Worldwide more than 140,000 people died from a resurgence in measles in 2018, according to new estimates from the World Health Organisation (WHO) and the US Centres for Diseases Control and Prevention (CDC).
The WHO's director general, Tedros Adhanom Ghebreysus, said in a statement that “the fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world's most vulnerable children.”
These deaths occurred as measles cases surged globally, amidst devastating outbreaks in all regions. Most deaths were among children under 5 years of age. Babies and very young children are at greatest risk from measles infections, with potential complications including pneumonia and encephalitis (a swelling of the brain), as well as lifelong disability – permanent brain damage, blindness or hearing loss.
Recently published evidence shows that contracting the measles virus can have further long-term health impacts, with the virus damaging the immune system’s memory for months or even years following infection. This ‘immune amnesia’ leaves survivors vulnerable to other potentially deadly diseases, like influenza or severe diarrhoea, by harming the body’s immune defences.
“The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children,” said Dr Tedros Adhanom Ghebreysus, director-general of the WHO. “To save lives, we must ensure everyone can benefit from vaccines – which means investing in immunisation and quality health care as a right for all.”
Measles is preventable through vaccination. However, vaccination rates globally have stagnated for almost a decade. WHO and Unicef estimate that 86% of children globally received the first dose of measles vaccine through their country’s routine vaccination services in 2018, and fewer than 70% received the second recommended dose.
Worldwide, coverage with measles vaccine is not adequate to prevent outbreaks. WHO recommends that 95% vaccination coverage with two doses of measles vaccine is needed in each country and all communities to protect populations from the disease. Estimating the total number of cases and deaths globally and by region, the report finds that the worst impacts of measles were in sub-Saharan Africa, where many children have persistently missed out on vaccination.
In 2018, the most affected countries – the countries with the highest incidence rate of the disease – were Democratic Republic of the Congo (DRC), Liberia, Madagascar, Somalia and Ukraine. These five countries accounted for almost half of all measles cases worldwide.
“We’ve had a safe and effective measles vaccine for over 50 years,” said Dr Robert Linkins, branch chief of accelerated disease control and vaccine preventable disease surveillance at the CDC and chair of the Measles & Rubella Initiative. “These estimates remind us that every child, everywhere needs – and deserves – the life-saving vaccine. We must turn this trend around and stop these preventable deaths by improving measles vaccine access and coverage.”
While the greatest impacts have been in the poorest countries, some wealthier countries have also been battling measles outbreaks, with significant ramifications for people’s health. This year, the US reported its highest number of cases in 25 years, while four countries in Europe – Albania, Czechia, Greece and the UK – lost their measles elimination status in 2018 following protracted outbreaks of the disease. This happens if measles re-enters a country after it has been declared eliminated, and if transmission is sustained continuously in the country for more than a year.
The Measles & Rubella Initiative (M&RI) – which includes the American Red Cross, CDC, Unicef, the UN Foundation and WHO – as well as Gavi – the Vaccine Alliance, are helping countries respond to measles outbreaks, such as through emergency vaccination campaigns.
In addition to rapidly immunising against measles, outbreak response also includes efforts to reduce the risk of death through timely treatment, especially for related complications like pneumonia. With partners, WHO is therefore providing support to help countries manage cases, including training health workers in effective care for children suffering the effects of the disease.
Beyond outbreak response, there is an urgent need for countries and the global health community to continue investing in high quality national immunisation programmes and disease surveillance, which helps ensure measles outbreaks are rapidly detected and stopped before lives are lost.
“It is a tragedy that the world is seeing a rapid increase in cases and deaths from a disease that is easily preventable with a vaccine,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “While hesitancy and complacency are challenges to overcome, the largest measles outbreaks have hit countries with weak routine immunisation and health systems. We must do better at reaching the most vulnerable, and that will be a fundamental focus of Gavi’s next five-year period.”
