Roy Probert in Washington DC
International efforts to dramatically reduce measles deaths in Africa have reached a critical juncture. The aim of vaccinating 200 million children by 2005, saving an estimated 1.2 million lives is well on track. But some of the hardest challenges remain ahead.
An annual meeting in Washington of Measles Initiative partner organizations, including the International Federation, heard that since the initiative began three years ago, some 115 million children have been vaccinated in 25 countries. Another 60 million children will be vaccinated in 2004.
The gathering also offered further proof that the measles campaigns have become an important vehicle for other health interventions. In one such integrated campaign, in Zambia, vitamin A, de-worming tablets and insecticide-treated bed nets to combat malaria were distributed.
Such was the success in Zambia that later this year, for the first time, bed nets will be delivered to a whole country, Togo, as part of a measles campaign. This is not the only innovation. Togo’s will be one of six synchronized campaigns in West Africa, aimed at tackling not only measles, but the biggest public health priority, polio.
“The Measles Initiative has moved to the next level, where, not content with vaccinating 115 million children, we are looking to broaden the public health impact,” says Nick Farrell, head of the International Federation’s Africa Health initiative.
The Measles Partnership brings together major public health organizations, including the American Red Cross, the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF), the Centre for Disease Control and Prevention (CDC), the UN Foundation and the International Federation.
“We will achieve and probably surpass our goal of halving measles deaths by 2005,” said Brad Hersch, WHO medical officer. But the upbeat mood at the conference was tempered by the knowledge that a big potential stumbling block remains: Nigeria.
“Nigeria is the biggest challenge the Measles Initiative faces,” warned Steve Cochi of the CDC. It was a recurrent theme throughout the meeting.
Nigeria, which registers 170,000 measles deaths every year, is not the only daunting country facing the partnership. This year, a fourth campaign will be held in Ethiopia and a first in the Democratic Republic of Congo (DRC), both of which have high measles mortality rates.
But Ethiopia has shown what can be achieved, even in countries that present major logistical, geographical and humanitarian problems. Last year, with the Ethiopian Red Cross playing a key regional role, nine million children were vaccinated there. In 2004, a further 8.3 million will be reached.
And the DRC can take inspiration from another conflict-wracked country, Angola, which conducted a hugely successful measles campaign in 2003.
“The very dynamics within Nigeria present all kinds of challenges. Add to that the sheer size of the population – we have to vaccinate 40 to 50 million children,” Farrell says. “The next step will be difficult, but not impossible – just look at Angola and Ethiopia.”
The likelihood is that in Nigeria, as in other countries, Red Cross volunteers will play a vital role in reducing measles mortality. Over the past three years, almost 50,000 Red Cross volunteers have managed to reach over 40 million children in measles immunization campaigns in Africa.
Their unique community-based network has been increasingly prized by other Measles Initiative partners because it can access even the remotest regions, ensuring that all children are protected from a deadly but entirely preventable disease.
Bruce Eshaya-Chauvin, head of the Federation’s health and care department says involvement in measles vaccination campaigns has brought immense benefits to these Red Cross societies.
“In places like Kenya, Ghana and Zambia, we have been able to re-energize networks of community volunteers. We can capitalize on this to bring other important health interventions to populations, in the form of community health or HIV/AIDS awareness,” he explains, adding that “their profile and credibility has also been boosted at the national level by the fact that they are treated as a serious partner by governments and international agencies.”
If the 2005 objectives are met, another challenge will present itself. What next? A central plank of the joint WHO-UNICEF measles strategy for sustainable measles mortality reduction is to ensure high routine vaccination coverage to reinforce the mass campaigns.
This approach has ensured the virtual elimination of measles in the Americas, but will the political desire, infrastructure and funding be there to ensure a similar success in Africa? Will donor attention switch instead to Asia, where the measles burden is also high?
“There is consensus on the strategy. Now it’s a question of implementing it – and not only in the short term. We must not drop the ball after 2005. Otherwise all this hard work will have been wasted,” Farrell warns.