Madagascar had outbreaks of the bubonic plague and pneumonic plague in 2017 (2575 cases, 221 deaths) and 2014 (263 confirmed cases, 71 deaths). In 2019, Madagascar had a measles outbreak, resulting in 118,000 cases and 1,688 deaths. In 2020, Madagascar was also affected by the COVID-19 pandemic.  Undernourishment and hunger rates were at 42% in 2018.