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Wednesday, Aug 21, 2019

How India can eliminate measles, protect its children

A favourable policy environment to vaccinate children and older age groups will help the country fight the disease.

analysis Updated: Jul 28, 2019 18:03 IST
Poonam Khetrapal Singh
Poonam Khetrapal Singh
A health worker gives the measles and rubella vaccine to a student at a government school, Assam, September 4, 2018. The drive to eliminate the diseases has gathered momentum.
A health worker gives the measles and rubella vaccine to a student at a government school, Assam, September 4, 2018. The drive to eliminate the diseases has gathered momentum.(AFP Photo)

Unprecedented progress is being made against multiple vaccine-preventable diseases in the World Health Organization’s (WHO) South East Asia region, which was certified polio-free in 2014, and two years later, in 2016, became the second WHO region to eliminate maternal and neonatal tetanus. Over the past five years, the drive to eliminate two deadly childhood diseases, measles and rubella, has gathered crucial momentum.

At a time when measles cases are increasing globally, the WHO announced on July 9, that Sri Lanka has eliminated measles, interrupting transmission of the indigenous virus that causes the killer childhood disease.

Five out of the 11 countries in the region have achieved the goal of measles elimination (Bhutan, DPR Korea, Maldives, Sri Lanka and Timor-Leste) while six have achieved rubella control (Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste).

The remaining countries, including India, have initiated the implementation of key strategies to prevent infection, following member countries in adopting the goal of measles elimination and rubella control by 2020, in the 66th session of the Regional Committee for the WHO South-East Asia region.

Measles is one of the most infectious viruses known to man. It not only inflicts a range of deadly complications such as pneumonia, diarrhoea, encephalitis and malnutrition, but can also kill children. Eliminating it in the South-East Asia region would avert more than half a million deaths every year.

Strengthening vaccination services, enhancing surveillance, building laboratory networks, and leveraging the reach and support of existing networks, such as that of the polio eradication programme, are significant in the elimination drive.

An estimated 366 million children have been reached through mass vaccination campaigns over the last two years, of which 305 million are in India and 58 million in Indonesia. Several countries plan to close immunity gaps by conducting mass vaccination campaigns with the measles-rubella vaccine in late 2019-early 2020.

Thanks to the concerted efforts of national and subnational leaders in health, the dedication of millions of health workers and the strong support from partners, measles-related mortality in the region has reduced by 75% since the turn of the millennium, of which 23% reduction was seen in the last four years.

While basic elimination strategies are sound, implementation has been limited by inadequate country-level governance, global and national political will, and insufficient advocacy resulting in a lack of resources. This has resulted in immunity and surveillance gaps leading to a continued transmission of the viruses. An estimated 4 million children in the region do not receive a single dose of the measles-vaccine annually, with more than 90% of these being in India and Indonesia.

With a political and administrative environment which is determined towards the goal of measles elimination, national programmes and partners need to capitalise on this political keenness. The current funding gap for measles elimination is around $1.3 per live birth and these financial inadequacies need urgent attention to sustain focus.

A favourable policy environment to vaccinate children in schools and older age groups will help plug the immunity gaps.

A functional disease surveillance system is a key component of public health decision-making and thus surveillance for measles and rubella will have to be enhanced to higher levels to identify areas with continued measles virus transmission. Measles elimination must be seen as an opportunity to strengthen immunisation systems to better enable the introduction of new vaccines and other interventions through the newborn-children-adolescent and pregnancy life cycle. It will provide a platform for rubella elimination, making it a double victory.

Every individual deserves the best state of health. Every family has the right to all health services in the spirit of universal health coverage. Measles elimination is the most effective yardstick to this indicator.

Measles moves fast, we need to move faster to protect our children against its severe consequences.

Poonam Khetrapal Singh is the WHO regional director for South-East Asia
The views expressed are personal

First Published: Jul 28, 2019 18:03 IST

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