Susan Reef, M.D., is the Rubella Team Lead of the Global Immunization Division at the Centers for Disease Control based in Atlanta, Georgia.
When I started focusing on rubella in 1994, it was mainly recognized as a significant public health problem in high-income countries. When the public health community realized that rubella and congenital rubella syndrome (CRS) were actually significant public health issues in the entire region of the Americas, things took a turn and an elimination goal was set for 2010. In the pre-vaccine era, some 20,000 infants with were born each year in the Americas region with CRS and one or more of its devastating birth defects. I look at our success in achieving the elimination goal —which occurred in 2009, a year before the target date—in terms of the lives it impacted: 20,000 of them, born free of CRS disabilities each year since then.
The Americas Region is rubella’s great success story. But unfortunately, that success isn’t always seen elsewhere; less than 55% of children live in countries with access to the rubella vaccine. In my decades of experience as a medical professional, I have seen my share of disease and the horrific impact it can have. But seeing infants with CRS has to be one of the most heartbreaking. Multiple defects, heart issues, cataracts, deafness all carry a significantly larger burden for families in low-income countries. They are often without extra resources, or access to services or facilities to help care for children born with CRS. Tiny babies starting their lives with a host of health issues that would challenge a full grown adult. Some infants even abandoned by their families because the costs and lifetime of dedication needed to care for them were too much to bear.
Between 1996 and 2014, the number of countries offering the rubella vaccine increased from 79 to 141 (73% of all countries). However, there are still 53 countries that have not yet introduced the vaccine. Most of these remaining countries are in the African and Eastern Mediterranean regions, but also in a few densely populated countries like India and Indonesia with substantial numbers of babies born with CRS each year. In an age where we have a safe and effective vaccine, 100,000 CRS babies are still born every year.
The fact that we can protect children everywhere from rubella and CRS motivates me to eliminate these viruses from the earth. Fortunately, the global health community is working hard to make this goal a reality. Over the last two years, there have been 10 countries that have introduced rubella vaccine and several more countries will be introducing rubella vaccine in 2015. It is so important to reach people with rubella vaccine when they are young, both male and female, to ensure rubella is eliminated in all regions where it is endemic. That is why conducting wide-age range vaccination campaigns like the one in this week’s photo essay from Nepal are essential when introducing rubella vaccines into national immunization systems – we can protect more than one generation at a time: children and their future children.
Progress is slow and steady, but is gaining momentum thanks to the advocacy and activities of the Measles & Rubella Initiative. It is a global partnership committed to ensuring no child dies from measles or rubella, or is born with congenital rubella syndrome. As a founding member, CDC provides scientific and financial support to partners and countries to protect against rubella and CRS. Our efforts have been strengthened with significant assistance since 2013 through Gavi, the Vaccine Alliance. Since 2013, Gavi supports catch up campaigns for measles-rubella for countries self-financing the introduction of the measles-rubella vaccine in their routine immunization programmes. This means that by 2020, more than 600 million children in 49 countries between 9 months and 14 years are expected to be immunized against measles and rubella.
Even with this excellent progress, there are too many infants being born with CRS simply because of lack of access to the vaccine. As a global community, we need to prioritize getting life-saving vaccines to children in even the hardest-to-reach places. We call them “vaccine-preventable” because immunization truly does prevent these devastating diseases from spreading. By working to ensure that safe, effective vaccines reach every remaining corner of the world, we will give babies around the world a chance to live healthier lives, free from the scourge of CRS.