A peek inside Romania’s family care practices 

The Challenge

Why are so many measles cases and deaths happening here?

The Context

Although unchecked anti-vaccination myths are what get the most media attention, it is only one reason more Romanian children contracted – and died from – measles during the 2018-2019 European outbreak than any other country in the European Union. Marginalized, often poor and without documentation, most under vaccinated children miss out because they are invisible to Romania’s health care system. The virus takes hold here first, and spreads to other communities.  For children who do get to health clinics, their family’s concerns are often unaddressed by the doctors who treat them.





WHO EURO + WHO Romania


Over 33,000 measles infections were recorded in the EU between 2016 and 2019. In that timeframe, Romania has been disproportionately affected by the outbreak – with nearly half of all cases in the EU.

Up to 160,000 undocumented people could be living in Romania, with limited access to the healthcare system.


Only 84% of Romanian children are vaccinated against measles in 2018.

The WHO recommends a vaccination rate of 95% for effective control of this deadly disease.

Over 95% of children who contracted measles had received no vaccination at all.

The most vulnerable children in Romania are 30% less likely to receive the measles vaccine (MMR) than their peers.

Over sixty children died in the first two years of the Romanian outbreak.

What We Heard

Together with the Romanian Ministry of Health, the World Health Organization wanted to understand the spoken and unspoken interactions between health staff and patients – especially the families most at risk of contracting measles.  Doctors have immense influence, and so even their most routine interactions could hold opportunities to promote vaccinations. Simple prompts from them could nudge an overloaded, anxious or hesitant parent towards vaccination. So why aren’t these practices a force of habit for all doctors? And what is it that would make the most difference in swaying unsure parents?

Together, we recruited, trained and placed observers in eight clinics across Romania. A behind-the-scenes look at what happens between families and doctors in the consultation room revealed fascinating clues to behavioral solutions that can help parents feel listened to and doctors supported to do their job. 

Our Solution

Clinics with better quality interaction between families and doctors tended to have higher vaccination rates, suggesting that constructive, evidence-based dialogue has an impact on vaccination acceptance and uptake. The most vulnerable families are as motivated as any others to do what is best for their children. If doctors could offer the right information during visits, build rapport with parents, and rely on a well-functioning reminder system, the vaccination landscape could be transformed. Many doctors wanted to play this role, but felt unsupported by administrative burdens, overbooked schedules, and outdated communication and technical skills.

The research helped trigger solutions with officials in the Ministry of Health, like guidelines that support doctors to take a more proactive approach to promote vaccination, mobile vaccination visits to the communities most likely to be left out of the formal health system, electronic registry systems to schedule and remind parents of appointments, and better investment to help doctors build confidence and skills that help them engage in constructive dialogue with parents about vaccination.

  1. The Story Behind the Worst Measles Outbreak in The European Union, NPR 2018.
  2. Measles, ECDC.
  3. Romania’s measles outbreak kills dozens of children,  NBC News.
  4. The Roma Vaccination Gap, HAL.
  5. The truth about Romania’s gypsies, Independent.
  6. Romania’s “invisible” Roma battle for identity, NST.

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