Feasibility of measles eradication

SAGE reviewed the report and recommendations from the July 2010 Global Technical Consultation to Assess the Feasibility of Measles Eradication. Measles has been eliminated in the Region of the Americas since 2002, and 4 of the remaining 5 Regions have established a target date for the elimination of measles: it is to be eliminated in the Eastern Mediterranean Region by 2010, in the Western Pacific Region by 2012, in the European Region by 2015 and in the African Region by 2020. In 2009, the Regional Committee for South-East Asia passed a resolution urging Member States to move towards eliminating measles. In May 2010, the WHA endorsed the following measles control targets for 2015 as milestones towards measles eradication: increasing measles immunization coverage to >90% nationally and >80% in every district; reporting an incidence of <5 cases/1 000 000 population; and reducing measles mortality by 95% compared with 2000 levels.

Remarkable progress has made been in reducing deaths from measles worldwide. From 2000 to 2008, an estimated 4.3 million additional deaths among children were averted as a result of increases in coverage of routine immunizations and implementation of measles SIAs. However, since 2009, the African Region has experienced outbreaks affecting 28 countries, and there have been >200 000 reported cases. These outbreaks highlight the fragility of the gains. There is a growing risk that the critical contribution of the reduction in measles mortality to achieving Millennium Development Goal 4 (approximately 25% of the overall reduction in child mortality) will be lost because of declining political and financial commitments to measles control and the competition for resources from other immunization and public-health initiatives.

SAGE noted the results of recent studies showing the overall positive impact that activities to eliminate measles have on immunization systems, and the predictions from 2 independent modelling groups that measles eradication would be highly cost effective across all countries’ income groups as well as cost-saving and lifesaving in countries that have already eliminated measles.

2 Considering these findings and the comprehensive review of evidence establishing the biological and technical feasibility of measles eradication, SAGE concluded that measles can and should be eradicated. A goal for measles eradication should be established with a proposed target date based on measurable progress made towards existing goals and targets. The eradication of measles represents unique disease control and developmental opportunities, and should be carried out in the context of strengthening routine immunization programmes. In addition, the programme efficiencies of using combined measles–rubella vaccine and integrated surveillance for fever and rash provide an opportunity for measles eradication activities to accelerate the control of rubella and the prevention of congenital rubella syndrome.

SAGE noted the substantial challenges to achieving the 2015 global targets and regional goals for elimination, including: weak immunization systems; the highly infectious nature of measles; populations that are inaccessible due to conflict; the increasing refusal of immunization by some populations; the changing epidemiology of measles which has led to increased transmission among adolescents and adults; the need to provide catch-up measles vaccination to >130 million children in India; and the gaps in human and financial resources at the country, regional and global levels. In addition, there is an urgent need for operational research to address the barriers to achieving current targets and confirm the operational feasibility of eradication in the most challenging settings.

Recognizing these challenges, SAGE strongly encouraged countries and the global community to enhance their efforts to fully implement and accelerate the expansion of proven strategies for measles immunization and surveillance. In addition, SAGE welcomed the news that India has begun implementing strategies to provide a second opportunity for measles immunization. SAGE also encouraged the South- East Asia Region to establish a target date for achieving measles elimination.

SAGE requested that progress towards meeting the 2015 global targets and regional elimination goals be monitored. SAGE proposed that the demonstration of sufficient achievements towards measles elimination be made as a basis for establishing a target date for measles eradication, and requested frequent updates on the progress.

SAGE requested that the measles and rubella working groups should merge and monitor progress, oversee the research agenda required for eradication and report back to SAGE regularly. The working group should liaise with QUIVER and IPAC to address relevant quantitative issues as well as those related to immunization practices.

SAGE noted the real threat of losing momentum in the fight against measles and recommended enhancing advocacy efforts to highlight the importance of measles control to achieving overall child-health goals; these efforts should emphasize that further reduction in measles mortality and measles eradication rank among the “best buys” in public health. A greater commitment of resources needs to be made by high-burden countries and their local and international partners to counter the threat of resurgence and achieve existing global and regional goals. The initiation of the Decade of Vaccines represents a unique opportunity for prioritizing the expansion of resources to support countries’ efforts towards achieving the 2015 global measles control targets and regional elimination goals.

FEASIBILITY OF MEASLES ERADICATION