Measles is one of the most contagious viral diseases of childhood and has been a major concern in global health for years. Even though there is an effective vaccine against measles, this disease remains an important cause of morbidity and mortality among children globally. It has set ambitious goals with its partners in global health to have all regions measles-eliminated by improving vaccination coverage and surveillance. However, vaccine hesitancy, along with health care access inequities and the hammer of worldwide disasters like COVID-19, jeopardizes the road to measles elimination. The current paper will focus on the global drive toward the elimination of measles, successes over the past two decades, and challenges that remain to these efforts.
Progress Toward Measles Elimination
The WHO Global Vaccine Action Plan passed the World Health Assembly in 2012, with a target to eliminate measles from five of the six WHO regions by 2020. Under this very plan, much headway has been made toward reducing the spread and mortality rate of measles. “During the period from 2000 to 2019, the incidence of measles dropped by 88% worldwide. During that time, an estimated 26.9 million deaths were prevented.” These great achievements were made possible due to the wide-scale use of the measles-containing vaccine and extensive vaccination campaigns carried out by many countries around the world.
IA2030 has definitely been at the forefront of the push for progress on the measles agenda. In fact, IA2030 sees measles as a critical indicator of the immunization system and health systems’ capacity to deliver important vaccines to children. IA2030 emphasizes the need to attain and sustain high vaccination coverage. The prevention of outbreaks and maintenance of measles elimination require at least 95% coverage with two doses of MCV.
This space has, however, not been uniform across all regions. There is outstanding progress noted in some countries, while others have regressed under the weight of political instability, resource constraints, and public health crises. The Americas and Western Pacific regions were on their way to the elimination of measles but faced major upticks due to vaccine hesitancy and reduced surveillance that followed suboptimal vaccination coverage.
Hesitancy to Vaccines and Gaps in Coverage
Vaccine hesitancy poses one of the toughest challenges in striving for the global elimination of measles. Measles vaccine efficacy has been established, and yet a number of countries show declining vaccination rates because of misplaced information and resultant mistrust against such vaccines. This mostly occurs in high-income countries where measles risks have increased with the reduced visibility of the disease.
Besides vaccine hesitancy, there are other critical barriers to the achievement of measles elimination: gaps in coverage. Inadequate health infrastructure, supply chain problems, and socio-economic issues ensure easy access to vaccines in most low- and middle-income countries. Many factors exacerbate these gaps, such as conflicts, natural disasters, and other emergencies that impact service delivery and often disrupt it, resulting in consequent fallout and further spreading measles.
Moreover, COVID-19 has further increased these gaps in coverage. Its unprecedented disruption to routine immunization services across most countries caused millions of children to miss scheduled vaccine doses of MCV. From 86% in 2019, MCV immunization coverage went down to 81% globally in 2021 the lowest since 2008 further putting endangered people at risk from outbreaks, with regional increases expected in parts of the world already reporting low vaccination coverage.