As the year limps to the finish line, new data from the World Health Organization and the CDC is shedding light on just how much we are losing ground in the fight against suffering and death caused by measles, a vaccine-preventable viral infection. According to the new estimates released last week, more than 140,000 people lost their lives in 2018. Most of these deaths occurred in young children:
Most deaths were among children under 5 years of age. Babies and very young children are at greatest risk from measles infections, with potential complications including pneumonia and encephalitis (a swelling of the brain), as well as lifelong disability – permanent brain damage, blindness or hearing loss.
Prior to the development of a safe and effective vaccine, which was introduced in 1963, there were millions of measles cases around the world and about 2.6 million deaths each year. The success of the vaccine, largely thanks to donor-driven efforts to reach the poorest regions of the world where the risk of death is higher, has been incredible. Though there have been serious concerns over lower than desired vaccine coverage in many areas, both resource poor and rich, worldwide measles deaths plummeted to an all-time low of 90,000 in 2016.
Since 2016, cases of measles have increased steadily, so it should come as no surprise that there have been more deaths. In 2017, 110,000 people died as a result of the virus. The 2018 data, as described above, confirms two consecutive years with a significant increase in mortality. 2019 is likely going to give us a third.
I’ve written about our 2019 year of measles here in the United States, which at nearly 1,300 cases is the worst since 1992. Things haven’t been any better worldwide, with the most cases since 2006 being reported though the first half of the year. When the 2019 mortality data is eventually made available, I’ll almost certainly cover it on SBM. Prepare yourself for the possibility that somewhere in the ballpark of a quarter of a million children will have died this year.
Of course, the number of reported deaths caused by measles each year is almost certainly an underestimate of how many ultimately will die from the infection. In October, the concept of immune amnesia in the aftermath of measles infection was a hot topic because of new and confirmatory data. Children who survive a bout of measles, in addition to the possibility of death years later from SSPE, are also at increased risk of serious infections because of an impairment of the immune system that can last for years.
Why are measles cases increasing? Unfortunately, the success of the worldwide vaccine program peaked about a decade ago. Currently only 86% of children around the world receive the first of two recommended doses of the measles vaccine, and only 70% get the second. This is well below the percentage required to prevent outbreaks, which because of the extreme communicability of the virus is 95%. That gap in coverage allows for outbreaks, and currently every WHO region is experiencing at least one that is large and extended.
These numbers reflect average coverage percentages, which means that there are large numbers of children who live in so-called hotspots where coverage rates are sometimes considerably lower. As I discuss in the post I’ve just linked to, this can represent bastions of anti-vaccine ideology in wealthy nations such as the United States. Or, as discussed in the WHO/CDC news release on the 2018 death toll, an insufficient access to appropriate care in resource poor regions plays the largest role:
In 2018, the most affected countries – the countries with the highest incidence rate of the disease – were Democratic Republic of the Congo (DRC), Liberia, Madagascar, Somalia and Ukraine. These five countries accounted for almost half of all measles cases worldwide.
What are we doing about it? Although we often focus on anti-vaccine propaganda and the effect of it on immunizations rates, that’s not the issue that is causing the most harm worldwide. That distinction unequivocally belongs to poverty, which results in both lower immunization rates and increased risk of morbidity and mortality when measles infections occur.
In 2001, the American Red Cross, the CDC, the United Nations Foundation, UNICEF and the WHO founded the Measles & Rubella Initiative:
The M&RI aims to reach the measles and rubella elimination goals of the Global Vaccine Action Plan by supporting countries to raise coverage of measles, rubella and other vaccines; fund, plan, implement and monitor quality supplementary campaigns; investigate outbreaks and provide technical and financial support for effective outbreak response, propose and participate in solutions to strengthen immunization delivery; and support a global laboratory network for measles and rubella.
This program has been astoundingly successful, having provided vaccines for just shy of 3 billion children around the world and saved millions of lives. One of the stated goals of the M&RI though has been to eliminate measles in five of the six WHO regions by 2020. Sadly, we don’t appear to be on target to do that. Measles is almost completely preventable, and it really could be eliminated from the Earth just as smallpox was decades ago. All that is needed is money and the political will to make it happen. (Insert joke about politics here)