Measles cases continue to increase globally since 2016

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There has been a 59% drop in measles cases between 2000 and 2018. Yet, since 2016, there has been a spike in the number of cases reported. There were over 3,53,000 cases last year while it has already crossed the 4,00,000 mark by mid-November this year.

Even as the number of reported measles cases globally during the period 2000 to 2018 decreased by 59%, there has been a spike in measles cases since 2016. Compared with over 1,32,000 reported measles cases in 2016, the numbers shot up to over 3,53,000 in 2018. While the number of cases in 2018 was more than double the previous year, the number in 2019 has already surpassed that of 2018. By mid-November 2019, over 4,00,000 cases have been reported from across the world.

Since measles surveillance remains weak in many countries, the World Health Organization and the Atlanta-based Centers for Disease Control and Prevention resorted to estimating the number of measles cases and deaths. Based on an updated model for estimating measles cases and deaths, there have been nearly 10 million cases and over 1,42,000 measles deaths in 2018. These could have been easily avoided had vaccine coverage using two doses reached over 95% across countries.

Last year, five countries — Democratic Republic of the Congo, Liberia, Madagascar, Somalia, and Ukraine — accounted for 45% of all reported cases. The situation has worsened in Congo by mid-November this year with over three-fold increase in the number of cases (from 65,000 in 2018 to 2,50,000 in 2019) and over 5,100 deaths.

The situation in Ukraine is grim. After a 50% drop in the number of cases in Ukraine in 2018 compared with 2017, the trend has reversed this year. There have been 58,000 cases by November this year, 4,000 cases more than 2018. There has been a decline in the number of cases in other three countries that reported the most number of cases last year.

Vaccine hesitancy has been one of the main reasons for the staggering spread and increase in the number measles cases globally. In the Democratic Republic of the Congo, there is low institutional trust, misinformation, vaccine shortage and even attacks on health-care centres and workers leading to spread of both measles and Ebola.

The Philippines and the small Pacific island of Samoa serve as a textbook case of sudden emergence of vaccine hesitancy. Mass immunisation using a newly approved dengue vaccine in Philippines before the risks associated with the vaccine were reported by the manufacturer shattered public trust on vaccines Low vaccine coverage led to measles and polio outbreaks in the country. In Samoa, an error in preparing the measles, mumps, and rubella (MMR) injection led to death of two infants. Fear mongering following this led to a sharp drop in vaccine uptake leading to measles outbreak.

But in many European countries and the U.S. vaccine hesitancy has been on religious grounds and primarily due to anti-vaccination campaigns spreading fake news about vaccine safety. To counter the rising hesitancy about a dozen European countries have already introduced laws making vaccination mandatory. New York City too introduced such a law when the U.S. was nearly about to lose its measles elimination status. Such laws will help quickly increase vaccination coverage but may prove counterproductive in the long run. The only sure way to increase vaccine uptake is by educating the public.

With 2.3 million children not vaccinated against measles last year, India has much to do to protect its young citizens.

Published in The Hindu on December 12, 2019