While reported measles cases have decreased compared to previous years, progress toward measles eradication continues to slow and the risk of outbreaks is increasing, according to a new report from the World Health Organization (WHO) and the U.S. Centers for Disease Control. and Prevention (CDC). In 2020, more than 22 million infants missed their first dose of measles vaccine — 3 million more than in 2019, the largest increase in two decades and creating dangerous conditions for outbreaks to occur.
Compared to the previous year, the number of reported measles cases fell by more than 80 percent in 2020.
However, measles surveillance also deteriorated with the lowest number of samples sent for lab testing in more than a decade. Weak monitoring, testing and reporting of measles for measles is jeopardizing countries’ ability to prevent outbreaks of this highly contagious disease. Major outbreaks of measles occurred in 26 countries and accounted for 84 percent of all reported cases in 2020.
“Large numbers of unvaccinated children, measles outbreaks, and disease detection and diagnostics being diverted to support COVID-19 responses are factors that increase the likelihood of measles-related deaths and serious complications in children,” he said. Kevin Cain, MD, CDC’s Global Immunization Director. “We must act now to strengthen disease surveillance systems and close immunity gaps, before travel and trade return to pre-pandemic levels, to prevent deadly measles outbreaks and reduce the risk of other vaccine-preventable diseases.”
Fewer reported measles cases in 2020 may not mask growing measles risk for children worldwide
The ability of countries to ensure that children receive both recommended doses of measles vaccine is an important indicator of global progress toward the elimination of measles and the ability to prevent the spread of the virus. First dose coverage fell in 2020 and only 70 percent of children received their second dose of measles vaccine, well below the 95 percent coverage needed to protect communities from the spread of the measles virus.
In addition to worsening immunity gaps worldwide, 24 measles vaccination campaigns in 23 countries, originally planned for 2020, were postponed due to the COVID-19 pandemic, leaving more than 93 million people at risk for the disease. These additional campaigns are needed when people have missed measles-containing vaccines through routine immunization programs.
“While the number of reported measles cases has declined in 2020, some indications suggest that we will likely see the calm before the storm as the risk of outbreaks continues to rise around the world,” he said. dr. Kate O’Brien, director of WHO’s Division of Immunization, Vaccines and Biologics. “It is critical that countries vaccinate against COVID-19 as soon as possible, but this requires new resources so that it does not come at the expense of essential immunization programs. Routine vaccination should be protected and reinforced; otherwise we risk trading one deadly disease for another.”
Immunization and surveillance systems need to be strengthened to reduce the growing risk of measles
The COVID-19 pandemic has caused significant disruptions to immunization services and changes in health seeking in many parts of the world. While the measures used to reduce COVID-19 – masking, washing hands, distancing – also reduce the spread of the measles virus, countries and global health partners must prioritize finding and vaccinating children against measles to reduce the risk of explosive outbreaks and preventable deaths as a result reduce disease.
Measles is one of the world’s most contagious human viruses, but it is almost completely preventable through vaccination. In the past 20 years, the measles vaccine is estimated to have prevented more than 30 million deaths worldwide. The estimated number of measles deaths has fallen from approximately 1,070,000 in 2000 to 60,700 in 2020. The estimated number of measles cases in 2020 was 7.5 million worldwide. Measles transmission within communities is not only a clear indicator of poor measles vaccination coverage, but also a known marker, or ‘tracer’, that vital health services are not reaching the populations most at risk.
The Measles and Rubella Initiative
The Measles & Rubella Initiative (M&RI) is a partnership between the American Red Cross, the United Nations Foundation, the American CDC, UNICEF and the WHO. In partnership with Gavi, the Vaccine Alliance and other stakeholders, the initiative is committed to achieving and preserving a world free of measles, rubella and congenital rubella syndrome. Since 2000, M&RI has helped deliver a measles vaccine to children around the world and saved more than 31.7 million lives worldwide by increasing vaccination coverage, responding to outbreaks, monitoring and evaluation, and building trust and support the demand for vaccination.
By the end of 2020, 81 countries (42 percent) had managed to maintain their measles elimination status despite the pandemic, but no new countries had been verified to have achieved measles elimination. There are still 15 countries that have not included the second dose of measles in their national vaccination schedule, making children and adolescents in these countries particularly vulnerable to measles outbreaks.
“For more than two decades, Red Cross volunteers have been reaching members of their communities in need of life-saving vaccines. Volunteers provide critical health information to families through encouragement and a familiar face. This has helped change the mind and heart to vaccinate millions of children in these communities,” says Koby Langley, Senior Vice President of the American Red Cross International Services and Service to the Armed Forces Department. “With the ongoing global effects of the COVID-19 pandemic, this work is vital. Now more than ever, we need to reach children who are not protected from deadly diseases and prevent further outbreaks.”
“The pandemic is having a huge impact on countries’ ability to provide essential health services such as routine immunization, putting millions of people, mostly children, at risk of highly contagious diseases such as measles. Our priority at Gavi is to help countries reduce this risk and prevent disease outbreaks by closing the growing immunity gaps by boosting routine immunization and conducting well-planned, targeted catch-up campaigns,” said Gavi. Anuradha Gupta, Deputy CEO, Gavi the Vaccine Alliance. “We urgently need to address the critical gaps in measles immunity, with a particular focus on reaching no-dose children most at risk of devastating measles outbreaks.”
“Even before the pandemic, we saw how even small pouches of low vaccination coverage against measles could fuel unprecedented outbreaks, including in countries where the disease was considered eradicated. And now, COVID-19 is creating wider coverage gaps at a rate we haven’t seen in decades,” said Ephrem Tekle Lemango, UNICEF Associate Director for Immunization. “While we haven’t seen an increase in cases yet, measles is just too contagious. If we don’t act, gaps will turn into eruptions and many children will be exposed to a preventable but potentially fatal disease,” he added.
“The decline in reported measles cases means we need to redouble our efforts to protect the millions of children at risk from dying from a completely preventable disease,” says Lori Sloate, Senior Director of Global Health at the UN Foundation. “The straightest course is to work together to harness scarce resources investing in strengthening the local health system’s efforts to tackle both covid and basic immunization. One should not come at the expense of the other.”