Measles vaccinations are falling. Measles deaths are rising.
In 2019, measles deaths stood at 207,000 – a fifty percent rise since 2016. Infections with the highly-contagious virus, meanwhile, hit almost 870,000 – a figure last seen in the mid-1990s. These alarming figures were published in a study jointly released by the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC).
“During 2000–2016, annual reported measles incidence decreased globally; however, measles incidence increased in all [six WHO] regions during 2017–2019,” the report said. It went on to outline that “during 2000–2016, the number of reported measles cases decreased 84 percent, from 853,479 in 2000 to 132,490 in 2016. From 2000 to 2016, annual measles incidence decreased 88 percent, from 145 cases per one million (2000) to eighteen (2016), the lowest reported incidence during this period.
“Incidence then increased 567 percent to 120 per million in 2019, the highest since 2001…the number of measles cases increased 556 perceny from 132,490 in 2016 to 869,770 in 2019, the most reported cases since 1996.”
The study authors pinpointed failures in measles vaccination as a reason behind the trend. 2010 saw the World Health Assembly establish the following milestones to be achieved by 2015, in the fight to eradicate measles: “increase routine coverage with the first dose of measles-containing vaccine (MCV1) by more than ninety percent nationally and more than eighty percent in every district; reduce and maintain annual measles incidence to less than five cases per million; and reduce estimated measles mortality by more than 95 percent from the 2000 estimate.”
The World Health Organization (WHO) subsequently reported
“In 2012, the Health Assembly endorsed the Global Vaccine Action Plan, with the objective of eliminating measles in four WHO regions by 2015 and in five regions by 2020. By 2018, the global push to improve vaccine coverage resulted in a 73 percent reduction in deaths. During 2000– 2018, with support from the Measles & Rubella Initiative and Gavi, the Vaccine Alliance, measles vaccination prevented an estimated 23.2 million deaths…but without sustained attention, hard fought gains can easily be lost.
“Where children are unvaccinated, outbreaks occur. Because of low coverage nationally or in pockets, multiple regions were hit with large measles outbreaks in 2018, causing many deaths. Based on current trends of measles vaccination coverage and incidence, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) concluded that measles elimination is greatly under threat, and the disease has resurged in a number of countries that had achieved, or were close to achieving, elimination.”
The COVID-19 pandemic thrust a spanner in the work. Earlier this year, UNICEF warned of children missing out on key vaccinations as a result of disruption to routine immunisation services. As reported by Health Issues India at the time, ““South Asia could face yet another health emergency if children across the region do not receive their life-saving vaccine shots,” the agency warned. It went on to note that the region is home to approximately 4.5 million children who are only partially immunised or not immunised at all, translating to a quarter of the global total. Three countries are home to 97 percent of these children – Afghanistan, Pakistan, and India.”
The agency warned “parents are increasingly reluctant to take their children to health centers for routine jabs. Sporadic outbreaks of vaccine-preventable diseases, including measles and diphtheria, have already been seen in parts of Bangladesh, Pakistan and Nepal…many of the health facilities throughout the region, where millions of children are normally vaccinated, have been closed and outreach sessions have been suspended, adding to the challenge.”
Even before the disruptions of COVID, UNICEF noted that more than thirteen million children missed out on vital vaccinations – including for measles. Indeed, in 2019, UNICEF reported that in the preceding eight years, more than twenty million children worldwide did not receive the all-important first dose of the measles vaccine with a total of almost 170 million children under the age of ten being unvaccinated. Of the twenty million+plus unvaccinated children, 2.9 million were Indian.
The CDC / WHO report lays out clear guidance on how to facilitate progress. “To achieve regional measles elimination goals, additional strategies are needed to help countries strengthen routine immunisation systems, identify and close immunity gaps, and improve case-based surveillance,” it says in summary. The full report speaks for itself and can be accessed here.
What is needed, both during the pandemic and beyond, is to raise awareness of why routine immunisation is important; to dispel myths about vaccines; and to work collaboratively and efficiently to ensure that no-one dies needlessly of a disease that can be prevented.
“Since 2000, estimated measles deaths decreased 62 percent and measles vaccination has prevented an estimated 25.5 million deaths worldwide,” the report notes. However, hard-won gains are too often easily lost. Taking onboard what this vital piece of research outlines and putting its recommendations into action is a public health – and moral – imperative.