Decline in Measles Deaths an Important Milestone, But Not the End of the Race

Paul Lagasse
March 2009

The global effort to roll back measles worldwide is succeeding, but declines in funding threaten to halt further progress.

In early December 2008 the Measles Initiative, an international partnership of the American Red Cross, the United Nations Foundation, UNICEF, and the World Health Organization (WHO), announced that the number of deaths from measles had fallen by nearly three-quarters between 2000 and 2007—-from 750,000 to 197,000—thanks in large part to vaccination campaigns being carried out by Global Impact charities and other non-governmental organizations worldwide.

In 2009 alone, the Measles Initiative expects to vaccinate 76 million children in twenty-five countries. However, charities are concerned that declining funding as a result of the economic downturn could mean the initiative misses its goal of reducing measles deaths worldwide by 90 percent of 2000 rates by the end of the decade.

Rash is Only One Aspect of Measles

Measles is a highly contagious virus that causes flu-like symptoms along with red eyes and skin rashes. Measles weakens the immune system, putting people at risk from complications such as diarrhea, pneumonia, blindness and brain damage. These complications can kill malnourished children. According to UNICEF, in 2004, measles was responsible for 4 percent of all deaths of children under 5 years old, or 410,000 children in one year. While measles deaths have declined since then, an estimated 540 children still die every day from measles worldwide.

Photo: Save the Children Eight year old Boru Wolde waits for his measles vaccination from a Save the Children staff member in Ethiopia. View additional member charity work to combat measles

As dangerous as it can be, measles is easily preventable through the use of safe vaccines that cost less than one dollar per shot and is also easily treatable once infection occurs.

According to Global Impact charity Save the Children, "The measles vaccine is known as one of the most cost-effective public health interventions, offering the highest health return for money spent and saving more lives per unit cost than any other health intervention."

Many member charities provide measles vaccinations to newborns, infants and children as part of routine preventive care services; others have established dedicated measles prevention, treatment and education programs.

Member charity Africare, for example, includes vaccinations as part of its efforts to promote "increased use of essential primary health care services through civil society." For children with measles, vaccinations are supplemented with oral rehydration therapy, antibiotics, clean water, vitamin A shots, nutritious food supplements and health education, significantly reducing the risk of death and long-term injury.

Much Remains to be Done

Photo: UNICEF/NYHQ2005-1497/Asad Zaidi A girl is vaccinated at Abbas Hospital in Muzaffarabad in a government-led measles campaign to vaccinate 4 million children under age 15. Children are also being immunized against tetanus and polio and are receiving vitamin A supplements to boost their immune systems.

Ongoing vaccination programs have all but eliminated indigenous measles outbreaks in the Western hemisphere (overseas exposure has caused recent U.S. cases) and have already reduced measles deaths in Africa and the Mediterranean by 90 percent. However, much work remains to be done in the region stretching from India to Southeast Asia.

India alone accounts for two-thirds of all measles deaths worldwide. In Pakistan, measles still kills 21,000 children each year, despite the world's largest-scale immunization campaign, which recently vaccinated 64 million children. Delays caused by natural disasters (such as Cyclone Nargis in Myanmar), economic and political strife, inaccessible terrain and cultural factors such as indifference to or suspicion of vaccinations have hindered large-scale vaccination and treatment programs in these regions.

One of the United Nations' Millennium Development Goals is to reduce the mortality rate among children under five by two thirds by 2015. Global measles vaccination and treatment is an important component of that ambitious goal and it can still be achieved. The challenge of finding ways to reach those who are the hardest to reach was daunting even before the economic downturn; as funding sources dry up, charities are at risk of losing precious momentum in sight of the finish line. With your support, member charities can continue to move towards their goal of creating a world in which measles deaths are all but history.