Over the last 18 years, measles vaccination alone is estimated to have saved more than 23m lives. M&RI is a global partnership founded by the American Red Cross, the CDC, the UN Foundation, Unicef and WHO, that is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome. Founded in 2001, the Initiative has helped vaccinate over 2.9bn children and save over 21m lives by increasing vaccination coverage, improving disease response, monitoring and evaluation, and building public confidence and demand for immunisation.
“We are alarmed at the increase in measles in the US and around the globe—but there is hope,” said Gail McGovern, president & CEO, American Red Cross. “Measles outbreaks are entirely preventable through strong systems that ensure no child misses lifesaving vaccines.”
“The unacceptable number of children killed last year by a wholly preventable disease is proof that measles anywhere is a threat to children everywhere,” said Henrietta Fore, Unicef’s executive director. “When children go unvaccinated in significant numbers, entire communities are at risk. We see that even today in remote places like in the Democratic Republic of the Congo, where measles has killed more than 4,500 children under the age of five so far this year; or in Samoa, where a rapidly spreading measles outbreak has left many children ill and unable to go to school.”
“This latest data show that we are unfortunately backsliding in our progress against an easily-preventable disease: measles,” said Kathy Calvin, president and CEO of the UN Foundation. “But we can turn the tide against these outbreaks through collective action, robust political commitment, and closing critical funding gaps. Working together works—it’s the only way we will be able to reach everyone, everywhere with life-saving vaccines and services and, more broadly, reach the UN’s Sustainable Development Goals.”
Professor Heidi Larson, the director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, is quoted in The Guardian as saying: “Despite an available, safe and effective measles vaccine, not enough people are being vaccinated to prevent this devastating loss of life. Some countries are scrambling to vaccinate in the face of serious outbreaks, far too late for many. Stressed systems due to multiple disease outbreaks, conflict, rumours and distrust contribute to the measles crisis.”
The US has already reported its highest number of measles cases in 25 years in 2019, while four countries in Europe – Albania, the Czech Republic, Greece and the UK – lost their WHO “measles-free” status in 2018 after suffering large outbreaks, reports Reuters Health.
In 2018, measles hit hardest in Liberia, Ukraine, Democratic Republic of Congo, Madagascar and Somalia, the WHO said, with these five nations accounting for nearly half of all cases worldwide.
The situation has been described by health experts as staggering, an outrage, a tragedy and easily preventable with vaccines. BBC News report that huge progress has been made since the year 2000, but there is concern that incidence of measles is now edging up.
Global estimates show: in 2000 – there were 28.2m cases of measles and 535,600 deaths; in 2017 – there were 7.6m cases of measles and 124,000 deaths; and in 2018 – they were 9.8m cases of measles and 142,000 deaths
Measles cases do not go down every year – there was an increase between 2012 and 2013, for example. However, the report says, there is greater concern now that progress is being undone as the number of children vaccinated stalls around the world.
Every single case of measles cannot be counted. In 2018, only 353,236 cases were officially recorded (out of the 7.8m estimated). So, the report says, scientists perform complex maths for each country. They take reported cases, the population size, deaths rates, the proportion of children vaccinated and more to eventually produce a global estimate.
Dr Minal Patel, who performed the number-crunching, is quoted in the report as saying: "We've had a general trajectory downwards for deaths, which is great. Everyone involved in vaccination programmes should be very proud. But we've been stagnating in numbers of deaths for about the past seven years, and what's really concerning is from last year we've gone up, and it looks like we've gone backwards."
Samoa has warned it will not tolerate anti-vaccine misinformation, after a prominent activist was arrested for opposing a mass immunisation drive launched to contain a deadly measles epidemic in the Pacific nation, says an Aljazeera report. At least 63 people, most of them children, have died since the outbreak began in mid-October and the country has started administering compulsory vaccinations in a desperate bid to stop the virus.
