After 18 months of work, the Measles Initiative, an alliance of international public health organizations including the International Federation, says it is on track to meet its target of saving the lives of 1.2 million African children by 2006. However, a number of key challenges remain, not least how to keep Africa measles-free in the future.
“Because of the quality of the partnership, we are on schedule, exceeding targets and under budget,” says Mark Grabowsky, senior health advisor of the American Red Cross, at the third meeting of the initiative partners in Washington on February 11 and 12.
“We’ve already planned our campaigns for 2003 and purchased the vaccines and syringes,” he adds.
The Measles Initiative was created in 2001 at the instigation of the American Red Cross. It brought on board key players in global public health such as the World Health Organisation, the UN Children’s Fund, the Centers for Disease Control and Prevention, the United Nations Foundation, African ministries of health and national Red Cross and Red Crescent Societies, supported by the International Federation.
The initiative was born out of the realisation that nearly half the 1.7 million vaccine-preventable deaths among children in the world are caused by measles, and well over half of these are in Africa. Indeed, every minute, a child dies of measles in Africa.
The alliance set itself the goal of immunising 200 million children in Africa by 2006, at a cost of less than one dollar per child. In so doing, it would prevent 1.2 million deaths.
So far, after 18 months of work, mass vaccination campaigns have taken place in 12 countries. Over 64 million children have received their measles jabs, which is higher than anticipated, and over 150.000 lives have been saved. The cost per child has been 79 US cents, and each campaign has had over 90 per cent vaccination coverage.
While eradication of the disease is not an explicit goal, Grabowsky says that “we are on target for zero deaths by 2006”.
In 2003, campaigns will be held in 14 countries, from tiny Gambia to the logistically challenging Democratic Republic of Congo. By the end of the year, a total 80 million children will have been vaccinated, an estimated 167,000 of whom would have died otherwise.
National Red Cross societies play a vital role in the campaigns, mobilising the population, usually in remote areas, and countering the misinformation and rumours that often arise in connection with mass vaccination.
“We bring in the national Red Cross societies to do a job that is critical and for which they have a unique capacity, that is social mobilisation and service delivery in the most difficult areas,” Grabowsky says.
“It is a great example of us reaching the most vulnerable,” echoes Alvaro Bermejo, head of the International Federation’s Health and Care department. “The national societies not only provide access to difficult areas – difficult either because of geography or security – more importantly, they arouse interest in families to get their children vaccinated, especially among the poor.”
Despite the general air of satisfaction in Washington, there was a realisation that a number of important challenges lie ahead. These include promoting closer collaboration between the partners at country level, analysing how the HIV/AIDS pandemic will affect measles immunisation campaigns, and surmounting an over-reliance on the network of staff employed in the drive to eradicate polio.
“We have to seek to maintain quality work in the field, to maintain high coverage and safety,” Grabowsky says. “As polio resources decline, what will the impact be on measles – can we still rely on polio-funded operations staff from the WHO?”
An even bigger concern was the sustainability of the battle against measles through routine immunisation. Where once high-profile mass catch-up campaigns were regarded by some as being in opposition to routine services, now they are seen as being equally important and complementary.
But as Andrea Gay of the UN Foundations pointed out, “who pays for follow-up campaigns and routine immunisation, while we are still doing catch-up campaigns?”
The importance of a dual approach is reflected in the appeal for measles launched by the International Federation in December. Half of the appeal is to fund mass campaigns, but the other 50 per cent is intended for long-term activities – a recognition that the impact of mass campaigns is impossible to sustain without improved routine coverage.
“Measles is easily transmitted and requires very high levels of community immunity,” Bermejo explains. “If we did not follow up with routine immunisation, our efforts would backfire. We would have created expectation in communities and within three years, communities would again be vulnerable and the outbreaks would return.”
The organisers of the initiative have been gratified to see that the mass campaigns have addressed the issue of equity. Before, vaccination coverage for wealthier sections of the population far outstripped that for those living in poverty. In those countries where campaigns have been carried out, the figures are the same for all levels of society.
The campaigns have also sought to tack on additional services in certain campaigns. Vitamin A, which boosts the immune system, is routinely given out, while bed nets to combat malaria were distributed as part of a pilot project in Ghana. The initiative is looking into how to further integrate measles and other immunisation efforts – against the likes of malaria, polio or rubella.
“If the initiative has been a success so far, we have to conclude that it is because of the collective strength of the partnership, which allows for a strong and rapid response in terms of planning and in terms of overcoming obstacles,” says Nick Farrell, head of the Federation’s African health initiative ARCHI 2010, who was singled out for special praise at the Washington meeting.
“We’re well on track to reduce measles mortality to the lowest level it has ever been on the continent,” he says.
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