text: Measles surged worldwide in 2019 reaching the highest number of reported cases in 23 years. Highlighted in a publication by the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), measles cases worldwide increased to 869,770 in 2019, the highest number reported since 1996 with increases in all WHO regions. Global measles deaths climbed nearly 50 percent since 2016, claiming an estimated 207,500 lives in 2019 alone.
  After steady global progress from 2010 to 2016, the number of reported measles cases climbed progressively to 2019. Comparing 2019 data with the historic low in reported measles cases in 2016, authors cite a failure to vaccinate children on time with two doses of measles-containing vaccines (MCV1 and MCV2) as the main driver of these increases in cases and deaths.
  “We know how to prevent measles outbreaks and deaths,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “These data send a clear message that we are failing to protect children from measles in every region of the world. We must collectively work to support countries and engage communities to reach everyone, everywhere with measles vaccine and stop this deadly virus.”
  Measles outbreaks occur when people who are not protected from the virus are infected and spread the disease to unvaccinated or under-vaccinated populations. To control measles and prevent outbreaks and deaths, vaccination coverage rates with the required MCV1 and MCV2 must reach 95 percent and be maintained at national and sub-national levels.
  MCV1 coverage has been stagnant globally for more than a decade at between 84 and 85 percent. MCV2 coverage has been steadily increasing but is only now at 71 percent. Vaccination coverage against measles remains well below the 95 percent or higher needed with both doses to control measles and prevent outbreaks and deaths.
  The global response to COVID-19 pandemic must not exacerbate the measles crisis
  Although reported cases of measles are lower in 2020, necessary efforts to control COVID-19 have resulted in disruptions in vaccination and crippled efforts to prevent and minimize measles outbreaks. As of November, more than 94 million people were at risk of missing vaccines due to paused measles campaigns in 26 countries.
  Many of these countries are experiencing ongoing outbreaks. Of countries with postponed planned 2020 campaigns, only eight (Brazil, Central African Republic, Democratic Republic of Congo, Ethiopia, Nepal, Nigeria, Philippines and Somalia) resumed their campaigns after initial delays.
  “Before there was a coronavirus crisis, the world was grappling with a measles crisis, and it has not gone away,” said Henrietta Fore, UNICEF Executive Director. “While health systems are strained by the COVID-19 pandemic, we must not allow our fight against one deadly disease to come at the expense of our fight against another. This means ensuring we have the resources to continue immunization campaigns for all vaccine-preventable diseases, even as we address the growing COVID-19 pandemic.”
  Causes of failure to control measles are many and must be addressed
  Global immunization partners are engaging leaders and public health professionals in affected and at-risk countries to ensure that measles vaccines are available and safely delivered and that caregivers understand the life-saving benefit of the vaccine. On 6 November 2020, WHO and UNICEF issued an emergency call to action for measles and polio outbreak prevention and response.
  “Measles virus easily finds unprotected children, adolescents and adults because it is so contagious,” said Dr. Robert Linkins, Measles & Rubella Initiative Management Team Chair and Accelerated Disease Control Branch Chief at U.S. CDC.
  “Infections are not only a sign of poor measles vaccination coverage, but also a known maker, or ‘tracer,’ that vital health services may not be reaching populations most at-risk. Our collective efforts to reach children with vaccines now, ahead of the possible easing of COVID-19 travel restrictions and increased population movement, will save lives.”
  The Measles & Rubella Initiative (M&RI), which includes American Red Cross, the United Nations Foundation, the U.S. CDC, UNICEF and WHO, and global immunization partners like Gavi, the Vaccine Alliance, the Bill and Melinda Gates Foundation and others, are working to address the current measles crisis and ensure that resources are positioned to address immunization delays – for measles and all vaccines – in every region of the world.
  A bold strategy released by M&RI, Measles & Rubella Strategic Framework 2021 – 2030, will help to address reversals in global progress toward measles elimination by bolstering strong, national immunization systems that can reach and protect children. This strategic shift by the partnership will focus on strengthening the routine delivery of all vaccines, and quickly and effectively detecting and responding to measles outbreaks.
  Quotes from Our Partners
  “These alarming figures should act as a warning that, with the COVID-19 pandemic occupying health systems across the world, we cannot afford to take our eye off the ball when it comes to other deadly diseases.
  Measles is entirely preventable; in a time in which we have a powerful, safe and cost-effective vaccine nobody should still be dying of this disease. COVID-19 has resulted in dangerous declines in immunization coverage, leading to increased risk of measles outbreaks.
  This is why countries urgently need to prioritize measles catch-up immunization through routine services to mitigate the risk of outbreaks and ensure no child goes without this lifesaving vaccine.” – Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.
  “The fact that measles outbreaks are occurring at the highest levels we’ve seen in a generation is unthinkable when we have a safe, cost-effective, and proven vaccine. No child should die from a vaccine-preventable disease. We are proud to chart a bold way forward with partners to close gaps in access to immunization and rapidly respond to outbreaks so everyone, everywhere can live healthy lives.” – Elizabeth Cousens, President & CEO, United Nations Foundation.
  “We are concerned that COVID-19 will contribute to an increase in the number of measles cases and deaths. Measles knows no borders, and it is imperative we work together to vaccinate more children and continue the fight against this preventable disease. “Around the globe, Red Cross and Red Crescent volunteers help families in chronically unvaccinated communities to protect their children. Join us in this effort.” – Gail McGovern, President & CEO of the American Red Cross.
  The Measles & Rubella Initiative (M&RI) is a partnership between the American Red Cross, the United Nations Foundation, the U.S. CDC, UNICEF and WHO. Working with Gavi, the Vaccine Alliance and other stakeholders, the Initiative is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome.
  Since 2000, M&RI has helped deliver over 5.5 billion doses of measles vaccine to children worldwide and saved over 25.5 million lives by increasing vaccination coverage, responding to outbreaks, monitoring and evaluation, and supporting demand for the vaccine.