Act decisively to eliminate measles

The WHO South-East Asia region is making rapid progress in the fight against vaccine-preventable diseases. The region was certified polio-free in 2014. Maternal and neonatal tetanus was routed in 2016. And routine immunisation for diseases such as diphtheria and pertussis continues to expand. More than 90 per cent of populations region-wide are now accessing the life-saving benefits vaccines bring.

Health authorities now have measles in their crosshairs. Measles is a virus that can be transmitted through airdrops, personal contact and infected surfaces, and can inflict a range of deadly complications including pneumonia, diarrhoea, encephalitis and malnutrition.

Target 2020 Governments have committed to eliminating the problem by 2020. Two doses of measles-containing vaccine have now been introduced in each of the region’s 11 countries. 95 per cent coverage of both doses has been achieved in five. Where routine childhood vaccination programmes are less than ideal, supplementary immunisation drives have helped close immunity gaps. In 2015 alone around 18 million children were reached by supplementary campaigns, while an estimated 640 000 lives were saved.

There is, nevertheless, a need to scale up action. Measles is a major childhood killer, claiming an estimated 54 500 lives in 2015. Up to 5.5 million infants are deprived of even the first dose of the vaccine each year, many of whom are the most at risk of death if complications arise. Region-wide coverage of the second dose, meanwhile, is 71 per cent, signifying the need for further gains.

WHO is advocating for all of the countries to eliminate measles by 2020 — a target that is achievable. But health authorities and communities must act decisively.

To this end, strengthening routine immunisation programmes is critical. Though supplementary campaigns are useful to close immunity gaps in the short run, routine systems should be strengthened and coverage enhanced. In each of the countries the second dose should be provided to every eligible child, and communities being missed should be identified and catered for: At least 95 per cent of children region-wide should be covered by both doses of measles-containing vaccine. At the same time, in countries where most children are now covered by vaccinations, and where the disease is seen in adults, efforts should be made to achieve immunity at all ages.

Monitor and conquer Improving surveillance and laboratory capacity is likewise essential. Though each country has, to varying degrees, implemented functional surveillance systems, not all cases are reported or laboratory confirmed. Therefore, health authorities should reinforce and expand surveillance to the community level. That’s why society-wide buy-in is important. This means encouraging health-seeking behaviour when measles-related symptoms such as fever and rash occur. It means addressing socio-cultural issues while creating greater awareness. It means establishing and maintaining political commitment at the local and national level. And it means leveraging support from international stakeholders to mobilise resources and know-how. WHO is privileged to be a part of these efforts, and to support countries as they strive to eliminate measles’ preventable burden.

The wider benefits of measles vaccination strengthening will be substantial. This is especially so for the control of rubella, a disease that affects approximately 40 000 births in the region every year, and can cause a series of conditions such as deafness and heart disease when transmitted from mother to foetus. At the start of 2017 rubella vaccine was part of a combination vaccine in eight of the 11 countries. In February, India became the ninth; in August, Indonesia will make it ten. Mass immunisation catch-up campaigns will have wide-ranging impact , and will enhance the life chances of millions of children.

As countries scale-up their campaigns, this point must stay front-of-mind. By eliminating measles, millions of children will be given the opportunity to grow and prosper where they otherwise may not have. Health systems will be strengthened, and other diseases better controlled. For the South-East Asia region, and each of the countries within it, measles elimination is a cause worth mobilising for.

The writer is Regional Director, South-east Asia, WHO

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