Due to the blockages in the system and the distrust of parents, Romanian doctors expect a new serious epidemic soon.
At 10:00 a.m. on a spring morning, the corridor of the polyclinic in the Transylvanian town of Săcele was already full of parents and children. They were all waiting to be consulted by family doctor Mirela Csabai, one of only seven doctors serving a population of over 30,000 people.
Most of the cases that morning were routine: colds, routine check-ups, chronic conditions. But the peace is recent. In 2024, a measles outbreak hit the community and resulted in the death of a young, unvaccinated child.
“As long as vaccination rates remain low, it’s a powder keg”says the doctor. “When an epidemic starts, it’s already too late to vaccinate. We need to act now.”
Romania is facing the worst measles crisis in the European Union. Since 2005, the country has gone through four epidemics, separated by short periods of apparent calm, according to a report by the British publication The Guardian.
Between 2023 and 2025, more than 35,000 cases and at least 30 deaths were recorded, mostly in infants too young to be vaccinated, infected by older, unvaccinated children. About 87% of all measles cases in the EU were reported in Romania in 2024; the next affected country, Italy, reported just over 1,000. The disease can cause serious complications, especially in children, including pneumonia or, in rare cases, encephalitis.
The cause of the crisis is clear and measurable: declining vaccination coverage
The first dose of MMR vaccine is recommended between 14 and 18 months of age, but even at older ages coverage is only 81%, well below the 95% threshold required for herd immunity.
The second dose, given at age five, is taken by just over 60 percent of children nationally, and in some communities the rate drops to 20 percent, according to the National Institute of Public Health. In 2010, Romania exceeded the European average of 93%, but since then the trend has been downward, accentuated after the Covid-19 pandemic.
“It is completely insufficient for measles“, explains epidemiologist Aurora Stănescu. “It takes a strong political commitment to reduce deaths. We’re talking about a national security issue.”
Casandra Stoica, 25 years old, entered the doctor’s office with three of her children. Two of her daughters, now five and eight years old, contracted measles during the 2024 epidemic, when Brasov County was the most affected in the country.
At that time there were no more places in the local hospital, so the woman had to seek treatment in a neighboring county. “I was scared when they got sick and now I want to vaccinate them all”she says.
Even when parents are convinced, access remains a problem. Stoica is part of the Roma community and lives with her family in precarious conditions, without running water or electricity. In these conditions, keeping appointments becomes difficult.
Measles and other fatal diseases return to Romania. Vaccination, at the lowest level in recent decades
“The decision not to vaccinate does not always belong to the parents”, explains Gabriela Alexandrescu, representative of the Save the Children organization, who recently warned that Romania is going through “the worst vaccination crisis in recent decades”.
The causes are also of a structural nature: poverty, lack of doctors in certain areas
The causes are also of a structural nature: poverty, the lack of doctors in certain areas and the overloading of the existing ones.
Vaccination is not mandatory in Romania. Since 2015, responsibility for administering vaccines has been transferred solely to GPs, which has increased bureaucracy and pressure on the system.
At the same time, school nurses, who were an important support for children who had missed vaccinations, are no longer allowed to administer vaccines.
In Săcele, doctor Simona Codreanu has over 3,000 patients and consults more than 50 daily. “Most children are vaccinated at birth but then don’t come back for the full schedule”she says, flipping through incomplete sheets. One of his patients died in the last epidemic, infected by an unvaccinated brother.
Epidemiologist Mihai Negrea claims that systemic blockages and excessive dependence on family doctors slow down vaccination campaigns.
“It’s not just vaccine reluctance that’s the problem, it’s the mismanagement of the system”he states. “It can take a month to vaccinate your child because of red tape – parents can change their mind in that time.”
When access becomes difficult or delayed, vaccination rates inevitably decline, even among those who want to protect their children.
Proposed solutions
The proposed solutions are pragmatic: community vaccination centers and extending the right to vaccinate to other doctors.
Against this background, fears find fertile ground. Online groups have become spaces where concerns are amplified and opinions for and against vaccination circulate heavily.
Some mothers choose to discontinue the vaccination schedule. Laura, 36, gave up her second dose because of autism fears – a hypothesis refuted by the scientific community.
“I’m not against vaccines, but I’m scared and feel like doctors don’t explain enough“, she says.
Other parents are reconsidering the decision. Nicoleta Dima only vaccinated her child when she was six years old, after realizing that her fears had no real foundation. “I realized how easily we can be influenced,” she says.
At the “Matei Balș” Institute in Bucharest, the wards that were full during the epidemic are now quiet. However, doctors warn that this break will not last.
“With current vaccination rates, we expect a new epidemic”says doctor Gabriel Lăzăroiu-Nistor. “Most parents are not radical, just indecisive. That’s where you have to intervene.”
In Săcele, doctor Csabai continues to talk with the reluctant parents, without breaking contact with them. “If we lose them, we lose them for good,” she says.
“It is painful to see children suffering from preventable diseases”concludes the doctor. “We need to regain trust and break this cycle.”
