Alarm for unprotected children: Coverage of two-year-olds who received the MMR vaccine fell 9,4 percent in a year

Only 13,2 percent of two-year-olds received the MMR vaccine against measles, mumps, and rubella last year, which is alarming data and can lead to devastating consequences in an epidemic.

The Institute of Public Health (IJZ) in its annual vaccination report says that the lowest coverage of vaccinated children so far poses a great risk and requires an urgent, decisive and joint response from everyone, including international partners. The decline in MMR vaccine coverage is also associated with a lower rate of administration of other vaccines from the mandatory immunization schedule.

Epidemiologist Zoran Radovanović, a retired professor at the Faculty of Medicine, University of Belgrade, tells "Vijesti" that MMR is one of the safest vaccines and has no adverse effects. According to him, the reason for the drop in coverage in Montenegro, which once functioned flawlessly in terms of measles vaccination, is the spread of conspiracy theories through social networks and new communication channels.

"MMR is a very safe vaccine and it is unreasonable to link it to autism. Panic is spreading without any basis," says Radovanović.

It is reminiscent of the case of Serbia, which, after the active influence of anti-vaccinationists in 2017, was hit by a measles epidemic in 2018, during which 6.000 people fell ill and 15 died.

"Anti-vaxxers have become active again, now against the HPV vaccine that causes cervical cancer, but also 10-15 other sites, which is why there is a proposal that vaccination against human papillomavirus should now be mandatory," explains Radovanović.

He reminds us that measles (smallpox) is the most contagious disease and that one patient can infect 12 to 18 - an average of 15 - people, and that in addition to being fatal, it can also lead to serious complications such as meningitis and encephalitis.

Therefore, he says, at least 95 percent of those vaccinated are needed for collective immunity.

A 9,4 percent drop for the year

"After a slight increase in MMR vaccine coverage was recorded in 2022, the downward trend from 2024 continued in 2025 and amounted to an alarming 13,2 percent," the Institute of Public Health stated, adding that there is still a significant negative impact of anti-vaccine messages, misinformation on social media, and the active work of anti-vaccine movements in the region.

"These messages further confuse parents, and it is concerning that the response from the health sector, especially at the secondary and tertiary levels, has not been strong enough," the authors state.

According to the data, coverage fell by 9,4 percent for the year, when it was 22,6 and is far lower than the required 95 percent.

"The main reason for such low coverage is not so much the 'loud', but very present engagement of members of anti-vaccination groups who, despite falling ill and dying from measles during 2017 and 2018, especially in Serbia, continued to spread unverified and inaccurate information, disinformation and controversies regarding the safety of the MMR vaccine via social networks," the Public Health Institute explains.

The effect of anti-vaccination messages, they claim, is most noticeable in the southern (coastal) and central regions, that is, in the most touristically interesting parts of the country where the population lives with easier access to the internet and a large number of different anti-vaccination websites.

"Low coverage is partly a consequence of parents' confusion due to the insufficiently strong and unanimous stance and response of pediatric services to the increasing number of anti-vaccination messages, but also to the increasing number of requests from parents for education and information when it comes to the MMR vaccine, to which pediatricians are unable to respond due to their workload and volume of work, and often inadequate training in communication skills," the IJZ explains.

They claim that they have also noticed that a certain number of pediatricians are uncritically inclined to establish temporary contraindications to vaccination, thus undermining the position of the profession and evidence-based medicine when it comes to the use of the MMR vaccine.

"All of which further increases the confusion of parents and the delay in MMR vaccination. The Institute has repeatedly drawn the attention of health center administrations and selected pediatricians to such practices in recent years as part of continuing medical education, as well as during visits to health centers."

No municipality has achieved coverage above 50 percent of vaccinated children, while in some municipalities coverage levels that pose a serious epidemiological risk have been registered.

"The situation in Šavnik is particularly worrying, where coverage is zero percent, which requires a response from the competent health center in Nikšić, although coverage rates have been drastically variable with vaccination for several years due to the small number of children in this municipality." Low vaccination rates, below ten percent, are also recorded in the municipalities of Zeta, Budva, Nikšić, Plužine, Danilovgrad, Cetinje and Ulcinj.

Enhanced surveillance remains in effect

As a result of unsatisfactory and insufficient measles vaccination coverage, and due to the devastating impact of anti-vaccination movements since 2014, as claimed by the Public Health Institute, 200 cases of the disease were registered in 2018, without serious complications and without fatalities. According to the data, in 2023, 35 people fell ill, none of whom were fully vaccinated, and last year there were 12.

The most cases were registered in Plav and Gusinje, and only one was fully vaccinated.

"Before the introduction of mandatory immunization, practically every person exposed to measles contracted measles. After the introduction of mandatory immunization against this disease in the 20s, the number of people infected decreased proportionally to the vaccination coverage, but measles in Montenegro maintained its usual cyclical course with an epidemic peak every three to five years, primarily due to lower vaccination coverage than would have ensured the cessation of the occurrence of this disease in epidemic form," the IJZ report states.

They claim that a strengthened measles surveillance system, which includes epidemiological and laboratory testing of every case of measles, will remain in force until further notice, although experience (measles epidemics in Bulgaria, Germany, France, etc.) indicates that a particular risk is posed by hard-to-reach and mobile populations who frequently change their place of residence and inadequately respond to regular and emergency vaccination campaigns, while living in densely populated collective centers.