Measles deaths are on the rise for the second year in a row, killing more than 140,000 people worldwide in 2018 according to estimates released Thursday by the World Health Organization and the United States Centers for Disease Control and Prevention (CDC). Also on Thursday, a massive measles vaccination campaign was announced in North Kivu, the Democratic Republic of the Congo – the country where a full one-third of the world’s reported measles cases have so far occurred in 2019.

“Our finding is that in 2018, there has been an increase in both the cases and the deaths that have occurred from measles. In other words, we’re backsliding,” said WHO’s Director of Immunization, Vaccines and Biologicals Kate O’Brien.

Total deaths in 2018 were 26,000 more than in 2017, where an estimated 124,000 people died, and 55 percent more than the 89,780 deaths reported in 2016. The number of measles cases also increased by more than 2 million between 2017 to 2018, with 9,769,400 estimated cases in 2018 as compared with 7,585,900 estimated cases in 2017, according to the WHO and CDC estimates. As in previous years, most deaths were among children under the age of 5, and the most highly impacted region was Sub-Saharan Africa.

One of the worst afflicted countries, the DRC, has been concurrently battling a massive measles outbreak and deadly Ebola outbreak for over a year. It’s estimated that over 5000 people, mostly children have died in the current measles outbreak, more than double the number killed by Ebola over the past year.

The DRC appears to account for about one-third of this year’s measles case load, WHO said, although the national data upon which that estimate has been made has yet to be validated.  DRC, together with Liberia, Madagascar, Somalia, and Ukraine, accounted for almost half of all measles cases worldwide in 2018. Children in these countries persistently miss out on measles vaccination.

“The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children,” said Dr Tedros Adhanom Ghebreysus, Director-General of the World Health Organization in a press release. “To save lives, we must ensure everyone can benefit from vaccines – which means investing in immunization and quality health care as a right for all.”

While low-income countries bear the brunt of the global burden of measles, it has also resurged in some wealthy countries, including some that had previously eliminated the disease.

This year, the United States reported its highest number of cases in 25 years, while four countries in Europe – Albania, Czechia, Greece and the United Kingdom – lost their measles elimination status in 2018 following protracted outbreaks of the disease.

Measles is a highly contagious virus, and outbreaks can occur when coverage of the vaccine is too low, leaving a proportion of the community unprotected. Some 95% of the population receive at least two doses of the measles vaccine in order to prevent outbreaks from occurring, according to WHO recommendations. In countries that have lost measles-elimination status, misinformation spread about the safety and efficacy of vaccines has contributed greatly to vaccine hesitancy, leading parents to forgo vaccinating their children.

Global measles vaccination rates have stagnated for almost a decade. WHO and UNICEF estimate that 86% of children globally received the first dose of measles vaccine through their country’s routine vaccination services in 2018, and fewer than 70% received the second recommended dose. In 2019, as of mid-November, there have already been over 413,000 cases reported to the WHO globally, with an additional 250,000 cases in DRC reported through the national surveillance system. Together, this marks a three-fold increase compared with this same time period in 2018.

2.2 Million Children To Be Vaccinated Against Measles In North Kivu

While the Ebola outbreak has captured international attention, the DRC is also currently experiencing the world’s largest and most severe measles epidemic, with an estimated 250,000 suspected cases and over 5000 deaths so far. Low rates of vaccination and high rates of malnutrition have contributed to the measles epidemic, and the high rate of mortality in the outbreak.

“While the Ebola outbreak in the DRC has won the world’s attention and progress is being made in saving lives, we must not forget the other urgent health needs the country faces,” said WHO Regional Director for Africa Matshidiso Moeti in a press release by WHO’s African Regional Office.

As part of a second phase of a country-wide preventative vaccination campaign, this specific surge aims to vaccinate an additional 2.2 million children in North Kivu province, a particularly challenging context, as it is the center of the Ebola outbreak and has been plagued with insecurity. Just last week, four Ebola responders were killed in a directed attack in Biakato Mines and Mangina.

“In the context of North Kivu, where the population is highly mobile, it is imperative that we reach out to travelers and ensure that their children are also covered,” said Deo Nshimirimana, WHO acting representative in the DRC.

The five-day campaign is being implemented by the Ministry of Health with the support of WHO and partners and is fully funded by Gavi, the Vaccine Alliance. North Kivu is the last province in the second phase of the country-wide preventative vaccination campaign, and will be followed by a third and final phase planned in 10 remaining provinces: Bas Uélé, Equateur, Haut Katanga, Haut Lomami, Haut Uélé, Kasai Oriental, Lualaba, Maniema, Mongala and Tshuapa.

The campaign ultimately plans to reach 18.9 million children, with a particular focus on children who may have been missed by routine immunization.

“Sadly, measles has claimed more Congolese lives this year than Ebola. We must do better at protecting the most vulnerable, who are often also the hardest to reach. This campaign is an important step in that direction,” said Thabani Maphosa, managing director of Country Programmes for Gavi. “For maximum impact, campaigns must be combined with the strengthening of routine immunization and health systems.”

To date, US$ 27.5 million have been mobilized for the measles response; however, another estimated US$ 4.8 million are needed to complete the vaccination campaign and to strengthen other elements of response such as disease surveillance, case-management and communication.

Image Credits: WHO/Kisimir Jonh Shim, WHO AFRO.