The World Health Organization (WHO) has revealed that Nigeria has the highest number of unvaccinated infants in the world with 3.9 million, representing 20% of the world’s under-vaccinated children.
Nigeria is followed by India with 2.9 million. Other countries with high number of unvaccinated children are Pakistan (1.2 million), Indonesia (1.2 million), Ethiopia (1.1 million) and Angola (0.7 million).
These countries are threatening the achievement of globally set goals to eliminate measles – increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% the national level and to ≥80% in every district; reduce global annual measles incidence to <5 cases per million population; and reduce global measles mortality by 95% from the 2000 estimate.
According to the WHO, the age, education status and quality of life of the mother can influence the vaccination of the child.
“In Nigeria, children of older, well-educated, well-off mothers in the south were 300 times more likely to be vaccinated than children with teenage, uneducated, poor mothers in the north-west,” the WHO stated in the in the 2018 assessment of the Global Vaccine Action Plan.
Global spike in measles
The global health body revealed reported measles cases spiked in 2017, as multiple countries experienced severe and protracted outbreaks of the disease.
Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease.
Using updated disease modelling data, the report provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunizations. However, reported cases increased by more than 30 percent worldwide from 2016.
The Americas, the Eastern Mediterranean Region, and Europe experienced the greatest upsurges in cases in 2017, with the Western Pacific the only World Health Organization (WHO) region where measles incidence fell.
“The resurgence of measles is of serious concern, with extended outbreaks occurring across regions, and particularly in countries that had achieved, or were close to achieving measles elimination,” said Dr Soumya Swaminathan, Deputy Director General for Programmes at WHO. “Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under-, or unimmunized children, we risk losing decades of progress in protecting children and communities against this devastating, but entirely preventable disease.”
Measles is a serious and highly contagious disease. It can cause debilitating or fatal complications, including encephalitis (an infection that leads to swelling of the brain), severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss. Babies and young children with malnutrition and weak immune systems are particularly vulnerable to complications and death.
The disease is preventable through two doses of a safe and effective vaccine. For several years, however, global coverage with the first dose of measles vaccine has stalled at 85 percent. This is far short of the 95 percent needed to prevent outbreaks, and leaves many people, in many communities, susceptible to the disease. Second dose coverage stands at 67 percent.
“The increase in measles cases is deeply concerning, but not surprising,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Complacency about the disease and the spread of falsehoods about the vaccine in Europe, a collapsing health system in Venezuela and pockets of fragility and low immunization coverage in Africa are combining to bring about a global resurgence of measles after years of progress. Existing strategies need to change: more effort needs to go into increasing routine immunization coverage and strengthening health systems. Otherwise we will continue chasing one outbreak after another.”
Responding to the recent outbreaks, health agencies are calling for sustained investment in immunization systems, alongside efforts to strengthen routine vaccination services. These efforts must focus especially on reaching the poorest, most marginalized communities, including people affected by conflict and displacement.
The agencies also call for actions to build broad-based public support for immunizations, while tackling misinformation and hesitancy around vaccines where these exist.
“Sustained investments are needed to strengthen immunization service delivery and to use every opportunity for delivering vaccines to those who need them,” said Dr Robert Linkins, Branch Chief of Accelerated Disease Control and Vaccine Preventable Disease Surveillance at the U.S. Centers for Disease Control and Prevention (CDC) and Measles & Rubella Initiative Management Team Chair.