Measles mortality reduction: A successful global public health strategy

A guest blog By Dr. Edward Hoekstra Coordinator of the Measles Program at UNICEF from 2000 to 2012

In the year 2000 at the outset of my tenure at UNICEF, there was a strong outcry from mothers in communities in countries throughout the whole of Africa, a plea for help to stop their children from dying from measles.

Almost half of the children (44%) in Africa did not have access to the measles vaccine and none had access to a second dose of the vaccine. As a result about 337,000 children died from the disease that year in sub-Saharan Africa. This in contrast to North and South America, for example, where all children had access to two doses of measles vaccine and no measles deaths were reported.

Traveling through Africa in 2000 to assess the needs and begin to devise a plan, I was shocked to see every hospital had an entire ward for children with serious measles complications. Large numbers of beds were crowded into small areas occupied by children in their last phase of life.

In rapid response to this grim situation, I at UNICEF together with Dr. Ana-Maria Henao-Restrepo from the World Health Organization and Dr. Peter Strebel from the US Centers for Disease Control and Prevention designed a strategic plan to increase access to the measles vaccine and introduce a second dose. Based on the experience of the Americas the second dose would be provided through campaigns.

Together with the American Red Cross and United Nations Foundation the Measles Initiative was formed to fund and roll out this plan throughout Africa and later globally. Communities and governments seized this opportunity and took a leadership role in making the program a success. By 2008, measles mortality in Africa has been reduced by more than 90%. Access to vaccines had significantly increased and all countries had introduced the second dose of measles.

Nowadays when I travel in Africa, I am overjoyed to find that measles wards have disappeared.

Although outbreaks have occurred in Africa during the past three years, most of these have typically been minor compared with outbreaks a decade ago, and have mainly occurred in countries in which the measles strategy had not been fully implemented. Most of the outbreaks in the affected countries are now controlled and governments are aware that measles will come back if they don’t implement the measles strategy.

Continued strong commitment from the governments will be needed to implement high quality immunization services, including further improving measles vaccination coverage through routine immunization. This will ensure that all children are protected.

As I look back to evaluate what a successful vaccine program entails, there are several factors: First, a demand was voiced by the communities in Africa for help. Secondly, the strategy, that of introducing a second dose of measles including through campaigns instantly worked to reduce measles mortality. Finally, by working together, using the strengths of communities, governmental agencies, ministries of health and education, UN and other international organizations, NGOs, public and private donors and professional societies, the result has been powerful. Africa showed that the region could lead implementation of a public health program.

Building on the success of the Americas and Africa, other continents, including Asia have now also introduced a comprehensive two-dose measles schedule. In the coming years we are looking forward to further increasing coverage among children so that one day we will have a world without measles.

Dr. Edward Hoekstra is a Public Health Physician. His work in the private sector, for governmental and international organizations has taken him to over 150 countries in the world. He has recently retired as Coordinator of UNICEF’s measles programme, a position he led from 2000-2012, where he was dedicated to the effort to introduce a second dose of measles vaccine to communities in the 47 poorest countries in Africa and Asia. The ultimate goal of this effort is to eliminate measles and its devastating effects on children.

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