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Monday, 11th of March 2013 Print



Athalia Christie a , Andrea Gay b 


The recommendation by David Heymann and colleagues (Nov 20, p 1719)1 that high routine immunisation coverage be a prerequisite for measles campaigns or a measles eradication goal disregards current policy and the progress made in the past decade.

Two doses of measles vaccine are already offered to all children in 192 of 193 WHO member states through a combination of routine immunisation and campaigns.2 Countries with weak health systems use campaigns to reach those with otherwise poor access to health services. Unlike those for polio, measles campaigns are done once every 2—4 years and, therefore, pose no risk of becoming a substitute for routine immunisation, as suggested by Heymann and colleagues. Measles campaigns also strengthen routine immunisation by retraining health-care workers, supplying cold-chain equipment, and developing strategies to access hard-to-reach populations.

Between 2000 and 2008, about 686 million children received measles vaccine through campaigns and routine coverage rose from 72% to 83%.3 As a result, global measles deaths declined by 78%.3 Measles campaigns also provide a rapid and equitable means of reaching children across all wealth quintiles with multiple interventions.4 Since 2001, integrated campaigns have delivered more than 41 million insecticide-treated nets, 94 million deworming tablets, 127 million polio vaccines, and 213 million doses of vitamin A (Measles Initiative, unpublished data).

As an inexpensive and highly effective vaccine against a deadly disease, measles immunisation is one of the most cost effective public health interventions available, at about US$184 per death averted (Measles Initiative, unpublished data). Measles eradication is more cost-effective than incremental mortality reduction goals and delaying it will only increase the cost in dollars and lives.5

Five of six WHO regions have set measles elimination goals. The sixth region (southeast Asia) has agreed in principle but has yet to set a target date. WHO's Strategic Advisory Group of Experts on Immunization agreed that measles can and should be eradicated. However, a funding gap since 2008 has delayed campaigns leading to outbreaks in Africa. A measles eradication goal will build on progress, further strengthen health systems, and help pull polio over the finish line.

We coordinate the Measles Initiative. We declare that we have no conflicts of interest.


The Lancet, Volume 377, Issue 9768, Pages 807 - 808, 5 March 2011

Measles eradication

Original Text

Text is at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60298-5/fulltext



1 Heymann DL, Fine PE, Griffiths UK, Hall AJ, Mounier-Jack S. Measles eradication: past is prologue. Lancet 2010; 376: 1719-1720. Full Text | PDF(44KB) | CrossRef | PubMed

2 World Health Organization. Measles vaccines: WHO position paper. Wkly Epidemiol Rec 2009; 84: 349-360. PubMed

3 Centers for Disease Control and Prevention. Global measles mortality, 2000—2008. MMWR Morb Mortal Wkly Rep 2009; 58: 1321-1326. PubMed

4 Grabowsky M, Farrell N, Hawley W, et al. Ghana and Zambia: achieving equity in the distribution of insecticide-treated bednets through links with measles vaccination campaigns. In: Gwatkin DR, Wagstaff A, Yazbeck AS, eds. Reaching the poor with health, nutrition, and population services: what works, what doesn't and why. Washington, DC: World Bank, 2005.  

5 Levin A, Burgess C, Garrison L, Bauch C, Babigumira J. Global eradication of measles: an epidemiologic and economic evaluation. J Infect Dis (in press).

a American Red Cross, Washington, DC 20006, USA 

b United Nations Foundation, Washington, DC, USA