Measles Mortality Reduction: the risk of resurgence Global Immunization Meeting Geneva, Switzerland 1-3 February 2010 Balcha Masresha, WHO/AFRO

2 |2 | Overview Achievements to date Resurgence; examples from AFR How can resurgence be avoided?

3 |3 | Measles disease burden Major cause of global morbidity and mortality 1980: >2.5 m deaths 2000: 733,000 deaths (4th leading cause of child mortality in 2000) Major component to achieving MDG4

4 |4 | Measles Mortality Reduction 47 UNICEF / WHO Priority Countries, Nationwide catch-up SIAs as of end 2008 (46) No catch-up campaign yet ( 1 ) 94% of measles deaths No 2 nd dose MCV

5 |5 | Global Achievements, MCV1 coverage 72% to 83% Over 600 million vaccinated in SIAs 78% reduction in global measles deaths 12.7 m. estimated measles deaths prevented since 2000 –8.4 million deaths prevented as a result of maintaining routine immunisation coverage –4.3 million deaths prevented due to accelerated control efforts Measles elimination in The Americas since 2002 –strategies proven to work

6 |6 | Number of reported measles cases and estimated MCV1 coverage, WHO African Region, 2000–2008 MCV1 increased from 52% to 73% Since 2000: –398 m vaccinated in SIAs –94% reduction in reported cases –92% reduction in estimated deaths Source: Wkly Epid Rec, Sept 2009, 84:

7 |7 | Confirmed measles cases. AFR. 2009

8 |8 | Confirmed measles cases by proportion of age category Selected countries in AFR

9 |9 | Vaccination status of confirmed measles cases. Burkina Faso (n=10,012)*

10 | Why Resurgence? Measles no longer perceived as a major threat : decreased political and financial commitment Gaps in immunisation coverage –7.8 million infants did not get MCV in 2008 in AFR –Only 3 of 18 AFR countries achieved >95% coverage in 90% districts in SIAs in 2009

11 | Immunization coverage with measles containing vaccines in infants, 2008 Source: WHO/UNICEF coverage estimates , July WHO Member States. Date of slide: 21 July % (33 countries or 17%) 50-79% (46 countries or 24%) >=90% (111 countries or 58%) <50% (3 countries or 1%) The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO All rights reserved 60% of 21 m unvaccinated infants in 6 countries: India 7.6 m Nigeria 2.0 m China 1.0 m DRC 0.8 m Pakistan 0.7 m Ethiopia 0.7 m

12 | Measles Initiative donations and Funds projected or pledged, Total donations: $673m

13 | Measles Initiative Donations and Financial Resource Requirements, * 2010: Funding gap $59m 2011: Funding gap $47m Excluding activities in India and anticipated country contributions for SIAs

14 | Risk of resurgence; scenario Projected worst case scenario: none of 47 priority countries carry out SIAs during Source: WHO/IVB measles deaths estimates, October 2009; Lancet 2007;369:

How can resurgence be avoided?

16 | Keys to maintaining the success of measles mortality reduction Sustainable financing Effective lab-based surveillance Linking with other interventions Routine immunization strengthening High quality SIAs

17 | Full implementation of existing strategies and innovative approaches Uniform, high routine vaccination coverage –RED approach, PIRI, continued efforts to strengthen immunisation systems High quality SIAs –Integration of best practices into SIAs Effective laboratory-backed surveillance –Case confirmation and virus tracking through Global LabNet –New tools for specimen collection

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO All rights reserved Measles Genotype B3 distribution (Stars may not represent exact location of cases) Acknowledgements: WHO Measles LabNet Measles Surveillance Programmes As of 28 Jan 2010 B3 B3 B Year of detection

19 | New Tools to Support Surveillance Oral fluid (OF) & Dried blood (DBS) samples fully validated as alternative to serum –OF = Non invasive, DBS = minimally invasive –OF used for measles surveillance in UK for >12 years –Five AFR countries to use OF starting 2010

20 | Continue promoting linkages with other programs and health systems strengthening Measles SIAs integrated with polio, malaria, de-worming, Vit A, praziquantel Using SIAs to strengthen immunisation systems: –Training, logistics, social mobilisation, microplanning, injection safety Linkages with other initiatives: –the global action plan for the prevention of pneumonia –the global initiative for the elimination of avoidable blindness Integrated VPD surveillance supported by a lab network

21 | Sustainable financing Conduct focused advocacy efforts to increase country financing –Involvement of “Global Elders” –Lions International Advocate with donors: risk of resurgence –Need for multi year commitments Demonstrate positive impact on health systems

22 | Conclusion "So much has been achieved [in measles control] in the past several years thanks to the hard work and commitment of national governments and donors. But …, there are signs of stalling momentum. This is a highly contagious disease that will quickly take advantage of any lapse in effort." –Dr Margaret Chan, WHO Director-General.

23 | Measles Initiative Japanese Government