In a more thorough cataloguing of the challenges facing the global measles eradication  program, Keegan and colleagues have identified the six most daunting challenges currently facing the worldwide measles eradication program

J Infect Dis. (2011) 204 (suppl 1): S54-S61. doi: 10.1093/infdis/jir119

1. Key measles-endemic countries are at war in 2011, and the world is more heavily armed than ever. Terrorism, both real and perceived, adds to the complexity, and reaching high rates of vaccination coverage in conflict-affected areas will be extremely difficult and dangerous.

2. The highly infectious nature of measles, combined with an increasing global population, greater population density, migration, and urbanization, presents greater challenges in comparison with those faced by 20th century eradication programs.

3. Measles is not perceived as a serious problem in some wealthy and middle-income countries, because the development of effective health services has reduced the mortality rate to low levels. The European Region has not eliminated measles, and although changes appear imminent, India, the country with the largest estimated number of measles cases, has not fully embraced existing measles control and mortality reduction strategies.

4. The resistance of the antivaccination lobby in Europe and elsewhere must be overcome.

5. The technical challenges of measles eradication in India may not be fully understood. It remains unclear what level of vaccination coverage will be required to stop transmission in the large, densely populated states of Uttar Pradesh and Bihar or the level of effort that will be required to achieve it.

6. The coexistence of the polio eradication program and other health initiatives could create an unhealthy competition for political commitment and human and financial resources globally. The successful completion of polio eradication would remove this competition and provide renewed confidence in the potential of vaccines to eradicate disease.