Measles surges to 23-year high as children left unvaccinated

Measles surged worldwide in 2019 to reach the highest number of reported cases in 23 years, according to a new report from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) in the United States, which blamed falling rates of vaccination for the resurgence of the highly infectious and sometimes deadly disease.

Cases increased in all parts of the world to reach 869,770, the highest number since 1996, while deaths rose to an estimated 207,500. Global measles deaths have climbed nearly 50 percent since 2016, the report said.

Comparing data from 2019 with the historic low in reported measles cases in 2016, authors said the failure to vaccinate children on time with two doses of measles-containing vaccines (MCV1 and MCV2) was fuelling the disease.

“We know how to prevent measles outbreaks and deaths,” WHO chief Tedros Adhanom Ghebreyesus said in a joint statement with the CDC. “These data send a clear message that we are failing to protect children from measles in every region of the world.”

The warning on measles comes as the world struggles to contain the coronavirus, which first emerged in the Chinese city of Wuhan late last year. Governments around the world are hoping a new vaccine will bring an end to a pandemic that has so far affected more than 52.5 million people around the world and killed 1.3 million.

“These alarming figures should act as a warning that, with the COVID-19 pandemic occupying health systems across the world, we cannot afford to take our eye off the ball when it comes to other deadly diseases,” said Dr Seth Berkley, chief executive of Gavi, the Vaccine Alliance.

“Measles is entirely preventable; in a time in which we have a powerful, safe and cost-effective vaccine nobody should still be dying of this disease. COVID-19 has resulted in dangerous declines in coverage, leading to increased risk of measles outbreaks. Countries urgently need to prioritise measles catch-up immunisation through routine services to mitigate the risk of outbreaks and ensure no child goes without this lifesaving vaccine.”

Measles is a viral disease that attacks mainly children and can cause blindness, brain swelling, and severe respiratory infections.

Closing gaps

Vaccination coverage rates with MCV1 and MCV2 must reach 95 percent of people and be maintained at national and subnational levels for the disease to be contained, the report said.

But the cheap and effective vaccine has been undermined by misinformation campaigns and conspiracy theories that emerged in the wake of a now-retracted and discredited 1998 study by a British former doctor and academic Andrew Wakefield.

MCV1 coverage has been stagnant globally for more than a decade at between 84 and 85 percent, while MCV2 coverage has been increasing steadily but is still only at 71 percent.

While the travel restrictions, physical distancing rules and school closures imposed to deal with the coronavirus have also helped curb measles, with fewer cases being reported so far in 2020, the WHO says COVID-19 control efforts have also disrupted vaccination programmes.

As of November, more than 94 million people in 26 countries were at risk of missing vaccines because measles campaigns had been suspended. Only eight countries have resumed their campaigns – Nepal, Nigeria, Somalia, Ethiopia, Philippines, Democratic Republic of Congo, Brazil and the Central African Republic.

Mothers carry their children towards a health centre in Kathmandu. Nepal is one of the few countries to resume its vaccination programme despite the coronavirus pandemic [Narendra Shrestha/EPA]The Philippines, which is battling the worst COVID-19 outbreak in Southeast Asia, has also resumed its immunisation campaign for young children [File: Francis R Malasig/EPA]“Before there was a coronavirus crisis, the world was grappling with a measles crisis, and it has not gone away,” Henrietta Fore, UNICEF executive director, said in a statement.

“While health systems are strained by the COVID-19 pandemic, we must not allow our fight against one deadly disease to come at the expense of our fight against another. This means ensuring we have the resources to continue immunisation campaigns for all vaccine-preventable diseases, even as we address the growing COVID-19 pandemic.”

WHO and UNICEF issued an emergency call for action on measles and polio outbreak prevention and response on November 6.

“Measles virus easily finds unprotected children, adolescents and adults because it is so contagious,” said Dr Robert Linkins, Measles & Rubella Initiative Management Team Chair and Accelerated Disease Control branch chief at the CDC. “Infections are not only a sign of poor measles vaccination coverage, but also a known marker, or ‘tracer,’ that vital health services may not be reaching populations most at-risk.”

A measles outbreak in the Democratic Republic of Congo, which began in 2018 and killed more than 7,000 children, was declared over in August after a massive vaccination campaign. An outbreak in Samoa, late last year was also brought to an end by mass vaccination.

The Measles & Rubella Initiative (M&RI), which includes the United Nations Foundation ICEF, the WHO, international and national health agencies as well as global health organisations, has been established to help put the world back on track towards measles elimination and respond to immunisation delays – for measles and all vaccines – in every region of the world.

The UN Foundation’s President and CEO Elizabeth Cousens said the initiative is a “bold way forward” and would help close gaps in access to immunisation.

“The fact that measles outbreaks are occurring at the highest levels we’ve seen in a generation is unthinkable when we have a safe, cost-effective, and proven vaccine,” she said. “No child should die from a vaccine-preventable disease.

The Measles & Rubella Strategic Framework 2021 – 2030 aims to support national immunisation systems, strengthen the routine delivery of all vaccines, and detect and respond quickly and effectively to measles outbreaks.