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Meeting of the International Task Force for Disease Eradication, November 2015

Sunday, 14th of February 2016

 

Meeting of the International Task Force for Disease Eradication, November 2015

Excerpts below; full text is at http://www.who.int/wer/2016/wer9106.pdf?ua=1 

Conclusions and recommendations

1 At the beginning of this century, measles was one of the 5 leading killers of children with an estimated 546 800 annual deaths. Since then, with some support from the Measles and Rubella Initiative, there has been remarkable progress with a 79% reduction in deaths to 114 900 in 2014. However, this continuing mortality burden is unacceptable given the availability of a highly effective and inexpensive vaccine (US$ 0.25 per dose through UNICEF) for more than 50 years. 

2. Rubella virus is the leading infectious cause of congenital birth defects. Remarkable progress has been achieved in introducing use of this vaccine in developing countries and reducing the global inequity in its use, as well as in the numbers of reported cases of rubella and of CRS. Use by countries in their routine childhood vaccination schedules has increased from 99 (51%) countries in 2000 to 140 (72%) countries in 2015, and in the Region of the Americas endemic rubella transmission has been interrupted since 2009.

3. Efforts to control and eliminate measles and rubella have accelerated incrementally since 2000, but have been greatly overshadowed in magnitude of resources and political commitment by the global polio eradication initiative (GPEI). The impending completion of polio eradication opens a window of opportunity to devote greater attention to measles and rubella eradication. Since 2012, GAVI has opened funding windows for rubella vaccine introduction into GAVI-eligible countries, and measles follow-up SIAs in high burden countries, pledging US$ 820 million for the period 2016–2020 for measles and rubella immunization. 

4. The high level of measles and rubella control that has been attained already has significantly reduced deaths from measles and cases of congenital rubella syndrome, which is a major accomplishment, but a paradigm shift will be needed in order to eradicate measles and rubella. Eradication will require a much more demanding enterprise than the current effort, which has suffered from insufficient resources and wavering political commitment.

5 There is currently no global commitment to eradicate measles or rubella, although all 6 WHO Regions, through their regional committees, have now agreed to eliminate measles by no later than 2020; for rubella, 2 regions have set an elimination goal. The ITFDE encourages discussion of the feasibility and potential timing of such a global commitment in countries, in each WHO Region and at the WHA.

6. The ITFDE still firmly believes that both measles and rubella eradication are technically feasible, but the very high contagiousness of measles is the biggest challenge to success, and measles and rubella eradication would require a sustained global commitment and a clear accountability framework such as exists for the GPEI.

7. Careful consideration should be given to how best to blend the scaling up of interventions against measles and rubella with the scaling down of the polio eradication initiative, in order to maximize benefits to both efforts. Countries should adapt infrastructure and resources developed for polio eradication to measles and rubella eradication; conversely measles and rubella eradication infrastructure could help to support high quality surveillance and any supplemental immunizations needed to detect, investigate and contain imported or suspected cases of polio in the future. 

8. Strategies and plans for eliminating measles and rubella must be developed and adapted by individual countries and WHO regions, with appropriate attention to innovative strategies, local circumstances, capacities and cultures. Each national programme should engage local communities in determining how best to obtain and sustain high vaccination coverage and prompt reporting of cases.

9. Because of the high contagiousness of measles, strengthened routine immunization services may be required in order to attain and maintain the unusually high immunization levels and prompt immunization of new birth cohorts that are needed for measles eradication, to a much greater extent than was necessary for smallpox or polio eradication. The occurrence of measles outbreaks can and should be used as an indicator of well (or poorly) performing routine immunization services and as a means to target countries and high risk areas in need of efforts to improve routine vaccination coverage. The polio eradication programme has learned a lot about reaching children who are usually missed by routine immunization efforts, and country immunization programmes should use this knowledge. 

10. Measles eradication also necessitates support for an accelerated and prioritized research agenda, including improved tools for immunization, diagnosis, and rapid assessment of immunity; and operational research to improve surveillance and reporting, as well as delivery of vaccines. The thermostable microneedle patch for delivery of measles and rubella vaccine seems especially promising and innovative but urgently needs funding for clinical testing.

11.The health economics literature and the measles-rubella investment case confirm that eradication is more cost effective than indefinite control. 

12. Combining immunization against rubella along with measles immunization using MR vaccine could eliminate rubella even sooner than measles because of its lower transmissibility, thus providing an enormous additional benefit at relatively low cost.

13.For operational purposes, the campaign to stop measles transmission should focus on the numbers of incident cases remaining, not on rates of cases per population or on reductions in deaths, since the goal is to reach zero indigenous cases. The latter measures are more appropriate for advocacy, rather than for running a programme.

14.Advocacy for eradication of measles and rubella would be improved by:

a. strengthening the investment case for eradication; 

b. recognizing the significance of eradication as a public health and social movement, an issue of equity;

c. linking eradication to the Global Health Security agenda; 

d. establishing a robust strategy to communicate the urgency of eradication to decision-makers; and

e. identifying champions for eradication, particularly from countries bearing the greatest disease burden.