Roy Probert in Cape Town
Public health experts gather in Cape Town this week for a landmark meeting aimed at building on the advances made over the past three years in reducing measles mortality. A key element of the meeting is strengthening and widening the partnership that has grown up around measles, and in which the International Federation and National Red Cross and Red Crescent Societies have become enthusiastic participants.
Anton Chilufya encapsulates the unique role Red Cross volunteers can play in reducing measles mortality. When Zambia staged a mass measles vaccination campaign in June, Anton could be seen pushing his bicycle along a long stretch of road, pied-piper-like, with a string of children following in his footsteps.
These were youngsters whose parents were unable to accompany them, so Anton, one of 1,800 Zambian Red Cross volunteers participating in a week-long campaign, had rounded the children up from villages along the way and taken them to the nearest immunisation post, eight kilometres away, ensuring that no child was left unprotected.
Red Cross volunteers have carried out a similar role in many countries in Africa, including Angola, Eritrea, Kenya, Ghana and Uganda, Togo, Benin, Burkina Faso, Mali, Tanzania, Senegal. Red Cross Societies are gearing up to play their part in similar campaigns in Guinea, Gambia, Sierra Leone and Ethiopia. Measles campaigns are massive undertakings, aiming to reach all children aged between six months and 14 years, which can mean half the total population.
“When all the ‘hardware’ is in place, one critical piece of the puzzle is the ‘social mobilization’ – persuading children and their parents to visit the vaccination posts on the day of the campaign,” explains Dr Bernard Morinière, senior health officer at the Federation Secretariat. “Red Cross community-based volunteers are in a unique position to pass on that information, especially to those most at risk of being missed: orphans, disabled children, households with multiple children or with pregnant or sick mothers, migrants and so on.”
“Not only can Red Cross volunteers inform households, they can also assist vulnerable families to bring their children to the post on the day of the vaccination. A successful social mobilization by Red Cross volunteers not only contributes to the success of the vaccination campaign, it also enhances and highlights the services rendered by Red Cross volunteers to their communities, as partners to local health and other public services,” he adds.
That view is supported by Robert Kezaala, World Health Organization medical officer for measles in Africa: “The Red Cross Movement’s vital interlocutor role at local, national and international level will help to consolidate the gains made so far – at local level for social mobilization, at national level to advocate for commitment by decision-makers and at international level to mobilize resources. There is almost no other movement that has this comparative advantage.”
The Cape Town meeting, which runs from 15-17 October, has the theme, ‘I want to be … alive - protect me against measles’.
“This meeting is ultimately about working together to ensure that all children, no matter where they live, have the opportunity to be immunized against measles. It is unacceptable that children are still dying from an easily preventable disease,” said WHO medical officer, Dr Brad Hersh.
Even though a cheap and effective vaccine has been available for over 40 years, measles remains the leading vaccine-preventable cause of death among children. Every year, over 30 million children are affected by measles and more than 745,000 die from the disease – over half of them in Africa.
“In the developed world, parents have become complacent about the danger measles poses. They have very little idea of the grief and suffering it causes. The measles virus is highly contagious, and causes a high fever, rash and cough. If measles doesn’t kill an infected child, he or she might succumb to complications like pneumonia or diarrhoea. Or they might be left with a permanent and painful reminder of the virus, such as brain damage or blindness,” said Alvaro Bermejo, head of health and care at the International Federation.
The Cape Town meeting comes at an important juncture: just two years remain to reach the objective - identified in the UN Millennium Declaration and the 2002 General Assembly Special Session on Children – of halving measles deaths by the end of 2005, compared with 1999 levels. This meeting gives partners and donors the opportunity to review progress made in reaching this target, and to engage with governments in 45 priority countries, which account for 95 per cent of measles deaths.
Organized by the World Health Organization and UNICEF, it is also being attended by other leading public health bodies involved in the global partnership to combat measles: the International Federation of Red Cross and Red Crescent Societies, the American Red Cross, the US Centers for Disease Control and Prevention, the United Nations Foundation, representatives of governments and other humanitarian and non-governmental organizations.
On the final day of the meeting, participating organizations will sign up to a declaration, which commits them to working towards the implementation of the WHO/UNICEF measles strategy.
“The Cape Town Declaration reflects the already strong partnership that has grown up around this objective, and aims to bring on board new partners,” said Dr Hersh. “It will provide a launch-pad for a renewed commitment to reduce measles deaths for the long-term.”
Measles vaccination coverage is a critical indicator for monitoring progress towards the United Nations Millennium Development Goal of reducing the under-five mortality rate by two-thirds by 2015.
This cannot be achieved solely through mass one-off vaccination campaigns. The foundation of the WHO/UNICEF strategy is strong routine immunization – vaccinating babies shortly after birth. Ideally, this is followed by a “second opportunity”, to ensure that those who escaped measles vaccination the first time around and those who failed to respond immunologically to the vaccine, are protected.
“Today the call to action is clear,” says Nick Farrell, head of the Federation’s ARCHI 2010 Africa Health Initiative. “There’s no magic formula for saving children from measles. We have to ensure every child receives a second opportunity for measles immunization in these 45 countries, no matter how remote or marginalized, regardless of barriers of conflict, culture and poverty.”
Already hundreds of thousands of young lives have been saved by measles campaigns in Africa. Given this success, and the drastic reduction of measles deaths in Latin America, it is hoped that the partnership can be harnessed to have a similar impact in Asia.
But to achieve a sustained reduction in measles mortality rates, a high level of routine immunization coverage, whereby every child is vaccinated as a matter of course, is essential.
Measles campaigns allow unprecedented access to all of a country’s children, and increasingly they are being used as an opportunity to deliver other vital health interventions - vitamin A, oral polio vaccine, insecticide treated bed nets to treat malaria and de-worming medication.
Even in countries that have succeeded in drastically reducing measles deaths, there should be no complacency. The host country, South Africa, has registered 49 measles cases in the past few days.
More on: Measles
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