When I walked through an Ebola treatment centre in North Kivu Province in the Democratic Republic of the Congo (DRC), 12-year old Mumbere Kalegha pressed a paper to the glass that separated us and isolated him as he recovered from the virus.
“My name is Mumbere, come and talk to me,” he had written. I danced with four adult recent survivors shortly afterward in a rare moment of celebration. Soon we will have another deserved cheer for the 1,000th survivor in what is now the country’s tenth Ebola outbreak and the world’s second deadliest.
Yet, Mumbere’s boyish face will linger with me. I’m confident he will survive Ebola. But what about measles?
Millions of children his age and younger in the DRC have been missed by the routine immunisation for measles, one of the world’s most contagious viral diseases. Is he one of them?
All across the DRC, children are dying from measles in what is the world’s largest and fastest-moving outbreak – with the latest data showing that there have been 165,203 suspected cases already this year. Every one of the country’s 26 provinces has reported cases of measles and is battling to control this outbreak.
Since June, when the government declared the measles outbreak, emergency vaccination campaigns have reached more than 3.4 million children aged 6–59 months in at least 93 of the 186 affected health zones (of a total 519).
Another emergency campaign, one supported by the World Health Organization (WHO), begins on September 18 for 24 additional health zones that need it. Vaccines previously secured for supplemental campaigns planned long ago are now being fast-tracked for this October and November and January 2020.
What scares me is the number of deaths from measles, at more than 3,200, now exceeds the deaths from Ebola. Nearly all of them are children.
I want to talk with those children, as I did with Mumbere, and their parents. I want to know why they weren’t vaccinated. And yet, I already know. We all know.
Far too many children in Africa are still not accessing the vaccines they need. While routine immunisation coverage made an impressive leap from 54 percent in 2001 to 73 percent in 2008, the progress plateaued at roughly that level over the past decade.
Protection from measles relies on reaching herd immunity: to interrupt the endemic transmission of the measles virus, a country needs 95 percent population immunity enabled by the vaccine. The immunity of those vaccinated then protects the few who remain unvaccinated.
In most African countries, coverage of the routine immunisation remains sub-optimal, thus enabling large pockets of unimmunised children and adults. In the DRC, routine measles immunisation coverage was only 57 percent in 2018. It was only a matter of time before the number of children who are susceptible because they missed their routine vaccinations became an explosive pool of vulnerability.
This situation will replicate in other countries on the continent if nothing is done to, once and for all, reach every child. As the world’s largest outbreak is currently reminding us, we must stop aiming for this goal and hunker down to actually achieve it.
The crisis in the DRC amplifies the necessity of strong routine immunisation programmes in every country, which still need investments to move us across the finish line of elimination. This will be one of the topics discussed by vaccination experts and health ministers this week at the Global Vaccination Summit in Brussels sponsored by the European Commission and WHO.
The DRC may be the worst ongoing measles outbreak, with Madagascar not far behind, but they are not singular. More measles cases were reported worldwide in the first six months of 2019 than in any year since 2006, with 182 countries reporting a total of 364,808 cases by 31 July.
The WHO data characterises measles cases as soaring in Europe, with four countries – the United Kingdom, Greece, the Czech Republic and Albania – losing their free-of-the-disease status because of outbreaks.
Of course, there are different drivers of outbreaks. Vaccine hesitancy and possibly complacency is driving cases in Europe and North America. In contrast, epidemics in Africa are due to the weak health systems and insufficient funding for immunisation programmes. While some parents in developed countries choose to not vaccinate their children, too many parents in Africa never have the option.
We urgently need funding to save lives in the DRC now and to finally optimise the regular immunisation programme so that every future generation is routinely protected. The beauty of this impetus is that strong routine immunisation programmes protect children from many diseases, including measles.
We need to also strengthen our surveillance systems to detect cases and monitor immunisation coverage. We need reactive campaigns where immunisation coverage is uneven. And we need to continue working with – and investing in – partners, like GAVI the Vaccine Alliance, to deepen our prevention campaigns to avoid creating a dangerous pool of susceptible children.
When Mumbere goes home an Ebola survivor, I don’t want any vaccine-preventable disease waiting for him.
- Dr Matshidiso Moeti is WHO Regional Director for Africa
Protect yourself and your family by learning more about Global Health Security