Antananarivo/New York, 25 April 2019 – Over 7.2 million children have been vaccinated in an emergency response to an outbreak of measles that has claimed the lives of more than 884 people and is suspected to be the cause of another 376 deaths in Madagascar since September 2018.
Over 135,000 cases of measles have been reported between 3 September 2018 and 14 April 2019 and children account for most of those who have died or been affected, as per WHO-Government of Madagascar data. “This is equivalent to 40 elementary classrooms emptied in a year due to measles-related child deaths, which is unacceptable when it takes less than US$2 to vaccinate a child,” said Enrique Paz, UNICEF Madagascar health specialist.
The first phase of the country-wide vaccination program, during which 2.1 million were vaccinated, was mounted with support from the Measles & Rubella Initiative (M&RI), a global private-public partnership comprising American Red Cross, Centers for Disease Control and Prevention (CDC), United Nations Foundation, UNICEF and WHO.
Backed by financial resources from Gavi, the Vaccine Alliance, M&RI provided immediate response, in-line with its mandate to bring the world closer to control and elimination of measles, rubella and congenital rubella syndrome.
The first phase was conducted in 25 districts and the next two phases reached 89 districts to cover the remaining five million children below nine-years-old in a country with a population of 26 million. M&RI, Gavi and other partners provided technical support besides financing the purchase of vaccines and operational costs, helping meet the US$8.6 million required for comprehensive vaccination response. “We cannot afford to be only reactive. We must end this outbreak and save lives from this vaccine-preventable disease and go beyond to revitalize routine immunization,” said Dr. Magdi Ibrahim, senior country manager AFRO Francophone of Gavi.
Speaking about the response in Madagascar, which is one of the poorest countries in the world, Dr. Robert Linkins, CDC global measles expert and chair of M&RI’s management team, said: “We must ensure that every child, everywhere, is protected by two doses of measles vaccine. We must get ahead of this deadly virus.”
Support also came in from partners such as USAID, CDC, DFID (UK Aid), the French Embassy, the European Civil Protection and Humanitarian Aid Operations (ECHO), the Government of Madagascar, UNOCHA’s Consolidated Emergency Relief Fund (CERF), the African Bank of Development, the Community of the Indian Ocean and the World Bank. “CERF and USAID grant of $1 million and $800,000, respectively, were pivotal to meet most of what was needed but even after that we will still have a gap of $1.1 million to cover other components of the response,” said Michel Saint-Lot UNICEF representative in Madagascar.
“It is imperative we continue efforts, especially in the four most affected districts accounting for the 60 per cent of cases and strengthen systematic immunization to improve coverage among children under one,” said Charlotte Faty Ndiaye, WHO representative in Madagascar.
Due to the country’s efforts and support of partners, transmission of measles has slowed with a definite dip in number of cases reported among children below nine-years of age after the implementation of the first phase of vaccination itself. It is, therefore, important to maintain the momentum and increase coverage levels of measles vaccine through routine immunization systems.
Measles cases are on the rise globally, as per data available from M&RI and its partners. Reported cases have increased significantly from 2017 to 2018, with all WHO-designated regions experiencing large, often protracted outbreaks of the disease. Already in 2019, an estimated 110,000 measles cases have been reported. This number is an increase of nearly 300 per cent from the same period last year. An estimated 110,000 people, most of them children, died from measles in 2017, a 22 per cent increase from the year before. Though these numbers are provisional and underrepresent the true burden of the disease because of low reporting rates globally (in 2017 for instance, there were 6.7 million estimated cases from roughly 170,000 reported), the global upsurge in measles cases is alarming.
But unlike in the West where parents’ reluctance to get their children vaccinated is emerging as a key reason for the increasing number of measles outbreaks, the issue in countries like Madagascar is more due to inadequately funded and resourced health and immunization systems and overall poor infrastructure. Though measles is endemic in Madagascar, the last vaccination drive in the country was in 2016, leaving vast number of unvaccinated children among whom the potentially deadly virus built its stronghold.