Good News About Measles

Stephen DeAngelis

December 7, 2007

Very quietly — but very effectively — a global campaign has been waged against measles. This, of course, is good news. A healthy population is essential for development. It is one of the pre-conditions I have noted in previous posts that helps programs like Development-in-a-Box™ be implemented more effectively. While efforts to confront other diseases, like malaria and HIV, have received a lot of media attention, the campaign to fight measles has labored mostly in obscurity according to David Brown [“Globally, Deaths From Measles Drop Sharply,” Washington Post, 30 November 2007].

“Worldwide deaths from measles have fallen by two-thirds since 2000, the result of stepped-up immunization efforts and the distribution of vitamin A capsules in developing countries, [according to] a partnership of five health organizations. … Africa, which has long had the most measles deaths, has seen the biggest drop, 91 percent. In many villages, measles shots, polio vaccines, deworming pills and insecticide-treated mosquito nets for malaria prevention are all being given out together. Measles mortality has fallen less steeply in India and Pakistan, but campaigns are now starting there. The dramatic results are the product of a little-known project, the Measles Initiative, launched in 2001. The news comes as the better-known Global Polio Eradication Initiative is struggling to complete its job, nearly eight years over a self-imposed deadline.”

Many people are surprised that polio remains a problem in the developing world. In America, only those in Generation X and older remember how traumatic polio was for families before the development of vaccines. The same thing may be true for measles as well. Gen X’ers also have the distinction of being one of the last generations to bear the scars of smallpox vaccinations. With plenty of new diseases to worry about, like avian flu and super bacteria, getting a handle on more traditional communicable diseases is critical. Brown reports that like polio and smallpox:

“Measles is a potentially eradicable disease, as well, but experts said yesterday that is not their goal now. The initiative hopes to cut annual worldwide measles deaths by 90 percent by 2010. ‘At the moment, there is really not the political commitment to embark on another global eradication effort,’ said Peter Strebel, an epidemiologist at the World Health Organization, one of the measles partners. ‘It is an unwise strategy to, as it were, fight on two fronts at the same time.’ Only one disease, smallpox, has ever been eradicated. Measles is among the most contagious diseases in the world, spread through the air in droplets coughed out by infected people. Symptoms include fever, cough, rash, pneumonia and diarrhea. In developing countries, mortality rates are 5 to 15 percent of its victims, sometimes higher during epidemics. Most children recover fully, but a few are left blind or deaf. Children deficient in vitamin A, which is essential for robust immunity, are at especially high risk. In 2000, global measles mortality was 757,000. In 2006, it was down to 242,000 — a drop of 68 percent. In 1990, there were about 1.06 million measles deaths, more than four times the current annual total. ‘This is a major achievement in global health,’ said Kathy Bushkin Calvin, an official of the United Nations Foundation, one of the partners.”

One of the reasons that the campaign has been so successful is that women became involved. I keep wondering when we are going to finally learn what a powerful force for good women can be when they are committed to a cause. In previous discussions about Development-in-a-Box, I have noted how important it is to identify and involve communities of interest. The communities of interest must include local leaders and citizens if programs are going to be successful. The measles campaign bears this out.

“Luis Gomes Sambo, Africa region director of the World Health Organization, one of the other partners, said ‘individual communities, and especially women, played a very, very important role’ in reducing the deaths so much. The other partners are the American Red Cross, UNICEF, and the Centers for Disease Control and Prevention. The initiative has cost $470 million to date, with $130 million provided by the Red Cross. “

When discussing programs being implemented in the developing world, success is often measured by the percentage of the population the program has reached (coverage). For measles, program coverage is quite high.

“The portion of African children receiving the first dose of measles vaccine on time has risen from 56 percent to 73 percent in the last five years. It is now higher than South Asia’s 65 percent. Worldwide, coverage has gone from 72 to 80 percent, an unprecedented high. Coverage among American kindergartners last year was 96 percent. In addition to better routine coverage, nearly half a billion supplementary shots have been given since 2000 as part of the measles initiative. In terms of cost-effectiveness, few health measures can rival measles vaccination. In a group of southern African countries where ‘catch-up’ vaccination was done in 2001, the average cost of a life saved was $319.”

Technology has played significant role in achieving these coverage rates according to Brown.

“The initiative is the first mass health project in the developing world to use hand-held computers in coverage surveys conducted to measure the success of interventions. Normally, that work is done with pen, paper and clipboard, and tabulating data takes weeks or months. In October 2005, surveyors in tsunami-struck Aceh province of Indonesia figured out immediately after a vaccination campaign that as many as 70 percent of children had been missed in some districts. Vaccinators, who had not yet dispersed, were sent back to vaccinate in those areas. More recently, surveyors in Africa have been using pocket computers loaded with an open-source program, EpiSurveyor, developed by a Washington-based nonprofit, DataDyne, to track coverage after supplemental measles vaccination campaigns.”

An interesting sidelight noted by Brown is that most parents in the developing world prefer their children receive vaccination shots rather than oral medication, even though injectable vaccines are more difficult to deliver. They believe, rightly or wrongly, that injections are more potent. This may be because a shot provides a better perception that medicine is actually being delivered. As in many areas, perception matters. Fortunately, in this case, perception supports reality and whether children receive injected or oral medication it works.