Madagascar is currently in the grips of its history’s most deadly measles outbreak. Over 1,200 people – predominately children – have died on the island since October 2018, while a further 115,000 more are still infected with the disease, the Associated Press reports.

Madagascar is the ideal setting for measles to take root at the moment. Paired with a low vaccination rate and under-resourced medical facilities, a huge portion of the country are also suffering from malnutrition. Around half of the children in Madagascar suffer from chronic malnutrition, which is known to dramatically increase the risk of serious complications and death from a measles infection.

“Malnutrition is the bed of measles,” Dr Dossou Vincent Sodjinou, a WHO epidemiologist in Madagascar, told The Associated Press.

"The epidemic, unfortunately, continues to expand in size,” said Dr Sodjinou, although he added the rate of increase has slowed down in the past couple of months.

Measles is a highly infectious viral disease spread by coughing, sneezing, and close contact with an infected person. Symptoms start with a fever, coughing, and a distinctive rash. While there is no direct treatment for the disease, it is preventable through vaccinations.

Madagascar's immunization rate was just 58 percent in 2017. For context, the WHO recommends at least 95 percent of the population receive two doses of measles-containing vaccine to prevent an outbreak. However, unlike outbreaks in North America and Europe, low levels of vaccination are not the result of fear of vaccines or anti-vax misinformation. In Madagascar, one of the poorest nations in the world, the problem is access: vaccinations are too expensive, often too far away, or in short supply.

Back in March, Reuters reported the story of Dada, a Madagascan fisherman who had recently lost his 4-year-old son, his 3-year-old niece, and his 3-year-old nephew to the measles outbreak. After feeding his whole family on less than $2 a day, he couldn’t afford to pay $15 for a second-round of measles vaccines and was forced to resort to back-alley traditional medicines.

The WHO, UNICEF, the World Bank, the Madagascan government, and a number of other international organizations have contributed funds towards a vaccination campaign in the country with the aim of reaching over 7.2 million children under 9 years of age.

Most developed countries have reasonably good access to vaccines. However, certain parts of the world have seen vaccination rates slip over the past decade or so. In October 2018, a report found that the number of US children under the age of 2 who haven’t received any immunizations had quadrupled since 2001. By no surprise, this has also brought a sharp rise in measles cases to the US.