War, pandemic and measles: A knock-on wave is looming

What has been feared for two years, that the global coronavirus pandemic might trigger knock-on health crises, is now becoming a reality with measles, a highly contagious disease that can be stopped by effective immunization. The pandemic interrupted vaccination campaigns aimed at children, and the disease is roaring back.

Measles is spread when an infected person coughs or sneezes, and it can remain in the air for up to two hours afterward. The disease can lead to serious complications and death, especially among children. The effective way to stop transmission is to immunize 95% of a community.

Around the world, there was a substantial decrease in measles incidence and associated deaths between 2000 and 2016. Estimated measles cases plunged 65%, from 28.3 million in 2000 to 9.8 million in 2019. Likewise, measles deaths fell from 539,000 to 207,500 in the same period. Immunization saved millions of lives; the percent of children getting the first dose of measles vaccine went from 72% in 2000 to 84% in 2020, according to the Centers for Disease Control and Prevention. Just before the pandemic hit, there was a major global surge in measles cases in 2019, but then it declined in 2020 because of precautions such as face masks to fight the spread COVID-19.

However, the pandemic sowed trouble. It created logistical hurdles to vaccination campaigns and sapped resources. In a statement on April 27, the World Health Organization and UNICEF reported that 57 campaigns against vaccine-preventable diseases in 43 countries that had been scheduled to take place since the start of the pandemic are still postponed. Of these, 19 are measles campaigns, which put 73 million children at risk of measles because of missed vaccinations. Two doses of the safe and effective measles vaccine with high community coverage can protect children, but many of the disrupted campaigns were to provide the second dose. The impact is now being seen: 17,338 measles cases were reported globally in the first two months of this year, nearly twice the 9,665 cases during the first two months of 2021. In the past year, the agencies report 21 large and disruptive measles outbreaks around the world. The top five countries for cases were Somalia, Yemen, Afghanistan, Nigeria and Ethiopia.

The United States, which declared measles eliminated in 2000, had a big spike in 2019, but more recently, cases have been low. More than 90% of children are vaccinated by age 24 months with the measles, mumps and rubella vaccine.

In Ukraine, which suffered the second-largest measles outbreak in the world from mid-2017 to the end of 2019, a catch-up campaign was interrupted because of the pandemic and then by war. Ukraine managed to get a first dose to 85% of eligible children in 2020, but WHO says it is “seriously concerned about a potential measles outbreak,” and it reports overall immunity in Ukraine remains low.

Measles cannot be permitted to run free. The global immunity gap must be met with renewed vaccination efforts, despite obstacles of the pandemic and war.