An increase in measles cases in January and February 2022 shows that vaccine-preventable diseases are spreading rapidly and could trigger larger outbreaks, the World Health Organisation (WHO) and the UN children's agency have said.
The agencies say that pandemic-related disruptions, increasing inequalities in access to vaccines and the diversion of resources from routine immunisation are leaving too many children without protection against measles and other vaccine-preventable diseases.
The risk of large outbreaks has increased as communities relax social distancing practices and other preventive measures for Covid-19 enacted during the height of the pandemic.
In addition, the risk of outbreaks of disease have increased due to millions of people being displaced due to conflicts, disruptions in routine immunisation, a lack of clean water and sanitation, and overcrowding.
Almost 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the first two months of 2021.
As measles is very contagious, cases tend to show up quickly when vaccination levels decline.
Apart from its direct effect on the body, which can be lethal, the measles virus also weakens the immune system and makes a child more vulnerable to other infectious diseases such as pneumonia and diarrhoea.
Most cases occur in settings that have faced social and economic hardships due to Covid-19, conflict or other crises, and have chronically weak health system infrastructure and insecurity.
“Measles is more than a dangerous and potentially deadly disease. It is also an early indication that there are gaps in our global immunisation coverage, gaps vulnerable children cannot afford,” said Catherine Russell, executive director of Unicef.
“It is encouraging that people in many communities are beginning to feel protected enough from Covid-19 to return to more social activities. But doing so in places where children are not receiving routine vaccination creates the perfect storm for the spread of a disease like measles.”
In 2020, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009, and 3.7 million more than in 2019.
A total of 21 large and disruptive measles outbreaks have occurred around the world in the past 12 months, though the figures are likely higher as the pandemic has disrupted surveillance systems globally, with potential underreporting. Most of the measles cases were reported in Africa and the East Mediterranean region.
Countries with the largest measles outbreaks over the past year include Somalia, Yemen, Nigeria, Afghanistan and Ethiopia. Insufficient measles vaccine coverage is the major reason for outbreaks, wherever they occur.
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As of April 1, 2022, 57 vaccination campaigns in 43 countries that were scheduled to take place since the start of the pandemic are still postponed, affecting 203 million people, most of whom are children.
Of these, 19 are measles campaigns, which puts 73 million children at risk of measles due to missed vaccinations.
In Ukraine, the measles catch-up campaign of 2019 was interrupted due to the Covid-19 pandemic and thereafter due to the war.
Routine and catch-up campaigns are needed wherever access is possible to help make sure there are not repeated outbreaks. From 2017-2019, there were more than 115,000 cases of measles and 41 deaths in Ukraine, the highest incidence in Europe.
Coverage at or above 95 per cent with two doses of the safe and effective measles vaccine can protect children against measles. However, Covid-19 pandemic-related disruptions have delayed the introduction of the second dose of the measles vaccine in many countries.
“The Covid-19 pandemic has interrupted immunisation services, health systems have been overwhelmed, and we are now seeing a resurgence of deadly diseases including measles,” said Dr Tedros Adhanom Ghebreyesus, director general of the World Health Organisation.
“For many other diseases, the impact of these disruptions to immunisation services will be felt for decades to come.
“Now is the moment to get essential immunisation back on track and launch catch-up campaigns so that everybody can have access to these life-saving vaccines.”
