Interrupted Vaccination Got Measles Deaths to Soar in 2019

There was an overwhelming increase in measles deaths across the world last year. In fact, deaths due to measles, a vaccine-preventable disease, were the highest in 2019 than in the last 23 years, a report jointly published by the World Health Organization and the CDC says. The report published on Thursday raises fears that the disease will spread in the near future due to the COVID-19 pandemic, which has disrupted immunization and detection.

According to the report, global deaths in 2019 reached a staggering high of 2,07,500 cases—a more than 50% higher rate than just three years back. Even the United States was not spared from a measles outbreak, although no deaths were reported during the year. According to another CDC report, the United States registered 1,282 measles cases in 31 states, the most since 1992. Notably, in 2012, the country reported only 55 measles cases. 

Public health experts attribute the soaring measles deaths to years of insufficiency in vaccine coverage. Now, as the world is in the grip of a viral pandemic, the situation may worsen and the result will be that cases of measles—a disease more contagious than COVID-19—will swell.

Natasha Crowcroft, a senior technical adviser for measles and rubella at the WHO, told the New York Times on Thursday, “We are worried that there are new gaps in immunity opening because of COVID on top of those that were already there. We can’t carry on in the same way and expect a different result.” She called for more resources and their creative application to tackle the disease. 

Reported measles cases are low so far this year, but experts are not free of worry. They apprehend there has been a massive under-counting of cases as a result of the prevailing disruption of healthcare systems worldwide, which has led to reduced detection and medical care for measles.

According to reports, there have been measles outbreaks in at least 26 countries whose vaccination campaigns have been hampered because of the panic created by the COVID-19 pandemic. The WHO says until now some 94 million [9.4 crore] people are at risk of missing a measles vaccine. 

Details of the measles outbreaks were reported by the Measles and Rubella Initiative, an international consortium that includes the WHO, CDC, UNICEF, American Red Cross and the United Nations Foundation. The report emphasises that vaccination should proceed even during the pandemic and that it is even more necessary when overall healthcare systems are close to exhaustion.

However, experts also argue that the current spike in measles detection and mortality is not only due to the pandemic. Rather, they compare the spurt in measles with a small fire that has, over time, turned explosive. For almost a decade now, the worldwide vaccination rate has stagnated, which guaranteed a steady immunisation in many regions. Yet this stagnation has given rise to another problem—a failure of vaccination drives to reach more people, which was actually required if the contagion was to be eradicated. 

Out of 184 reporting countries, nine accounted for over 73% of measles cases during 2019. Those nine countries with a heavy incident rate are the Central African Republic, the Democratic Republic of Congo, Georgia, Kazakhstan, Madagascar, North Macedonia, Samoa, Tonga and Ukraine. This data, which is from the CDC, shows that apart from the low-income countries that were hit hard by the measles outbreaks, middle-income countries such as Ukraine were also prominent in the list of most-affected nations. 

More alarming is the fact that “zero dose” children—those who received no vaccines—are on a rise in countries like Brazil, Mexico and Philippines. This accounts for 9.5 million [95 lakh] or a massive 69% of children who are due to receive the vaccine.

It is noteworthy that between 2010 and 2016, deaths and positive cases of measles declined to 18 cases per million persons. But vaccination efforts have begun to decline since 2010. Preventing a measles outbreak through vaccination would mean that 90% of the population has been vaccinated with two doses. However, since 2010, the worldwide average has been stuck at 85% for the first dose and for the second dose, the rate decreases further, and hovers at around 71%. 

Besides, babies are taking birth every day and thus, the gross numbers of both unvaccinated and under-vaccinated children are increasing worldwide in a situation where the vaccination rate has stagnated.

Robb Linkins, an epidemiologist at the CDC, who is the present chair of the Measles and Rubella Initiative’s management team said on the alarming situation that the measles mortality rate in high-income countries like the United States is “virtually nil”, because general health is already good and the healthcare system is robust. But last year’s high number of measles deaths worldwide is a terrible testimony to poor health care as well as under-vaccination. 

“It’s just hard for me to believe that kids are dying of a disease that we’ve had a great vaccine for, for 50 years,” he said.