Ideally, every child should have two doses of measles vaccine and a rubella-containing vaccine through routine services.
Global average coverage with a first dose of measles vaccine (MCV1) through routine immunization improved globally from 72% in 2001 to 85% in 2010, but it has remained stagnant the last four years. The percentage of countries that achieved more than 90% coverage rose from 44% in 2000 to 68% in 2012, but has decreased to 61% in 2015.
The Measles & Rubella Initiative advocates and offers technical support to countries to strengthen their routine services, and will assist countries to introduce a measles second dose and measles-rubella vaccine.
The countries reporting district-level MCV1 coverage exceeding the target 80% MCV1 coverage in 80% or more districts has also fluctuated. In 2003 it was only 1%, then grew to 44% in 2012 and has now declined to 39% in 2015.
In 2014, the American, European and Western Pacific regions maintained an average MCV1 coverage more than 90%.
Encouragingly, by the end of 2015, 160 countries introduced a second dose of measles vaccine into their routine program. Estimated global MCV2 coverage increased from 15% in 2000 to 61% in 2015.
Financial support offered by the Gavi, the Vaccine Alliance since 2012 has helped fourteen countries to introduce a second dose of measles-containing vaccine in their routine vaccination program.
Countries have been slower to introduce a rubella-containing vaccine and to date 140 (72%) countries have done so, with an estimated coverage of 46% globally. Here again Gavi funding offers an encouraging opportunity for improvement as Gavi will support countries to introduce a rubella-containing vaccine (combined with measles vaccine), first through a campaign and then via routine immunisation services.
It’s important to remember that an estimated 20.8 million infants did not receive the first routine measles vaccination in 2015. 11 million (53%) were in six countries: India (3.2 million), Nigeria (3 million), Pakistan (2 million), Indonesia (1.5 million), Ethiopia (0.7 million), and the Democratic Republic of the Congo (0.6 million). And 56% of those missed came from only six countries: the Democratic Republic of Congo, Ethiopia, India, Indonesia, Nigeria and Pakistan.
The world’s poorest children, who are less likely to receive the vaccine through the routine health system in the near future, are at a greater risk of contracting measles and dying from complications. Without interventions by the Measles & Rubella Initiative, including support for outreach and intensified campaigns, they remain vulnerable, and it will be a major challenge to reach the 95% mortality reduction and measles elimination goals.