Political commitment crucial to successful measles reduction

Publicado: 17 octubre 2003 0:00 CET

Roy Probert, Cape Town

There is an old African saying that parents should not give their children a name until measles has passed through their village, such was the toll it took.

Even if the disease still claims some 2,000 young lives every day, half of them in Africa, a landmark meeting in Cape Town has been hearing that significant inroads are being made in the battle against the disease.

Nevertheless, this has been tempered by the knowledge that the successes achieved so far can only be sustained with greater commitment from governments, and the funding that that inevitably entails.

“There has to a renewed commitment to eliminate measles from the world. If we redouble our efforts, measles will be a walkover,” said Dr Ebrahim Samba, director of the World Health Organization’s (WHO) Africa region. “No-one can do it alone, we have to work together. Polio and measles have shown that participation works.”

On the face of it, the will is there. All 45 priority countries, which account for 95 per cent of measles cases, are represented at the Global Meeting for Sustainable Measles Mortality Reduction and Immunization System Strengthening.

The global partners – the WHO and UNICEF, supported by the International Federation, the American Red Cross, the UN Foundation, the US Centers for Disease Control and Prevention and national ministries of health – are hoping that the presence of these governments will be translated into greater commitment and in turn, a sustained – and sustainable – reduction in child mortality.

“Access to basic health services, including childhood immunization, is a fundamental right of all children ... We urge all governments to allocate adequate resources from their national budgets to measles and other high impact child survival interventions,” said Dr Jean-Marie Okwo-Bele, head of immunization at UNICEF.

The aim is to cut global measles mortality by 50 per cent by 2005, compared to 1999 levels. Attention has been focused on Africa because it is here that the burden is heaviest. The meeting confirmed that the initiative was on track. By the end of 2005, measles deaths should have fallen to around 350,000 per year.

“That’s still far too many, but it is lower than the target we set,” said Edward Hoekstra, UNICEF’s senior health advisor on measles.

One recent success story has been Zambia, where the Zambian Red Cross was a vital component, mobilizing people, especially in remote areas, and ensuring a very high vaccination coverage.

“In the past, two or three children were sharing a bed in the measles hospitals. Since the campaign, the wards are empty. We haven’t registered a single measles case,” says WHO immunization specialist in Zambia, Adiele Onyeze.

One of the questions being asked in Cape Town is whether the partnership model developed in Africa could be transposed to other countries, especially in Asia, the region with the second highest measles mortality rate. “It’s not a one size fits all situation. Some tinkering will be needed,” says Nick Farrell, head of the International Federation’s Africa health programmes. “But ultimately it’s up to governments to take responsibility for making it sustainable.”

Mass measles campaigns aim to reach all children aged between nine months and 15 years, and often that means over half the population. It makes sense to take advantage of this unprecedented access to offer other health services to the target population. In Zambia, insecticide-treated bed nets, vitamin A and de-worming medication were distributed at the same time as the measles vaccine. Mali’s integrated approach also included vitamin A, oral re-hydration, and public awareness about HIV and hygiene.

“There’s now an openness to discuss how to use existing infrastructure to have a broader impact on the health of children, when the need exists and it is in line with the wishes of the government,” Farrell says.

The main catalyst for the advances made has been partnership – the coming together around a single common goal of several leading public health organizations. Where in 1991, only US$ 3 million was spent through UNICEF on measles mortality reduction, now that figure has risen to over US$ 46 million. In 2000, 97 million vaccines were shipped by UNICEF. This year, 164 million will have been transported.

The Red Cross Red Crescent family is able to assist this partnership in many ways – whether through fundraising, advocating with governments, or, most crucially, deploying its unique volunteer network on the ground.

“Our role is to support and complement national efforts and to concentrate on hard to reach sections of the population,” Farrell says. “In the long-term, the Red Cross has a role to play in routine immunization, through education and outreach. We can help to make it sustainable by making the process less passive.”

Another encouraging development is that many of the 45 priority countries have started implementing the WHO/UNICEF measles strategy, a central element of which is a second opportunity for children to receive their vaccination, thus ensuring a much higher coverage and reducing the likelihood of major outbreaks. By the end of the year, 29 of the 45 countries will have begun vaccinations using the WHO/UNICEF model.

In some areas of the world, notably Europe and the Americas, public health experts speak optimistically of eliminating the disease. But the overriding global goal is still reducing mortality.

WHO officials say that if its strategy is implemented to the letter, measles deaths could be virtually eliminated by 2012. But it is a big if. Polio eradication remains the number one priority for the UN agencies, and measles elimination requires a longer-term commitment. It’s also questionable whether some countries have the health infrastructure and funds to put in place a reliable routine immunization system.

For now, measles mortality reduction constitutes a public health success story in some regions of the world. But with three-quarters of a million children still dying from the disease every year, no-one is celebrating yet.

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