Measles Control & Eradication Efforts Fall Short of 2015 WHA Goals

An analysis published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) suggests that the world healthcare community has made significant strides in addressing the public health implications for measles in children, but that there is still significant work that needs to be accomplished.

In 2000, the United Nations established a goal of reducing child mortality by two thirds, globally, by 2015, with increased access to measles vaccination as a key component of the effort. Ten years later, the World Health Assembly (WHA) set three milestones related to the disease: to increase vaccination coverage, to reduce measles mortality by 95%, based on estimates from 2000, and to reduce overall incidence of the virus by 2015.

Although the authors of the MMWR analysis emphasize the “progress” that has been made toward achieving these and other related goals, they find that “none of the 2015 milestones or elimination goals were met.”

For example, efforts to increase access to and uptake of measles vaccine, while successful, fell short of the WHA’s stated goal of increasing “routine coverage with the first dose of measles-containing vaccine (MCV1)” among children to ≥90% nationally and ≥80% in every district within participating countries. Indeed, based on World Health Organization and United Nations Children’s Fund (UNICEF) usage data for 194 countries, the authors of the MMWR analysis found that MCV1 coverage increased globally from 72% in 2000 to 85% in 2015, although it has remained flat since 2009. Similarly, “the number of countries with ≥90% MCV1 coverage increased from 84 (44%) in 2000 to 129 (66%) in 2012,” before declining to 119 (61%) by 2015. The number of countries reporting ≥80% MCV1 coverage in all districts increased from 2% in 2003 (the first year for which data is available) to 44% in 2012, before declining to 39% in 2015.

The authors of the MMWR report noted that in 2015, approximately 11 million of the estimated 20.8 million infants who did not receive MCV1 through routine immunization services came from six countries: India, Nigeria, Pakistan, Indonesia, Ethiopia, and the Democratic Republic of the Congo. Importantly, though, from 2000 to 2015, the number of countries providing MCV2 via routine immunization services increased from 97 to 160.

The WHA’s objectives also sought to reduce the global incidence of measles annually to <5 cases per 1 million population as well as reduce mortality. Again, based on data reported to the WHO and UNICEF, the MMWR authors found that the number of measles cases reported annually worldwide decreased from 853,479 in 2000 to 254,928 in 2015, a decline of 70%; similarly, measles incidence over that period declined 75%, from 146 cases per 1 million population to 36 cases per 1 million population—a significant reduction, but still well short of the stated goal. The authors noted that outbreaks in 2014 to 2015 in several regions, including Africa, the Mediterranean, and Europe may have contributed to the failure to achieve the benchmark.

Finally, estimates of measles deaths between 2000 and 2015, according to the MMWR authors, revealed a 79% decline in overall mortality, again, short of the goal. The authors did conclude, however, that measles vaccination prevented approximately 20.3 million infections over the 15-year period.

In their concluding remarks, the authors noted, “The decrease in measles mortality is one of four main contributors (the others are decrease in mortality from diarrhea, malaria, and pneumonia) to the decline in overall child mortality worldwide… but continued work is needed to help achieve regional elimination [of measles]. Of serious concern is the possibility that the gains made so far and future progress in measles control and elimination could be threatened if polio-funded resources that support routine immunization services, measles [supplemental immunization activities], and measles surveillance activities diminish or disappear following polio eradication. Those countries with the highest measles mortality rely most heavily on polio-funded resources and are at highest risk if these resources are not transitioned to adequately support other parts of the immunization program after polio eradication is achieved. Countries and partners need to act urgently to secure political commitment, raise the visibility of measles, increase vaccination coverage, strengthen surveillance, and mitigate the threat of resources for immunization programs decreasing once polio eradication is achieved.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.