suspected cases must be reported, laboratory samples evaluated and outbreak data regularly transmitted to WHO. Moreover, Nepal will continue its vaccination programs despite the success, as the health ministry explicitly confirmed. As long as rubella circulates in other parts of the world, the risk of reintroduction remains.
For families, elimination means reliability: no child in Nepal should be born deaf or heart-damaged because the mother contracted rubella during pregnancy. In regions where rubella circulates endemically, WHO estimates the rate of congenital defects at up to four per 1,000 live births. Nepal no longer carries this risk.
In Comparison: Global Decline in Congenital Rubella Syndrome
Nepal's success stands in the context of a worldwide trend. According to the US Morbidity and Mortality Weekly Report (MMWR), annual CRS cases globally fell from approximately 101,000 (2012) to about 27,000 (2024), a decline of almost 73 percent. 179 of 194 WHO member states have now incorporated a rubella vaccine into their national vaccination programs. By 2024, 117 countries had officially verified elimination.
Smallpox vaccination serves as an overarching comparison: in 1967, an estimated 10 to 15 million people contracted smallpox worldwide; in 1980, WHO declared the disease globally eradicated. With rubella, complete eradication is not yet the stated goal, but regional elimination is achievable for several WHO regions and is actively pursued. The WHO Americas region declared rubella eliminated in 2015.
Six of Eleven: The Roadmap to Regional Goal 2026
The WHO South-East Asia region comprises eleven countries. Nepal is now the sixth to have eliminated rubella, following Bhutan, the Democratic People's Republic of Korea, the Maldives, Sri Lanka and Timor-Leste. Five countries remain to reach the declared regional goal: complete elimination of measles and rubella in all eleven countries by the end of 2026.
WHO emphasized in its press release that urgent accelerated measures are necessary, as geopolitical events and limited funding strain vaccination programs in individual countries. Nepal shows the goal is achievable despite adversity. Critical was political continuity: for two decades, through government changes, earthquakes and pandemic, the vaccination program remained a priority. This is the lesson the remaining five countries in the region most need to learn.