When it comes to health issues, it is unsurprising the pandemic of COVID-19 dominates the conversation. Yet, as we appraise the gravity of COVID-19, it is important to remember that the world grapples with a plethora of public health concerns. Among them is measles – and it is deeply concerning that the line of defence offered by the measles vaccine is one tens of millions of children could miss out on in the era of COVID-19.
The World Health Organization (WHO) notes that “before the introduction of [the] measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every two to three years and measles caused an estimated 2.6 million deaths each year.” Now, the situation is different. The WHO notes that “measles vaccination resulted in a 73 percent drop in measles deaths between 2000 and 2018 worldwide.” This was made possible by the increase in immunisation rates using the measles vaccine since the turn of the century. According to the WHO, 86 percent of children worldwide received one dose of the measles vaccine before their first birthday in 2018. The figure in 2000 stood at 72 percent.
Yet children do miss out on the vaccine. This is despite, as the WHO emphasises, the measles vaccine being “safe and cost-effective.” As reported last year by Health Issues India, the past eight years saw more than twenty million children miss out on the first dose of the measles vaccine with almost 170 million children under ten unvaccinated as a result. This was the finding of UN research which – in the Indian context – saw that 2.9 million Indian children did not benefit from the all-important first dose.
The consequences of measles can be horrifying. The United States Center for Disease Control and Prevention (CDC) outlines that “some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalised.” Such consequences can have lifelong implications for health and wellbeing. In terms of mortality, measles led to more than 140,000 deaths among children under the age of five in 2018 alone.
The death toll in just one year from measles in an age group the CDC and other experts identify as being particularly vulnerable to serious complications underscores why the measles vaccine is so important. In the 2000-18 period, 23.3 million deaths were averted because of immunisation against measles according to the WHO, leading the Organization to describe the measles vaccine as “one of the best buys in public health.”
However, the global crisis that has unspooled because of COVID-19 carries with it the potential that receiving the critical dose of the measles vaccine could be a lost opportunity for a staggering number of children. Across 37 countries, more than 117 million children could miss out with 24 nations having postponed measles immunisation drives in light of the crisis.
This grim news came earlier this week from the Measles and Rubella Initiative, an international partnership of agencies including the American Red Cross, the CDC, UNICEF, the United Nations Foundation and the WHO. “The pandemic sweeping the globe requires a coordinated effort and commitment of resources to ensure frontline health workers around the world are protected, as they face and respond to this new threat,” the statement reads. “At the same time, we must also champion efforts to protect essential immunisation services, now and for the future.”
The Initiative pointed to a set of guidelines issued in March by the WHO concerning immunisation, one endorsed by the Strategic Advisory Group of Experts on Immunisation. The objective of such guidelines, the WHO said, is to “help countries protect critical immunisation services during the COVID-19 pandemic, so that ground is not lost in the fight against vaccine-preventable diseases.” Measles, of course, ranks among such diseases.
Dr Katherine O’Brien, director of the Immunisation, Vaccines and Biologicals Programme at the WHO, commented at the time the new guidance was released that the “WHO is working constantly with partners and scientists to accelerate vaccine development for COVID-19, but we must also ensure people are protected against those diseases for which vaccines already exist. The message from this guidance is clear. Countries should take what steps they can to sustain immunization programmes and prevent unnecessary loss of life.”
As explained by the WHO press release
“The guidance calls for countries to prioritize routine immunization of children in essential service delivery, as well as some adult vaccinations such as influenza for groups most at risk. If immunization services must be suspended, it recommends urgent catch-up vaccinations as soon as possible, prioritising those most at risk.
“In line with physical distancing measures, the guidance recommends temporarily postponing preventive immunization campaigns where there is no active outbreak of a vaccine-preventable disease. In the event of an outbreak, however, rapid vaccination campaigns may be essential after a careful risk assessment analysis. Where these are conducted, health workers and the public must be protected from COVID-19 through appropriate hygiene procedures, the guidance states.
“All immunization services must consider the importance of both ensuring people are protected against preventable diseases, as well as the safety of communities and health workers.”
The full guidelines can be accessed here.
“If the difficult choice to pause vaccination is made due to the spread of COVID-19, we urge leaders to intensify efforts to track unvaccinated children, so that the most vulnerable populations can be provided with measles vaccines as soon as it becomes possible to do so,” reads the statement by the Measles and Rubella Initiative. “While we know there will be many demands on health systems and frontline workers during and beyond the threat of COVID-19, delivering all immunisation services, including measles vaccines, is essential to saving lives that would otherwise be lost to vaccine preventable diseases.”
As previously noted by Nicholas Parry for Health Issues India, COVID-19 does not amount to India’s sole health concern. The same is true internationally. India grapples with a dual burden of noncommunicable and infectious diseases, ranging from cancer to tuberculosis. Measles ranks among the major perils faced by vulnerable populations and the very real potential for COVID-19 to disrupt immunisation schedules is not one the world should take lightly.