In a warning over dangerously low vaccination levels and large outbreaks in several countries – spurred on by social media “misinformation campaigns” – the UN health agency insisted that anything less than 95 per cent coverage risked sparking an outbreak.
In the Pacific island nation of Samoa, just 31 per cent of the island’s people have immunity against measles, the WHO said, highlighting the impact there of a single anti-vaccine group’s social media messaging (whose leader has been just arrested).
The situation has resulted in a major health crisis, with hospitals and clinics reportedly overwhelmed and struggling to treat the most vulnerable – children under the age of five – and other patients with chronic illnesses including diabetes.
More than 60 mainly babies and young children have died since the epidemic began, with over 4,200 recorded cases, and on Thursday the Government ordered a national shutdown ahead of a mass vaccination campaign for the entire population.
“Misinformation that is spread through social media channels is really affecting the decisions of parents around whether they are going to vaccinate their children and the impact is that children are developing measles and some of them are dying,” said Dr Kate O’Brien, WHO’s Director of Immunization, Vaccines and Biologicals.
‘A collective failure’
“We are all aware that there’s a safe and effective and affordable and widely available vaccine to prevent measles, it’s been around for 50 years. Hundreds of millions of people have received the vaccine and it’s really a collective failure that these outbreaks are happening and an increase in the number or cases and deaths, and the underlying reason is that people are not vaccinated.”
Today, average global vaccine coverage against measles is around 86 per cent – up from 72 per cent in the year 2000 – a measure that WHO has credited with saving more than 23 million lives during that time.
Although this is a major public health achievement – and the reason why measles deaths since the turn of the century decreased from 535,000 to 142,300 last year, little progress has been made on improving vaccine coverage “in about a decade”, Dr O’Brien explained.
Backsliding has led to increase in infections
“We are on a trajectory that is going in absolutely the wrong direction…it’s not just a 2018 phenomenon. We’re actually seeing an increase in the reported cases to date in 2019 that will substantially exceed the number in 2018,” she said.
According to WHO’s latest measles data, suspected and confirmed cases of measles in 2019 (614,915 suspected, 413,308 confirmed) were both higher than in 2018 (483,215 and 333,445 respectively).
“We have to really move from putting out fires, responding to outbreaks all the time and strengthen the essential immunization programmes so that we’re not facing these situations country by country, month in, month out, year in, year out,” Dr O’Brien insisted.
The best way for countries to protect themselves is by having a strong immunization programme, she added, based on a two-dose vaccine where the first is given to infants “at the earliest possible age”.
Noting that some countries do not have a second-dose policy in place, the WHO official urged all ministries of health to incorporate this measure into their national immunization programmes as a global standard.
The move would go a long way to improving community resistance to measles, which is widely regarded as a “litmus test” for any country’s health system, Dr. O’Brien maintained.
Measles linked to ‘immune amnesia’
Underscoring the wider impact of the disease, the WHO official also cited recently published evidence showing that contracting measles can also damage the immune system’s “memory” for months or even years following infection.
This “immune amnesia” leaves survivors vulnerable to other potentially deadly diseases, Dr. O’Brien explained, such as influenza or severe diarrhoea.
Measles, which is highly contagious, is transmitted via droplets from the nose, mouth or throat of infected people.
According to the WHO, it is more likely to impact poorly nourished youngsters, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.
Initial symptoms, which usually appear 10–12 days after infection, include high fever, a runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.
Complications include blindness, brain swelling (encephalitis), severe diarrhoea and respiratory infections such as pneumonia.
Worst impact in Sub-Saharan nations
While global measles deaths have decreased since the year 2000, the worst impacts – and highest number of fatalities – are in countries “where many children have persistently missed out on vaccination”, particularly in sub-Saharan African States.
By region, WHO estimates that the African region saw 1,759,000 total cases and 52,600 deaths last year.
- Eastern Mediterranean: 2,852,700 cases and 49,000 deaths
- European region: 861,800 cases and 200 deaths
- Southeast Asia: 3,803,800 cases and 39,100 deaths
- Western Pacific: 408,400 cases and 1,300 deaths
- Americas: 83,500 cases
In 2018, the countries with the highest number of infections were the Democratic Republic of the Congo (DRC), Liberia, Madagascar, Somalia and Ukraine, according to the WHO report.
Together, these five countries accounted for almost half of all measles cases worldwide.
In the DRC, which is battling insecurity linked to armed groups and an Ebola virus outbreak that has claimed more than 2,000 lives, its ongoing measles outbreak is the largest outbreak ever witnessed globally, with more than 5,000 deaths since January this year.
Nine in 10 victims in DR Congo outbreak, children under-five
According to the UN Children’s Fund, UNICEF, over 90 per cent of the measles victims – 4,500 – have been children under the age of five.
Wealthier countries have also been battling outbreaks, WHO added.
These include the United States – which reported its highest number of cases in 25 years – while four European nations – Albania, Czechia, Greece and the United Kingdom – lost their “measles elimination status” in 2018 following protracted outbreaks.
This happens if measles re-enters a country after it has been declared eliminated, and if transmission is sustained continuously in the country for more than a year.