Transcript of WHO podcast - 19 January 2007
Measles deaths reduced by 60% worldwide
Christine McNab: Welcome to the World Health Organization podcast. Today, WHO and its partners announce a major achievement in global public health, one that has saved hundreds of thousands of children's lives.
Christine McNab: A global health goal has not only been met, it's been surpassed. In 1999, measles killed at least 800 000 children every year. Now, as a result of stepped-up immunization efforts, measles deaths have been reduced by 60%. Here is Dr Margaret Chan, WHO's Director-General.
Dr Margaret Chan: Cumulatively, from 2000 to the end of 2005, the estimates we have are that the accelerated immunization efforts have averted 2.3 million deaths, thanks to the efforts of the Measles Initiative. And the news is actually even better for Africa, the region with the highest measles burden. The measles death there, in Africa, declined by a very impressive 75%. So the good news is Africa is leading the way.
Christine McNab: The Measles Initiative, a partnership of the WHO, UNICEF, the UN Foundation, the U.S. Centers for Disease Control and the American Red Cross, has supported country efforts to reach the goal. Here to talk about this measles success story and the next measles goal is Dr Peter Strebel. He leads WHO's technical measles work.
Dr Strebel, how is this success possible?
Dr Peter Strebel: Importantly for measles, we have a very safe and effective vaccine which is relatively cheap. We've also learned in recent years how to deliver this vaccine, and this is really where the innovation came in. It came from building on the experience with the polio eradication effort where we have learned how to do mass vaccination campaigns that in fact reach almost all children. Particularly children who live in remote areas who are underserved and normally don't get vaccinated. And it's this strategy of taking measles vaccine to scale, as it were, that's really given us the population-level protection required for measles. In addition though, it has been important to expand delivery of measles vaccine, that's the first dose of measles vaccine for all children through routine health services. And here we benefited from the additional funding of the Global Alliance for Vaccines and Immunization (GAVI) that helps countries actually develop health systems to get a high proportion of young infants vaccinated through routine health services.
Christine McNab: For people who don't know much about measles or might think of it as a disease every child gets before they are five, what kind of difference is there between the effect of measles in the developed world and measles in developing countries, and why do we need to work extra hard to reach these children with vaccination as a result?
Dr Peter Strebel: There is an important difference in the complication rates from measles in a well-nourished child versus an undernourished child. So in developing countries, under-developed countries, where children have vitamin A deficiency and maybe protein-energy malnutrition, these children are particularly susceptible to an infection of measles. And they get complications like pneumonia, infection of the lungs, infection of the intestinal tract, diarrhoea, they can get dehydrated, and of course they can also get blindness. The measles virus can attack the cells lining the eyes, and they can end up blind. And of course, about up to 10% of children in developing countries may actually die from a measles attack - very different to an industrialized, well-nourished child setting with a proportion (of) who die maybe as low as 1 in 1000.
Christine McNab: When you're on the ground, there's a big campaign going on, who is involved, what kind of energy is there, and what does it actually take to get the vaccines from the city capital out to the most remote areas in a country?
Dr Peter Strebel: I think the most recent experience I had was in Nigeria, in fact northern Nigeria, when they were working on vaccinating some 29 million children, over a period of about 10 days. And this really involves a massive firstly planning exercise and a training exercise with all the health workers. These are trained health workers to give actual injections that get trained in the techniques and reason for doing the mass vaccination campaign. So, there is quite a long preamble, planning preparation phase. However, when you get close to the actual day, there is a lot of excitement. There's often a launch which involves local leaders, ministry of health officials, donors. And they have what they call a flag-off ceremony which often involves going to a big stadium, speeches, drums, excitement, and then the actual work starts. This really means that teams, small teams of vaccinators and volunteers, are going out to communities, many communities which are normally not reached by health services. This may involve taking boat rides, special efforts to reach children outside of the health services and to vaccinate them. And the other thing that often is happening in these vaccination campaigns is they combine with other child survival interventions. In other words, you don't just vaccinate the child; you may give out a bednet which would protect the child from malaria, you may give de-worming medicine, vitamin A or other vaccines for example. So this is quite a festive occasion, but also a lot of hard work with a lot of field workers doing really heroic efforts to reach children who normally don't get vaccinated.
Christine McNab: What are they saying in the hospitals? What are they saying at the ministries of health about what this actually means?
Dr Peter Strebel: When you visit villages, you actually get feedback from village leaders that they notice the measles epidemic has not come. And particularly, for example, they've experienced that after a measles epidemic they have extra graves. Basically young kids get measles and die, and so they will actually tell you that our measles graves are no longer here, for example, and that is really satisfying to hear. I think at the hospital (and) health clinic level, doctors and nurses will tell you that wards have been closed; the measles ward doesn't exist anymore. The ward is still there. Children are in there with other diseases, diarrhoea, pneumonia, HIV problems, etc. Then at the national level, of course, this has made a big difference in that health workers and ministries of health can recognize the success that they have actually achieved a major public health goal. And of course, this frees up resources to direct towards other more pressing health problems.
Christine McNab: What's next for measles then? You've not only met, but surpassed the goal of halving measles deaths by 2005. What happens next?
Dr Peter Strebel: Right, now measles is something you can't stop vaccinating against. So we don't relax after achieving this goal. We go on to the next goal which is a 90% reduction in worldwide measles deaths by 2010 compared to 2000 levels. And this of course involves taking the strategies that have been so successful in Africa and applying them in Southeast Asia where there is still a large number of measles deaths. Furthermore, it's going to require the countries in Africa that have achieved good measles control to maintain this. And this involves strengthening routine vaccination services as well as doing periodic outreach campaigns or mass vaccination campaigns in order to maintain such high levels of protection in the population.
Christine McNab: That was Dr Peter Strebel who leads WHO's technical measles work and works closely with WHO's partners and with countries to ensure measles vaccine reaches as many children as possible.
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