Global Impact Member Charities with Measles Programs

Here is just a sampling of Global Impact member charity programs dedicated to combating measles worldwide:

Doctors Without Borders/Médecins Sans Frontières specializes in rapid-response measles vaccination campaigns that set up inoculation centers in areas with reported outbreaks, as well as treating children who have contracted the disease. A typical intervention might last no more than two or three weeks, but in that time doctors can inoculate several hundred thousand children. Recent campaigns have vaccinated 120,000 children in North Kivu, DR Congo; 300,000 children in Niger; and 170,000 children in Indonesia.

Africare's immunization programs focus on children under five as well as pregnant women and are essential components of Africare's efforts to improve public health infrastructures in African countries. For example, vaccinations were a key component of the five-year Improved Community Health Project in Liberia, which also included education in reproductive health, good nutrition and prevention of communicable diseases. As a result, full immunization coverage increased from 24 percent to 60 percent. In southwestern Uganda, immunization represented a quarter of the level of effort by the four-year Community Integrated Management of Childhood Illnesses (CIMCI) project to reduce childhood morbidity and mortality among nearly 40,000 children under five and 43,000 women. Nearly 81 percent of children between the ages of 12 and 23 months received a measles vaccine.

Save the Children has ongoing efforts to reduce the prevalence of measles in Afghanistan, Bangladesh and Mozambique by increasing immunization coverage to 90 percent or more. In 2008, its programs helped increase immunization rates from approximately 10 percent to 60 percent in Afghanistan, from just over 60 percent to over 80 percent in Bangladesh and from 40 percent to over 60 percent in Mozambique.

U.S. Fund for UNICEF is undertaking comprehensive measles vaccination programs throughout India and Southeast Asia. For example, UNICEF trains local staff to carry out week-long "immunization drives" deep into India's remote regions as well as vaccinating children in relief camps who have been displaced by natural and manmade disasters. Similar campaigns in Pakistan, Bangladesh and Afghanistan have so far resulted in over 98 million children between 9 months and 13 years old being vaccinated against measles.

United Methodist Committee on Relief (UMCOR)'s Mother and Child Survival program focuses on nutrition education, training in oral rehydration techniques, immunization against communicable childhood diseases such as measles and growth monitoring to ensure child health. For example, in Côte d'Ivoire and nine other countries, UMCOR teamed with UNICEF, the Measles Initiative, CARE and other aid organizations to include measles vaccinations as part of an integrated health intervention campaign that also provides malaria nets, deworming tablets and vitamin A doses and trains local volunteers in preventive health techniques.

Mobile clinics set up by African Medical & Research Foundation (AMREF) worked hard to contain a measles outbreak in the slums of Nairobi, Kenya's capital city, early last year. Activities included vaccinating hundreds of children and adults per day, administration of vitamin A tablets, deworming, preventive medical screenings and basic laboratory testing. AMREF staff also teamed with local partners to provide counseling to measles victims.

Plan USA's Child Survival project in Mali focuses on improving the health of at-risk children in one district by addressing the most common causes of death. In addition to measles, these include malaria, HIV/AIDS, pneumonia, diarrhea and neonatal complications. In 2006 alone, Plan estimates that its program prevented measles-related deaths in over 500 children. Plan recently returned to Liberia following the end of its devastating civil war to open up health clinics to aid poverty-stricken children with vaccinations, nutrition programs and health education for parents and children alike. Plan also supports vaccination programs in Ethiopia, Kenya and Nicaragua.

ChildFund International (formerly Christian Children's Fund) ChildFund International's health interventions for children under five living in remote locations includes national immunization programs that target measles and other communicable diseases, as well as the distribution of vitamin A. For example, ChildFund International has been active in Togo since 1984 providing vaccinations as part of health and sanitation programs that serve 3,600 children and families. ChildFund International also specializes in emergency health interventions; in October 2005, following the devastating Southeast Asian tsunami, ChildFund Indonesia, a ChildFund International emergency response team, set up a free vaccination clinic for over 1,100 displaced children in the coastal city of Bireun.

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