Scientists Thought They Had Measles Cornered. They Were Wrong.

The measles outbreak that led to a state of emergency in New York’s Rockland County began far away: in an annual Hasidic pilgrimage from Israel to Ukraine.

It is emblematic of a series of fierce, sometimes connected measles outbreaks — in places as diverse as Indonesia, the Philippines, Madagascar and Venezuela — that have shaken global health officials, revealing persistent shortcomings in the world’s vaccination efforts and threatening to tarnish what had been a signature public health achievement.

In 2001, the United Nations declared war on measles. With help from the federal government, the American Red Cross and big donors like Ted Turner and Bill and Melinda Gates, the U.N. began the Measles and Rubella Initiative and created Gavi, the Vaccine Alliance.

Together, they poured billions of dollars into buying vaccines and helping countries deliver it safely, which meant building refrigerated storage facilities, supplying clean needles, training vaccinators and countering other logistical obstacles common in poor countries.

Vaccination rates among the Orthodox in Israel were in the 80 percent range — better than in many other countries, but not enough to stop measles. Another contributing factor: Even if they are sick, children are often brought to Orthodox weddings or other gatherings.

At first, the virus moved slowly through Orthodox communities in Jerusalem and Tel Aviv. Then in September, Dr. O’Connor said, a major outbreak in Ukraine supercharged Israel’s modest one — and probably led, indirectly, to outbreaks in Britain and in the United States.

Several other measles outbreaks are crisscrossing the globe. They follow similar patterns but have unique triggers and pose individual public health challenges.

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