As measles epidemics skyrocket, global response lags

September 12, 2011

As measles epidemics skyrocket, global response lags © Sven Torfinn

On September 13-14, 2011, the Measles Initiative will meet in Washington, D.C., bringing together organizations seeking to eliminate measles disease worldwide. Given the troubling resurgence of measles epidemics over the last three years, Médecins Sans Frontières (MSF) is calling for an effective outbreak response mechanism to be established immediately, with secure financial and technical resources.

"We know for a fact that there will be additional epidemics in the near future," says Florence Fermon, MSF's vaccination coordinator. "It would simply not be right to wait for them to occur. We need an effective system to anticipate and prepare for the coming outbreaks."

Since 2008, MSF has responded to epidemics that have expanded over time. In 2010 for example, more than 4.5 million children were vaccinated in an emergency in many countries: Yemen, Zimbabwe, Chad, Swaziland, South Africa, Malawi, and Nigeria. This year, medical teams in the Democratic Republic of Congo (DRC) vaccinated three million children, but could not halt the epidemic. Despite data showing the urgent need for action, actors in the field were slow to organize. The DRC is no exception. Most countries that experience these epidemics do not adequately mobilize the resources available to them and organize vaccination campaigns.

"The fight against measles is no longer seen as a political priority – not within ministries of health, which must make trade-offs for public health, and not by donors, who are reducing funding," says Gwenola François, measles vaccination campaign manager in the DRC. "However, NGOs like MSF cannot just rush in to put out the fires caused by the structural deficiencies of measles prevention programs."

Recurring measles epidemics point to the weaknesses of vaccination programs and demonstrate the failure of global strategies to eliminate the disease. There are many flaws in prevention activities (systematic vaccination or follow-up campaigns), including over-estimating the rate of vaccination coverage, the rigidity of limiting vaccination before the age of 1, delays in and cancellations of certain follow-up campaigns, and the failure to identify areas at risk of outbreaks.

In addition, weak monitoring systems cannot detect outbreaks quickly.Official declarations of epidemics come too late and adequate responses are not implemented fast enough. Ultimately, an increasingly large group of children at risk of measles has formed over the years and has become large enough to trigger an epidemic.

With additional epidemics imminent, vaccination policies should be revised completely -- both in terms of epidemic response and preventive vaccination programs to achieve optimal protection against future outbreaks in high-risk areas. To prepare for the coming epidemics, these efforts require actual technical and financial resources that can be mobilized quickly. Measles treatment must also be incorporated systematically into overall public health strategies.

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