But Communications Minister Afamasaga Rico Tupai said anti-vaxxers spreading conspiracy theories were hindering the unprecedented public health mobilisation. "The anti-vaxxers, unfortunately, have been slowing us down," he is quoted in the report as saying. "We've had children who have passed away after coming to the hospital as a last resort, and then we find out the anti-vaccine message has got to their families and that's why they've kept these kids at home," he said.
He warned anti-vaxxers "don't get in the way, don't contribute to the deaths". "We will advise police to act when we have no choice," Attorney General Lemalu Hermann Retzlaff added.
The report says the government-backed its tough rhetoric by arresting vocal anti-vaccination campaigner Edwin Tamasese and charging him with incitement. Officials said Tamasese had been warned about his activities previously but posted a message to social media regarding the immunisation drive saying: "I'll be here to mop up your mess. Enjoy your killing spree."
The government also said that US-based anti-vaxxers were swamping government websites with material that Tupai described as "nonsense".
Samoa’s draconian restrictions come as the administration of Prime Minister Tuilaepa Sailele Malielegaoi faces mounting public anger for its failure to prevent what critics say was an accident waiting to happen. According to a report in The Daily Telegraph figures reported from the WHO reveal that in the last five years, levels of vaccination against measles, mumps and rubella have collapsed in Samoa, from 90% to just 31% of eligible infants.
Relatives of children who have died in the present crisis say the government must have known the likely result: a population left wide open to infection. The report says the New Zealand, 3,200 miles southwest, has strong ties with the tiny Polynesian country, and since last February has experienced a string of high-profile measles outbreaks, leading to alerts throughout the WHO’s Western Pacific region.
“New Zealand warned them in August,” a Samoan community leader, Tupai Molesi Taumaoe, whose 20-month-old nephew, Lotolano, died of measles last month, is quoted in the report as saying. “But they did nothing.” According to official data, New Zealand has seen 2,140 confirmed measles cases this year, including more than 1,700 around the country’s biggest city, Auckland, where many families of Somoan origins are concentrated. Air New Zealand and other carriers operate daily services from the city to the Samoan capital, Apia.
Since the Samoan crisis began in October, and was later proclaimed a state of emergency, government sources have criticised anti-vaccine campaigners, purveyors of worthless quack remedies, and even bereaved parents for failing to bring their sick children to hospitals in time.
Additional intensive care equipment has been flown in and the Soman government is taking daily deliveries of oxygen from neighbouring American Samoa such is the scale of the crisis. “Most of the kids have severe pneumonias, often complicated by multi-resistant bacterial infections,” said Dr Stephen Owens, the clinical leader of a 13-strong emergency medical team from the UK. “Any one of the children I saw yesterday would have been a child being cared for in a high dependency unit at home, or even intensive care,” he said. “But here that’s not possible. There’s not enough beds to provide that level of care for every child, so many of them are being cared for on a general paediatric ward.”
A measles epidemic in the Democratic Republic of Congo (DRC) has killed 5,000 people this year, many of them young children, the WHO is quoted in a Physicians Weekly report as saying. Low immunisation rates and high levels of malnutrition have fuelled the epidemic and high mortality rates, especially in North Kivu province, which is also reeling from an Ebola epidemic, it said.
“Since the start of 2019, more than 250,000 suspected (measles) cases and over 5,000 deaths mostly among children under 5 years, have been recorded,” the WHO said. A first measles vaccination campaign was launched to protect people against the infectious disease that has struck all of the country’s 26 provinces, it said. A third phase of the campaign is planned, with the ultimate aim of reaching 18.9m children across the country by year-end, it added.
“While the Ebola outbreak in the DRC has won the world’s attention and progress is being made in saving lives, we must not forget the other urgent health needs the country faces,” said Dr Matshidiso Moeti, WHO regional director for Africa.
Vaccination is most challenging in North Kivu, where 2.2m people are to be vaccinated in this round, because of high insecurity following armed attacks that make some areas inaccessible to aid workers, WHO said.WHO material CDC/WHO report The Guardian report Reuters Health report BBC News report Aljazeera report The Daily Telegraph report Physicians Weekly