A record more than 41,000 children and adults in the World Health Organization European Region have been infected with measles – one of the most vaccine-preventable infectious diseases known to man – in the first 6 months of 2018, according to a newly published WHO press release. The total number for this period far exceeds the 12-month totals reported for every other year this decade, and this has policymakers grasping for ways to address the rise, while a WHO official says elimination is possible.

So far, the highest annual total for measles cases between 2010 and 2017 was 23,927 for 2017, and the lowest was 5,273 for 2016, according to WHO. Monthly country reports also indicate that at least 37 people have died due to measles so far this year.

“Following the decade’s lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks,” stated Zsuzsanna Jakab, WHO regional director for Europe. “We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease. Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our [United Nations] Sustainable Development Goal commitments.”

Uneven Progress towards Measles and Rubella Elimination

According to the latest assessment by the European Regional Verification Commission for Measles and Rubella Elimination (RVC), released on Monday August 20, 43 of the region’s 53 member states have interrupted the endemic spread of measles and 42 have interrupted rubella (based on 2017 reporting).

At the same time, the RVC expressed concerns about inadequate disease surveillance and low immunization coverage in some countries. It also concluded that chains of measles transmission continued for more than 12 months in some countries that had previously interrupted the endemic spread of the disease, reverting their status back to endemic,  as explained in the WHO press release.

“This partial setback demonstrates that every person who is not immune remains vulnerable no matter where they live, and every country must keep pushing to increase coverage and close immunity gaps, even after achieving interrupted or eliminated status,” said Nedret Emiroglu, director of the Division of Health Emergencies and Communicable Diseases at the WHO Regional Office for Europe.

What Should Be Done?

In such a context, what should global policymakers do in order to tackle the problem? Health Policy Watch consulted Dragan Jankovich, technical officer, vaccine-preventable diseases and immunization, WHO regional office for Europe, in order to find some answers.

“Measles can be eliminated,” said Jankovich. “All countries in the European Region have committed to this goal in the European Vaccine Action Plan 2015-2020, which is a regional adaptation of the Global Vaccine Action Plan 2011-2020.”

At the upcoming European Regional Committee, which will take place in Rome on 17–20 September, ministers of health of all 53 member states will assess progress towards EVAP goals, including measles elimination.

Commitment is Needed

“On the global level, through the mechanism of the World Health Assembly, member states are working on the post 2020 global plan to reduce the burden of vaccine-preventable diseases,” he added. “Most importantly, commitment of all countries is needed to stop these diseases and prevent further outbreaks.”

According to Jankovich, for measles specifically (in comparison to other preventable diseases), action appropriate to the national context and based on available evidence is needed. He provided a list of actions:  

• To achieve and sustain routine immunization coverage to 95% for both doses of measles vaccine in every community (to prevent outbreaks, at least 95% immunization coverage with 2 doses of measles-containing vaccine is needed every year in every community);
• To identify who has been missed in the past and reach them with vaccination services; among adults, it is extremely important to ensure that all health care workers are protected to prevent spread of the disease in health care institutions;
• To improve surveillance with detection and epidemiological and laboratory investigation of all suspected cases;
• To improve outbreak detection, investigation and use of collected information to better understand and define susceptibility in the population;
• In the event of an outbreak to initiate an immediate response, immunizing all susceptible/not immunized contacts;
• To provide understandable, clear and evidence-based information to health care workers (so they can recommend vaccination to their parents), to the general public (to promote immunization and make them understand its importance), and decision makers (to ensure political support and sufficient resources).