Global health leaders issue call to action for measles eradication

Various authors. J Infect Dis. 2011;204(suppl 1).

Issue: August 2011

Measles incidence has decreased about 80% in the past 10 years, but increased funding and political backing are needed to completely eradicate this deadly disease, according to a special supplement published this month by the CDC and other global health leaders.

The Journal of Infectious Diseases supplement contains 71 comprehensive articles that outline the global effect of the disease, eradication goals and possibilities, and surveillance issues. The supplement was published at a time when importations of measles into the Western Hemisphere continue to climb, and endemic transmission from children who have not been vaccinated is becoming increasingly common. So far this year, 152 measles cases have been reported, according to CDC data.

Despite rising numbers in the United States this year, authors of an editorial in the supplement said there has been “impressive” progress in eradicating measles.

Before vaccines, more than 90% of children had measles by the time they were 15 years of age, according to Peter Strebel, MPH, and colleagues at WHO. After vaccine introduction, rates declined by “an impressive 78% from an estimated 733,000 deaths in 2000 to 164,000 in 2008.” These reductions prompted WHO leaders to eye a goal of reducing measles mortality by 90% by the end of 2010. But a resurgence of measles in 2009, particularly in sub-Saharan Africa, forced global health leaders to push this goal to 2015. Much of this resurgence has been attributed to the HIV/AIDS epidemic there, and a study published in the supplement also alluded to suboptimal coverage in certain areas as being partially to blame.

Other regions of the world are also experiencing outbreaks, including France, which is currently dealing with an outbreak that has affected about 10,000 people this year alone. The now-retracted Wakefield study, which claimed to have found a link between autism and vaccines, had a particular negative effect in Europe. After that article, there was a decrease in the number of people who were immunized because of suspicions about vaccines from parents.

Exacerbating these outbreaks is the fact that financial support for the Measles Initiative, which is a collaboration of several organizations such as UNICEF, WHO, Red Cross and the CDC, has waned in recent years, decreasing from $150 million in 2007 to just $35 million in 2010. These funding cuts could result in an “additional 200,000 measles deaths this year, rising to a worldwide total of more than 500,000 deaths in 2013,” the researchers said.

According to the authors of the supplement, this decrease in funding is unfortunate because “the availability of an inexpensive and effective vaccine makes measles immunization one of the most cost-effective public health interventions across a range of development settings,” they wrote.

The International Task Force for Disease Eradication completed a review in 2009 and concluded that measles eradication is biologically feasible. Programmatic feasibility has been demonstrated by the Region of the Americas sustained elimination, they wrote in their report. A year later, at the 63rd World Health Assembly, member states endorsed the following accelerated measles control targets to be achieved by 2015: “Exceed 90% coverage with the first dose of measles-containing vaccine (MCV) nationally and exceed 80% vaccination coverage in every district; reduce annual measles incidence to less than five cases per million and maintain that level; and reduce measles mortality by 95% or more, compared with 2000 estimates.”

The main obstacle is operationalizing the political commitment and biological feasibility to a high level of social commitment on all levels, according to the supplement authors.

Graegar Smith, MBA, of the Chicago management consulting firm Oliver Wyman and colleagues, said in the supplement that vaccine availability would likely not be a problem. Their study concluded that “5.9 billion doses would likely be needed with a 2020 eradication goal; in the most intensive scenario, demand could increase to 7.5 billion doses. These volumes are within existing and planned MCV-manufacturing capacity, although there are risks.”

The researchers in that study said in some markets, capacity is concentrated, so “supply-chain disruptions could reduce supply or increase prices.” They recommended mitigation strategies in the interim, including “stockpiling, long-term contracts and further coordination with manufacturers.”

The supplement contained global data indicating that measles elimination is feasible. In one of the studies, researchers from Pan American Health Association (PAHO) looked at data from the Region of the Americas.

In that study, the researchers said: “Regional vaccination coverage increased during the period 1987–2010, sustained at 90% or more since 1998. Measles elimination efforts led to the implementation of 157 national vaccination campaigns, vaccinating a total of 440 million people. Endemic measles virus transmission was interrupted in 2002. After elimination, measles importations and associated outbreaks occurred. Measles incidence has remained at less than one case per 1 million population since 2002.”

Another study that looked at a nationwide measles-rubella immunization campaign, targeting children, adolescents and young adults aged 2 to 20 years in Egypt, showed similar successes. “With the decrease to record-low levels of cases of measles and rubella in 2009 and 2010, Egypt should achieve measles and rubella elimination in the near future, but high coverage (.95%) with two doses of measles-rubella vaccine needs to be maintained, measles-rubella surveillance strengthened, and CRS surveillance developed,” the study concluded.

Disclosure: The researchers in the commentary and studies mentioned did not report any relevant financial disclosures.

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