How Are We Doing With Measles Elimination?

Vaccine-preventable diseases continue to plague us as gaps in vaccination occur globally. Diseases like pertussis, polio, mumps, measles, and more can be prevented on large scales through widespread vaccination programs. As an epidemiologist, outbreaks of vaccine preventable diseases are particularly heartbreaking and frustrating.

Years ago measles was burning through California as a result of exposures in Disneyland and a healthcare facility. Our pediatric facility experienced a significant exposure due to a single case. Measles, from an infection prevention and epidemiological perspective is tricky. It's highly transmissible, we have to consider who has been within that space for two hours after the infectious person left. Vaccine hesitancy and decreased rates over time have amplified the impact that a single case of measles can have.

In the face of global vaccine hurdles and inequity, a pandemic can amplify the roadblocks we face in trying to eliminate a disease like measles. In a recent report from the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly (MMWR), researchers share an update on progress made towards regional measles elimination across the world for the past twenty years.

In 2012, the World Health Assembly added the goal of eliminating measles in five of the six World Health Organization (WHO) regions by 2020. Often this disease is used a canary in the coal mine for how strong immunization systems are. Rates of the first measles vaccine doses dropped from 86% to 84% from 2019 to 2020, likely as a result of the COVID-19 pandemic. The authors of the report that “annual reported measles incidence decreased globally during 2000–2016, increased in all regions during 2017–2019, then decreased in 2020. Measles surveillance, already suboptimal, worsened in 2020. Since 2000, estimated measles deaths decreased 94%. Measles vaccination has prevented an estimated 31.7 million deaths worldwide. No WHO region has achieved and maintained measles elimination.”

Of the 1940 WHO members, over 39% had achieved at least 90% one dose of measles-containing vaccine (MCV) coverage within 2020. Interestingly, by the end of 2020, “81 (42%) countries had been verified by independent regional commissions as having sustained measles elimination, but no new countries had achieved elimination. No WHO region had achieved and sustained elimination, and no AFR country has yet been verified to have eliminated measles. The WHO Region of the Americas achieved verification of measles elimination in 2016; however, endemic measles transmission was reestablished in Venezuela (2016) and Brazil (2018). Since 2016, endemic transmission has been reestablished in nine other countries that had previously eliminated measles (Albania, Cambodia, Czechia, Germany, Lithuania, Mongolia, Slovakia, the United Kingdom, and Uzbekistan).”

Ultimately, this not only indicates an impact of the COVID-19 pandemic on vaccine efforts, but also a desperate need to ramp up efforts as we are globally, very behind.That no WHO region has achieved and maintained measles elimination indicates the challenges of such work, but that it increasingly must be prioritized. While we continue to battle against COVID-19, we can’t lose focus on vaccine-preventable diseases like measles.