Is a global measles elimination target feasible, and what else needs to be done to achieve that goal?

Address vaccine concerns

If enough people realize that this disease can be tragic and fatal and if enough people are willing to be immunized, you can virtually remove the disease from your country. It’s just a matter of establishing an infrastructure for making sure the vaccine gets to where it needs to go.

The biggest thing is to try and make the science of vaccine safety compelling, to show people that there are studies that have addressed their concerns about measles vaccine safety and to make it clear that a choice not to get a measles vaccine is not a risk-free choice. It’s just a choice to take a different and far more serious risk.

We’re at a stage where we’ve largely eliminated measles, and therefore, we’ve eliminated the fear of measles. Anybody who lived through measles knows that measles makes you sick. It’s often a pneumonia. And it can cause infection of the brain, encephalitis; it can cause residual brain damage.

Young parents not only didn’t see the diseases like measles, they didn’t grow up with them, so for them, vaccination becomes a matter of faith — but faith in whom? Faith in pharmaceutical companies, faith in the federal government, faith in doctors — and there’s been an erosion in that kind of faith, so it’s really a cultural problem.

The question is, what compels people in the developed world to get vaccines? People are generally compelled by their fears, so it will be fear of measles that will make them get the vaccine. But what causes people to fear measles? There are two options: 1) seeing it again, which you would hope you wouldn’t have to resort to that to get people interested in measles; and 2) a massive educational campaign about what measles can look like if you continue to play this dangerous game of not vaccinating.

Paul Offit, MD, is chief of the division of infectious diseases and director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

Comprehensive child health program needed

I don’t know if it’s feasible, but it’s possible. Is it likely? I’m not certain. I think a great deal depends on how you organize the infrastructure and the implementation in those countries that are not organized, in the resource-poor countries, in countries where the finances are a real challenge. There gets to be donor fatigue. The Measles Initiative program, which has been really successful so far, is already talking about being short $60 million for next year.

Another thing is that there is a lot of competition, if you will. People want to eradicate polio; people want to do something about meningococcal disease and the meningitis belt of Africa. It’s hard to pick out a single disease like measles and say this is what we’re going to focus on for the next 10 years.

My own approach would be to talk about child health in general and put all of these things together into a single program. I know the Measles Initiative has been very good about that. They don’t just go into a community and vaccinate for measles; they try to do measles and polio, they give vitamin A to the kids, they give tetanus toxoid to women of child-bearing age, they give albendazole or mebendazole for intestinal parasites, and they try to supply insecticide-treated bed nets for malaria. All of those need to be organized in a way that is not just a single program for a disease but a collaborative program.

I’d also like to see us get away from an injectable vaccine. One approach is inhalation. The other, which I think is even more exciting and perhaps more feasible, is the so-called dermal patches. If we could get away from needles and syringes and the problems of how you safely dispose of the needles and syringes after you use them, it would greatly ease the ability to get the measles vaccine going in a number of these countries where both the finances and the organizations of the health systems are such that it’s very difficult.

Samuel L. Katz, MD, is Wilburt Cornell Davison Professor and chairman emeritus of pediatrics at Duke University Medical Center in Durham, N.C.