In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district, 2) reduce global annual measles incidence to less than five cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* ( 1 ). In 2012, WHA endorsed the Global Vaccine Action Plan, † with the objective of eliminating measles § in five of the six World Health Organization (WHO) regions by 2020. This report updates a previous report ( 2 ) and describes progress toward WHA milestones and regional measles elimination during 2000–2018. During 2000–2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000–2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine ( 3 ). Immunization Activities WHO and the United Nations Children’s Fund (UNICEF) use data from administrative records and vaccination coverage surveys reported annually to estimate MCV1 and second dose (MCV2) coverage through routine immunization services. ¶ During 2000–2018, estimated MCV1 coverage increased globally from 72% to 86% (Table), although coverage has remained at 84%–86% since 2010, with considerable regional variation. Since 2016, MCV1 coverage has remained relatively constant in the African Region (AFR) (74%–75%), the Eastern Mediterranean Region (EMR) (82%–83%), and the South-East Asia Region (SEAR) (88%–89%); and it has remained constant since 2008 in the European Region (EUR) (93%–95%) and in the Western Pacific Region (WPR) (95%–97%). Estimated MCV1 coverage in the Region of the Americas (AMR) decreased from 92% in 2016 to 88% in 2017 and increased to 90% in 2018. TABLE Estimates of coverage with the first and second doses of measles-containing vaccine administered through routine immunization services, reported measles cases and incidence, and estimated measles cases and deaths,* by World Health Organization (WHO) region — worldwide, 2000 and 2018 WHO region/ Year (no. of countries in region) % MCV1† coverage % countries with ≥90% MCV1 coverage % MCV2† coverage % of reporting countries with 600 per million and accounted for 45% (157,239 cases) of all reported cases worldwide. The percentage of reporting countries with annual measles incidence of 100 importations in 2018 as a consequence of inadequate vaccination coverage, endemic measles virus transmission has been reestablished in the United Kingdom. Countries such as Cambodia, which, through sustained efforts, identified and closed immunity gaps to achieve elimination, but which border countries with ongoing endemic transmission, must remain vigilant to identify and stop measles outbreaks rapidly. Before international travel, travelers from all countries should ensure they have been appropriately vaccinated against measles. Progress toward measles elimination will regress without a unified effort by all communities and countries. Evaluations of routine immunization programs to identify barriers to vaccination indicate that children miss MCV1 and MCV2 doses for many reasons, including families’ limited awareness of the need for vaccination, limited access to or financial barriers to receiving vaccination; vaccine stock-outs; political instability; and vaccine hesitancy and misinformation. WHO’s Global Routine Immunization Strategies and Practices and The Guide to Tailoring Immunization Programmes provides guidance on identifying demand and supply barriers to routine vaccination and strengthening immunization programs ( 8 , 9 ). Outbreaks should serve as opportunities to investigate underlying causes of undervaccination and to design specific routine immunization strengthening activities to prevent future outbreaks. In addition, population immunity gaps should be identified through triangulation of data, including surveillance and vaccination coverage data, and should be targeted by vaccination activities. The findings in this report are subject to at least two limitations. First, large differences between estimated and reported incidence indicate overall low surveillance sensitivity, making comparisons between regions difficult to interpret. Second, the measles mortality model estimates might be affected by biases in model inputs, including vaccination coverage and surveillance data. The trends of increasing measles incidence and mortality are reversible; however, further progress toward achieving elimination goals will require 1) resource commitments to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance to rapidly detect and respond to cases, and 2) a new perspective to use measles as a stimulus and guide to improving immunization programs. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine. As the period covered by the Global Vaccine Action Plan 2012–2020 approaches its end, a new vision and strategy for accelerated progress on immunization for 2021–2030 is being developed by countries and stakeholders ( 10 ). Pillars of this evolving strategy include commitment and demand, research and innovation, life course and integration, and supply and sustainability; all of these are vital to achieving and maintaining measles elimination. This new agenda should be used to secure the necessary resource commitments to improve coverage and equity substantially and, in so doing, further progress toward achieving the measles elimination goals. Summary What is already known about this topic? In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan; countries in all six World Health Organization regions have adopted goals to eliminate measles by 2020. What is added by this report? During 2000–2018, annual reported measles incidence decreased 66%, and annual estimated measles deaths decreased 73%. Since 2000, measles vaccination has prevented an estimated 23.2 million deaths globally. However, measles incidence increased in five regions during 2016–2018. What are the implications for public health practice? To achieve regional measles elimination goals, resource commitments are needed to strengthen routine immunization systems, close immunity gaps, and improve case-based surveillance.