Measles outbreaks around the world are drawing attention to the need for greater attention to be paid to this childhood disease. The reason for the rise in cases is multifold, but the main one is the disruption of immunization programs because of COVID-19. As a result, a gap has developed in medical treatment needs and requirements.
Research shows that the low case numbers reported in 2020, after a worldwide resurgence of measles between 2017 and 2019, have to be interpreted cautiously because of the effect of the COVID-19 pandemic on disease surveillance. This is because COVID-19 appears to have created widening gaps in disease maintenance coverage at a pace not seen in clinics and medical literature in decades. If nobody acts, the gaps will become outbreaks and many children will be exposed. Measles cases have already surged nearly 80 percent worldwide and this may suggest that outbreaks of other diseases are likely because of the attention paid to COVID-19.
There were 21 “large and disruptive” measles outbreaks in the 12 months to April, most of them in Africa and the Eastern Mediterranean, a wide geographical range. Somalia recorded the most measles cases in the past 12 months with more than 9,000, followed by Yemen, Afghanistan, Nigeria and Ethiopia. The gap that has allowed other diseases to reemerge is part of the disease maintenance recovery process.
The icing on the cake is that measles is the most contagious vaccine-preventable disease. It is also, according to studies, a warning sign that outbreaks of other diseases may occur in poorer parts of the world. Measles is called a “tracer” that shows where the weaknesses are in the immunization system’s checks and balances. Yellow fever might surge next, with cases now rising in West Africa. Health ministries and nongovernmental organizations are heavily “taxed” by the potential for rising cases of other diseases because of the fragility of healthcare systems in Africa right now.
Research shows that children in low and middle-income countries are more likely to have missed out on measles vaccination and 59 percent of those that did in 2020 were from just 10 countries: Nigeria, India, the Democratic Republic of the Congo, Ethiopia, Indonesia, Pakistan, Angola, the Philippines, Brazil and Afghanistan. As a consequence, between 2019 and 2020, coverage of the first dose of the vaccine fell in India, for example, from 95 percent to 88 percent.
There are now questions being raised about how Russia’s invasion of Ukraine could spark a resurgence of measles cases after Kyiv recorded Europe’s highest rate of the disease between 2017 and 2019. One can only surmise that the situation is now much more dispersed in Europe. As the war continues, the probability of a rise in preventable cases is going to grow.
A case study from before the pandemic is illustrative of the fertile ground for measles. Montenegro, using the epidemiological data collected in 2018, illustrated the conditions for outbreak and spread. This outbreak was largely attributable to a dangerous accumulation of susceptible subjects across the country and represented an increased risk factor for reestablishing endemic transmission in the Balkans. This study showed how the outbreak of a vaccine-preventable communicable disease can have a dramatic impact and severe consequences on regional public health systems’ performance.
The risk of outbreaks of measles across the world from increasing poverty and warfare is undoubtedly mounting because the COVID-19 pandemic caused millions of children to miss out on essential vaccinations. This fact severely affects the ability of disease surveillance systems to do their job. As measles is very contagious, cases tend to show up very quickly when vaccination levels decline. That perhaps means trouble because of the gap created in current health provider capabilities. Many if not all countries are ill-equipped to handle an unexpected caseload of COVID-19 or measles or whatever comes next.
Current statistics further illustrate the result of the disease maintenance gap: As of April 1, 57 vaccine-preventable disease campaigns in 43 countries that were scheduled to take place since the start of the pandemic remained postponed, impacting 203 million people, mostly children. Of these, 19 were measles campaigns, putting 73 million children at risk of contracting the disease. In Ukraine, the measles catch-up campaign of 2019 was interrupted due to the COVID-19 pandemic and, more recently, due to the war.
Routine and catch-up campaigns are needed wherever access is possible to help make sure there are not repeated outbreaks, as in 2017 to 2019, when there were more than 115,000 cases of measles and 41 deaths in the country — the highest incidence in Europe.
Overall, restoring services and vaccination campaigns so countries can safely deliver routine immunization programs to fill the gaps left by the pandemic-related backsliding is key to catching these emerging cases. It is necessary to rectify gaps in immunization coverage quickly by identifying the communities and people who have been missed during the pandemic. All of this effort is about awareness and delivery of the necessary medical remedy.